Birmingham's hospital services rated as 'requires improvement'
Surgery and urgent and emergency care services have been rated by CQC inspectors
Two major services at Birmingham's Queen Elizabeth Hospital have been rated as requires improvement.
They are surgery and the urgent and emergency care departments.
The Care Quality Commission (CQC) says both need to do more to improve people's experiences.
CQC inspectors have downgraded surgery from good to requires improvement and rated urgent and emergency care services as requires improvement again following inspections in March.
The hospital, run by University Hospitals Birmingham NHS Foundation Trust, provides a range of outpatient, inpatient and urgent and emergency care services.
CQC carried out an unannounced inspection of surgery as part of its routine monitoring of services.
In addition, the CQC carried out an unannounced inspection of urgent and emergency care services to follow up on improvements it had told the trust to make at a previous inspection.
Inspectors found the service had made many improvements, but it still needed to make further progress.
CQC has again rated how effective, caring and well-led surgery services are as good. How safe the service is, has again been rated requires improvement, and how responsive the service is has dropped from good to requires improvement.
CQC has upgraded the rating for how safe urgent and emergency care services is from inadequate to requires improvement. How effective the service is, has improved from requires improvement to good. How responsive and well-led the service is, remains rated as requires improvement, and how caring the service is, remains good.
CQC identified one breach of regulation in surgery related to safe care and treatment, and three breaches of regulation in urgent and emergency care services related to safe care and treatment, management, and staffing. CQC told the trust to submit an action plan showing what action it is taking in response to these concerns.
Amanda Lyndon, CQC deputy director of operations in the midlands, said:
“While we found that some improvements had been made since our previous inspection, we found both services needed to do more to improve people’s experiences, specifically around the amount of time people waited for care.
“In surgery services, the service had declined in how responsive it was following the COVID-19 pandemic and effects on performance and waiting times across the NHS, which affected the overall rating. However, the service was making progress and moving in the right direction with significant efforts made to recover. We also had some specific concerns around how staff used equipment, managed medicines and provided treatment in a timely way.
“However, inspectors found the hospital had made some improvements to other areas of the service and they were no longer breaching regulations identified at the previous inspection. People were happy with the care they received, and staff treated them with warmth and compassion. They provided people with enough information to make informed decisions and involved them closely in their care.
“During our inspection of urgent and emergency care services, we were encouraged by improvements the trust had made but they still had more work to do to ensure people were safe. Staff didn’t maintain people’s records in line with the trust’s requirements for including information on risk assessments and care delivery.
“People waited too long to receive care in the department due to crowding and demand. Other departments in the hospital experienced delays in discharging people to social care placements, which had a knock-on effect on hospital capacity.
“However, people and their families were mostly positive about the care they received. They told us staff triaged them quickly on arrival to understand their care needs. Staff remained on hand for people in case they required further help or support.
“We told the leadership team at Queen Elizabeth Hospital and the trust the areas where they needed to make rapid improvements, and we will continue to monitor the services and make sure people are being kept safe while this happens.”
Inspectors found in surgery:
• Leaders and staff didn’t always investigate and manage potential risks people faced in the care environment. Staff didn’t always make sure equipment, facilities and technology supported safe care.
• People waited a long time to receive treatment as the service recovered from the increase in waiting lists during and after the pandemic. The trust was improving this in some areas, but delays in receiving diagnostic tests had increased.
• However, the service had a positive culture of safety, and staff cared for people in a safe environment. Staff cared for people with kindness and compassion and followed best practice.
• Staff put people at the centre of how their care was planned and delivered, and people had good outcomes.
• Leaders supported staff and provided support and guidance.
Inspectors found in urgent and emergency care:
• The department had a high vacancy and staff turnover rate, partly due to the pressures staff faced. However, the trust had a new recruitment strategy which had reduced the vacancy rate, with new starters due to join. They also made use of bank staff to fill gaps in shifts.
• People were waiting far too long in the department due to the continued pressure from crowding and demand. This was caused by a lack of available beds due to delayed discharges of people ready to leave hospital, mostly to social care.
• People with mental health needs and their families had to often wait many days in the department for a specialist bed.
• Leaders didn’t sufficiently oversee the service and manage areas of risk identified, specifically around people’s records. However, staff were keen to learn and develop and felt comfortable raising concerns. They listened to people and worked closely with other professionals to provide consistent care.
• Leaders had the skills and experience to manage what was an inexperienced or relatively new team in some areas.
The reports will be published on CQC’s website in the coming days.
Hospital Executive Director: "Patients wait too long for surgery"
In response to the inspectors comments regarding surgery services, Matt Metcalfe, Hospital Executive Director for the Queen Elizabeth Hospital Birmingham, said:
“I'm really proud of the excellent surgical services that we provide at Queenstown Hospital. It is absolutely true to say that patients wait too long for surgery, particularly the more routine surgery. And that means that the report is fair.
"However, we have driven a 5% improvement this year alone in our theatre productivity and that's led to reducing by 1/4 those patients who are waiting more than a year.
"I am confident those improvements will continue.”
And when asked about urgent and emergency care requirements, Mr Metcalfe said:
“Urgent and emergency care does indeed require improvement, and we have put in place a whole programme of work in the last month, which is right, right from the patients coming off the back of ambulances all the way through to the ward and back home again thereafter. And we're already seeing some significant improvements, in particular in reducing the length of time.”
Speaking generally about the CQC report, Mr Metcalfe added:
“CQC report is really helpful, fair and balanced. I’m delighted that the patient feedback that the inspectors had was so very appreciative of the care that's provided and I'm really proud of our clinical teams for the care that for the care they deliver in the improvements they're driving.”