University Hospitals Birmingham NHS Trust 'requires improvement'

The QE and two more hospitals are run by University Hospitals Birmingham NHS Trust - the biggest in England

The biggest NHS trust in England has been told by inspectors it requires improvement amid concerns over patient safety.

The Care Quality Commission (CQC) visited three sites run by University Hospitals Birmingham in June.

There were "concerning disparities" in processes across the hospitals, and some staff said their concerns about patient care were not listened to.

The trust said the report reinforced the challenges it was addressing.

The watchdog looked at urgent and emergency care at Birmingham Heartlands Hospital, Queen Elizabeth (QE) Hospital Birmingham, and Good Hope Hospital in Sutton Coldfield. Some cancer services were also inspected.

Following the visit, the trust's overall rating was downgraded from good to requires improvement.

Inspectors made the same judgment for the individual criteria of whether care was safe and responsive to people's needs.

The emergency department at Good Hope performed better than Heartlands, inspectors found

The emergency department at Heartlands was under significant pressure at the time of the visit, the CQC said.

Patients waiting to be seen were not always monitored effectively, and safety checks on equipment were not always completed, inspectors found.

They said they also discovered appropriate steps were not consistently taken to ensure patient safety where lack of space led to patients waiting outside on ambulances, despite staff raising concerns.

Analysis, Michele Paduano, Health Correspondent

Heartlands Emergency department has always been desperately busy and has been known for some time to be too small. It was one of the issues during the hospital merger.

Following a service redesign, a number of senior emergency department consultants left which has exacerbated the problem.

The trust now faces a cycle - not enough staff to do the work; more pressure; more staff leaving.

The CQC reports two further issues: The hospital serves some of the poorest who turn up at A &E because they can't see a GP. It also states that many arrivals are inappropriate because they don't understand emergency care.

Although emergency departments at QE and Good Hope performed better, emergency staff across the trust told inspectors that leaders held them responsible for risk and performance measures and did not appreciate these were part of a whole system.

Despite the unprecedented challenges throughout the coronavirus pandemic, the workforce remained "unwavering in its focus on the needs of patients" Fiona Allinson, CQC deputy chief inspector, said.

"We saw that patients were treated with compassion and kindness, and there were some areas of good and outstanding practice - particularly in cancer services at QE," she added.

However, Healthwatch Birmingham said it was concerned about long delays in cancer treatment at the trust.

"They have told us that they have an action plan in place to bring down those waits but when we look at the figures in recent months there are still very serious, long cancer waits," said Healthwatch Birmingham's Richard Burden.

"It's not always proved easy to get from the trust month-by-month progress reports on what they're doing, where they're doing it and what progress they're making."

The trust's rating for being well-led moves from outstanding to good. It maintains a rating of good for the criteria of caring and effective services.

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The trust's chief executive, David Rosser, said he was pleased the CQC recognised the "incredible efforts" staff made during the pandemic "in the face of by far the highest number of hospitalised patients in the country".

He added: "The findings of the report reinforce the challenges we are aware of, and are actively addressing, particularly in supporting our emergency departments.

"Sadly and despite the herculean efforts of the team, patients are now waiting longer to access care.

"The trust is already implementing plans, supported by NHSE/I [England/Improvement], to tackle these waits which include both increasing the capacity of the hospitals and transforming the way we deliver care."