Troubled hospital trust given warning about staffing levels

University Hospitals Birmingham was issued with a warning notice about improvements

A troubled hospital trust, blighted by reports of bullying, has been issued a warning about staffing levels at one of its hospitals.

The Care Quality Commission (CQC) carried out an unannounced inspection at Good Hope in Sutton Coldfield.

Heartlands Hospital, also part of University Hospitals Birmingham (UHB), was also inspected amid concerns about children's services.

The trust said it fully accepted the inspectors' findings.

The trust, one of the largest NHS trusts in England, has been heavily criticised with repeated cases of bullying and a toxic environment being revealed in a report by Prof Mike Bewick, published in March.

The CQC's inspection in December happened a week after a joint investigation by BBC West Midlands and Newsnight revealed a climate of fear at the trust was putting patients at risk.

UHB's chief executive Jonathan Brotherton said the trust was already working through the report's recommendations.

Healthwatch Birmingham and Healthwatch Solihull said they were concerned by the latest findings.

Following the visit, the CQC issued the hospital trust with a warning notice, meaning it had until 15 March to make the "significant improvements" that had been identified.

Patients raised concerns about care at Good Hope Hospital, prompting the inspection

Inspectors said when they visited in December they found "staff working extremely hard under pressure" but highlighted the "compassion and kindness" towards patients.

"However, we weren't assured leaders were appropriately managing priorities and issues, or reducing risks to keep people safe in medical care at Good Hope Hospital, particularly around staffing levels, which must be addressed as a matter of urgency," said Charlotte Rudge, the CQC's deputy director of operations in the Midlands.

"Across all the services we visited, there wasn't enough nursing staff to keep people safe and to provide the right care and treatment," she added.

• Fear culture prevalent at NHS trust - report author

• Patient safety concerns over 'toxic culture' probe

• Climate of fear putting patients at risk, say doctors

The report also raised concerns about how staff worked together at Good Hope, saying morale was "noticeably low" and the service "struggled to meet demand".

BBC Midlands health correspondent Michele Paduano said the hospital had a high turnover of staff, particularly in nursing, reaching more than 13.5% each year with some areas hitting 20%.

"High pressure wards have more safety issues and staff sustain more injuries - so leave. It's a vicious circle," he said.

Staffing levels at Heartlands regularly fell below planned levels, the CQC found

Staffing and morale was also highlighted as an issue at Heartlands Hospital in Bordesley Green, with inspectors also finding there was not enough suitable equipment to enable staff to safely care for patients and medicines were not always managed well.

It found the service did not always have enough nursing staff on children's wards with staffing levels regularly below planned levels, causing "significant stress to some staff".

Both hospitals, as well as the trust, are currently rated as requiring improvement by the CQC. As the inspections were targeted, the overall rating, which was last reviewed in October 2021, has not changed.

Analysis

By David Grossman and Sean Clare, BBC Newsnight

The inspectors' unannounced December visit took place just a week after a joint investigation between Newsnight and BBC West Midlands uncovered allegations a toxic, bullying culture was preventing doctors from speaking up and putting patients at risk.

In an otherwise deeply critical report, an NHS review launched in response to that investigation recently found hospitals in the trust were safe. But this finding by healthcare regulators appears to contradict the review's conclusions.

University Hospitals Birmingham has been under fire for months - beset by allegations of bullying and poor governance - and coming at or near the bottom of a league table of trusts across a range of measures.

This latest setback, which puts UHB on notice that patient safety must improve, provides yet another challenge for its under-fire management.

Healthwatch Birmingham and Healthwatch Solihull, groups which help patients and the public to have their says on health matters, said the report would "worry many people, particularly after the findings of the recent Bewick report into patient safety at UHB".

"This latest CQC inspection makes it clear that patients now require solid proof of action rather than just reassurance about safety if confidence in UHB is to be restored," said the group's chair, Richard Burden.

'Staffing levels challenged'

Mr Brotherton said the CQC report had "highlighted issues that we are working on to improve the care we provide for our patients".

"Our staffing levels, like much of the NHS, are challenged and we are continually working to address this," he added.

"We have a strong programme of work to support values-led recruitment, with a clear commitment to bring more brilliant people into our organisation, to continue to provide excellent care.

"Whilst we accept that we do not always get things right, we are pleased that good leadership in many areas and a strong commitment to safety were acknowledged in the CQC's report."