The Care Quality Commission (CQC) has rated Sandwell and West Birmingham Hospitals NHS Trust as good for how well-led it is following an inspection in November, and has published reports on four of its services.
The trust is an integrated care provider serving a local population of around 530,000 people in west Birmingham and the towns within Sandwell. The trust manages several hospital and community services including Midland Metropolitan University Hospital, City Health Campus and Sandwell Health Campus.
CQC last rated how well-led the trust is as requires improvement in an inspection using its previous methodology for trust ratings.
CQC currently gives NHS trusts a single trust-level rating focusing on leadership and culture that replaces all other ratings at that level. CQC consulted on this approach and will use the feedback gathered to consider whether this well-led key question at NHS trust level is appropriate for the new innovative, complex and integrated models of care being created.
CQC also inspected four of the trust’s services in September and October. At Midland Metropolitan University Hospital, it has rated both urgent and emergency care and surgery as good, and maternity as requires improvement.
Inspectors identified breaches of regulation relating to safe care and treatment in urgent and emergency care, and safe care and treatment, person-centred care and staffing in maternity services. CQC has told the trust to submit an action plan showing what immediate and widespread action it is taking in response to these concerns.
Midland Metropolitan University Hospital (MMUH) opened in late 2024 and this was CQC’s first inspection of these services. The hospital doesn’t have an overall rating yet as CQC hasn’t inspected all of its services.
CQC also rated surgery at Birmingham and Midland Eye Centre, located at City Health Campus, as good again. The overall rating for City Health Campus remains requires improvement.
Carolyn Jenkinson, CQC deputy director of hospitals in the midlands, said:
“During our inspection we found leadership at Sandwell and West Birmingham Hospitals NHS Trust had improved during a time when the trust had undergone major transformation, including the opening of a new hospital, bringing services together, and changes at senior executive level.
“We were pleased the trust’s shared direction, vision and strategy aligned with plans and objectives both internally and with partner organisations. The trust worked well with health and social care partners to help people achieve the best possible outcomes in their treatment.
“Our inspectors found leaders were committed to equality and inclusion, and valued diversity in the organisation’s workforce. The equality, diversity and inclusion strategy led to actions that supported leaders across the organisation and helped them better understand the needs of their local communities and disadvantaged groups.
“However, senior leaders needed to improve their systems and processes to gain a better understanding of service delivery. We found they needed to improve confidence in their digital systems and ensure systems could work together.
“During our service inspections, we found surgery services at both locations provided effective care that involved people in decisions about their care.
“The trust’s urgent and emergency care services had strong processes in place and staff were committed to providing caring services, although we had some concerns about delays caused by demand outside the department’s control.
“In maternity services, our inspectors found leaders needed to do more to ensure the service provided safe care and treatment for women, including employing more midwifery and nursing staff.
“Overall, leaders should be pleased with the findings of our well-led inspection. We have told them where they could make improvements in leadership and in the services we inspected, and we will monitor the plans they have to address these.”
Inspectors found during their well-led inspection:
- Leaders were capable, compassionate and inclusive, and led with integrity. They embodied the culture and values of their organisation’s workforce and were dedicated to supporting their local communities and staff.
- Leaders had overseen good progress in the trust’s environmental sustainability and had projects in place that were reducing carbon emissions. The new hospital was built with this in mind, and used intelligent LED lighting, solar panels, and combined heat and power systems.
- The trust had a comprehensive training programme for staff with a focus on career development. The leadership programme provided people with new skills for managing staff.
- Most staff felt confident speaking up and raising concerns, and noted how this had improved over time. However, the trust needed to address areas where staff said they spoke up to their detriment.
However:
- Leaders needed to improve the time it took to investigate serious incidents or demonstrate where they had taken action while a complex investigation was ongoing.
- Leaders needed to improve their governance systems as there was insufficient evidence of how actions taken had led to changes or how they would be measured.
- They also needed to improve some of the key performance indicators relating to waiting times, especially where they were worse than local or regional averages.
- The trust had too much clinical guidance that was non-compliant in practice.
Inspectors found in urgent and emergency care at MMUH:
- Staff were caring and committed to giving people the best possible experience and outcomes. People told inspectors that staff were kind and compassionate.
- Staff provided care that considered people’s individual needs and preferences, while following processes and best practice.
- However, people experienced delays in their care due to the amount of people needing care in the department and delays in discharging or transferring them to other areas of the hospital.
- Leaders hadn’t ensured that staff were up to date with their safeguarding training, which put people at risk.
Inspectors found in surgery at MMUH:
- The service had enough qualified and experienced staff to provide safe and effective care and treatment.
- Staff involved people in their care and made sure they understood the treatment they received.
- Managers had improved the culture across the service and provided strong leadership. Staff felt supported and were proud to work for the trust.
Inspectors found in maternity at MMUH:
- Some people told inspectors that language barriers affected communication.
- Staff sometimes took longer than appropriate to triage people and provide care, while leaders needed to do more to improve the flow of people through the department.
- The trust had improved the culture of the service since the previous inspection, with leaders and staff sharing a vision and making improvements to services together. Leaders supported staff well and communication between teams had improved.
- Staff treated women with kindness and compassion. Women had mostly positive experiences of the service, and felt staff supported them and included them in decisions about their care and treatment.
Inspectors found in surgery at Birmingham and Midland Eye Centre, City Health Campus:
- People told inspectors they were happy with the care and treatment they received. Staff delivered care that met people’s individual needs and treated them with kindness.
- Leaders were visible and approachable, and staff found them supportive and appreciated that they worked alongside them.
- The trust partnered with a national charity to fund dedicated eye care liaison officers who provided emotional and practical support to people.
- However, leaders needed to ensure staff completed specific learning disability and autism training as there were gaps in completion rates for this course.