Sandwell and West Birmingham Hospitals NHS Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Good

Our view of the service

Although undertaken through our previous methodology, our last assessment of the well-led key question at trust level rated the organisation as requires improvement. Following a major transformation focused on the opening of a new hospital and bringing services together, and changes at senior executive level, this assessment has seen the trust rating improve to good, although with some areas to tackle and improve.

Sandwell and West Birmingham Hospitals NHS Trust is an integrated care provider serving a local population of around 530,000 people from across west Birmingham and the towns within Sandwell. The population has an average age of 37 years which is 4 years below the national average age. Life expectancy at 78 years is 2 years below average. There are around 45% of children living in poverty, which is 15% above the national average. Around 30% of the population does not have English as their main language. This is twice that of the west Birmingham region and 21% above the national average. There are around 80 different languages spoken in the local community.

The trust manages several hospital and community services. This includes the Midland Metropolitan University Hospital (MMUH) in Smethwick which opened in the autumn of 2024. This hospital provides a full range of surgery, acute and emergency medicine (AE), and maternity services, among others. The trust also runs City Health and Sandwell Health Campuses which provide outpatient services, day case surgery and diagnostics. Sandwell Health Campus also has an urgent treatment centre open from 8am to 11pm, 7 days a week. The City Health Campus is also home to the Birmingham and Midland Eye Centre (BMEC) providing regional and specialist eye services and as a centre for clinical research. The trust provides stroke, medical outpatients, and intermediate care at Rowley Regis Hospital. It hosts both the National Poisons Information Service, the Sickle Cell and Thalassaemia centre, and audiology services at the Lyng Centre. The Lyng Centre and other sites provide community services to the local population. The trust also is responsible for several GP practices and local networks.

The trust employs around 8,200 permanent staff. It sees around 250,000 people each year in its AE and urgent treatment centre; around 618,000 people were seen by community teams; there were 45,000 day-case surgeries; and around 900,000 people had outpatient appointments. Just over 5,000 babies were born in 2024/25. Its annual income is in the region of £800mn. The trust is managed by a unitary trust board made up of executive and non-executive directors. The trust works in close cooperation with The Dudley Group NHS Foundation Trust and many of the trust directors have ‘group’ appointments spanning both organisations. There are a growing number of teams which also span both organisations for sharing both resources and experience.

During our assessment we visited 3 hospitals (Sandwell and City known as ‘Health Campuses’) and undertook assessments of 4 service groups. This included

• Urgent and emergency care (AE) at MMUH

• Maternity services at the MMUH

• Surgical services at MMUH and BMEC

On our visits to the 3 hospitals or health campuses we held focus groups for any members of staff to come and speak with us about their experiences. At Sandwell Health Campus we met 13 staff from across the service including community and administration staff who had 251 years of working in healthcare between them. At City Health Campus we met 9 staff from across the service including imaging, theatres, phlebotomy, physiotherapy and operations managers who had 213 years of working in healthcare between them. At the Midland Metropolitan Hospital, we met a wide range of staff including consultants, resident doctors, senior nurses, and the nursing and medical leadership teams. We met leaders for the staff networks, trades union representatives, diversity and inclusion leads and operational directors. We also talked with administration and corporate staff, the medicines management team, and staff who joined our ‘all staff’ focus groups.

We assessed Sandwell and West Birmingham Hospital NHS Trust for leadership using our standard methods. This included interviews with staff across the whole organisation, including members of the trust board and senior clinical leaders; we used evidence provided by the trust and stakeholders; and used data and intelligence we hold about the organisation.

We assessed each of the 8 new quality statements for the trust and have reported on the good practice in many areas, as well as those that need to be improved.

There was a shared direction, vision and strategy with the organisation aligned to plans and objectives and those of the local system and partners. The direction was based on understanding the challenges faced and for the future, including financial pressures and growing patient demand. There were capable, compassionate and inclusive leaders who led with integrity. There was commitment to equality, diversity and inclusion, and key indicators were showing improvement, although still with things to do. The diversity in the workforce was valued and recognised for its importance to the diversity of the local population.

There was a system of governance, although this needed to be improved. Executive and leadership responsibilities were clear and supported the delivery of good quality and sustainable care, treatment and support. However, there needed to be more evidence to support how actions taken in the past had led to improvements and were continuously evaluated, and how audits were effective in improving patient care. Too much guidance was significantly non-compliant in implementation. Some actions to make improvements had no objective measurements or explanations of how they would be achieved. There were improvements needed in some key clinical safety metrics and risk assessments. Further work was needed to improve the time taken to investigate serious incidents or be able to demonstrate action had been taken quickly where investigations were complex and/or drawn out.

The trust’s performance against key clinical measures and standards had improved in some areas but slow to make progress in others. As with the national picture, areas of concern remained in AE around waiting times. Diagnostic waiting lists had reduced but waiting times in some disciplines were still worse than local or regional averages.

There was more work required around the confidence in digital systems and their ability to work together. The trust needed to ensure its processes for determining if staff were fit and proper were comprehensive and met all statutory duties. There was work required to meet the recommendations from the trust’s auditors.

There was good partnership working and collaboration with health and social care stakeholders. The trust understood the duty to collaborate and work together in the best interests of patients and the community. The trust was making sound progress around environmental sustainability with some projects having major impacts in reducing carbon emissions.

However, there remained some staff who did not feel safe to speak up or felt it would mean detriment to their career. There were also concerns around safe levels of staffing, staff morale and wellbeing and some staff being concerned, despite assurances and the Chief Executive Officer’s commitment to patient safety, that finance was more important than patient safety.