Birmingham Children's Hospital told it needs to make improvements

The Care Quality Commission (CQC) has told Birmingham Women’s and Children’s NHS Foundation Trust to make improvements to urgent and emergency services at Birmingham Children’s Hospital following an inspection in January.

The emergency department at Birmingham Children’s Hospital provides a 24/7 service to children and young people in the local area and beyond.

The unannounced inspection was carried out following information of concern highlighted to the commission regarding the safety and quality of the service.

Following the inspection, the overall rating for urgent and emergency care at Birmingham Children’s Hospital, as well as the ratings for safe, effective, responsive, and well-led went down from good to requires improvement. Caring was rated as good again.

The overall rating for Birmingham Children’s Hospital is good. The overall rating for the trust remains as requires improvement.

Charlotte Rudge, CQC deputy director of operations in the Midlands, said: “When we inspected the urgent and emergency service at Birmingham Children’s Hospital, whilst we saw kind and considerate staff who worked hard to do their best, it was disappointing to see an overall decline in the quality of care being provided to children and young people.

“Leaders need to ensure staff are trained in how to deal with young people attending the unit who are experiencing a mental health crisis. Staff told us they weren’t clear on what to do if a child was in a mental health crisis which could place them and the young person at risk of harm.

“We saw that understaffing impacted on staff ability to administer medicines, triage in a timely manner and complete observations. On some shifts there were lots of newly qualified nurses meaning there was more pressure on qualified nurses to take on additional tasks. The service had secured funding to increase the triage nurse capacity and plans were in place to recruit.

“However, it was positive that children and young people were usually triaged within 15 minutes of arrival at the department. A system of prioritisation was in place which ensured the most urgent cases were escalated as quickly as possible.

“In addition, leaders were visible and approachable, and staff felt respected, supported, and valued. Leaders collaborated with partner organisations to help improve services.

“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so children and young people can receive safe and appropriate care.”

Inspectors found:

• The service provided mandatory training in key skills but not all staff completed it.
• The service was inclusive but didn’t always take account of people’s individual needs and preferences.
• The service didn’t always control infection risk well and scored poorly in some cleanliness audits.
• The layout of the department meant staff didn’t always have sight of all people waiting in the department which could place people at risk.
• Staff didn’t always store or manage medicines safely or securely.

However:

• Parents said staff responded to call bells within reasonable timescales.
• Staff respected people’s privacy and dignity, took account of their individual needs, and helped them understand their conditions.
• Staff understood their responsibilities to raise concerns and reported incidents and near misses in line with trust policy.

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