Good Hope Hospital

Good Hope Hospital is part of the University Hospitals Birmingham NHS Foundation Trust which is one of the largest teaching hospital trusts in England, serving a regional, national, and international population. The combined organisation has a turnover of £1.6 billion and provides acute and community services across four main hospital sites:

• The Queen Elizabeth Hospital Birmingham
• Birmingham Heartlands Hospital
• Good Hope Hospital
• Solihull Hospital

The trust also runs Birmingham Chest Clinic, a range of community services and several smaller satellite units, allowing people to be treated as close to home as possible.

The trust has 2,366 in-patient beds over 105 wards in addition to 115 children’s beds and 145 day-case beds. The trust operates 7,127 outpatients’ and 304 community clinics per week. The trust has over 20,000 members of staff.

At the time of our inspection, the trust was 10 months into the pandemic response to COVID-19 with over 450 COVID-19 inpatients. A number of changes to services and ward specialties had taken place since March 2020 in response to the emergency to ensure the trust was able to provide care and treatment as appropriate to the increasing number of COVID-19 patients. Throughout the pandemic, University Hospitals Birmingham NHS Foundation Trust has had a consistently high number of COVID-19 inpatients.

Concerns had been raised through enquiries and serious incident reporting about medical care services at Good Hope Hospital in relation to:

• Venous thromboembolism (VTE) assessment and management
• Discharge processes and communication
• Staffing
• Incident reporting and sharing of learning including never events
• Support, care, and treatment for patients with learning difficulties
• Patient care and emotional support
• Concerns around ‘do not attempt cardiopulmonary resuscitation’ paperwork
• Concerns around staff culture
• Infection control procedures
• Nutrition and hydration

These concerns led to a decision being taken to complete an unannounced (staff did not know we were coming) focused inspection on two separate dates: 2 and 9 December 2020. We inspected elements of our safe, effective, responsive, and well led key lines of enquiry. The inspection team comprised two CQC inspectors and a specialist advisor who had expert knowledge in the medicine core service.

During our inspection we visited eight wards and spoke with 25 members of staff. This included medical staff, nursing staff between band four to seven, flow co-ordinators, ward clerks and ward managers. We also held two remote interviews with site and divisional directors.

We reviewed 202 sections of patient records. During the first day of our inspection, we reviewed ten records of current inpatients to explore venous thromboembolism (VTE) assessment and management, discharge processes and nutrition and hydration management. We reviewed 20 further patient records for the purpose of reviewing VTE management only. We also reviewed five records for patients already discharged. On the second day of inspection, we looked at 121 records specifically for the purpose of reviewing VTE management, 15 records for the purpose of reviewing nutrition and hydration and 16 ReSPECT forms. Please note that some of these records may have been for the same patients. In addition, we reviewed 10 records of discharged patients to review discharge management.

The medicine core service was last inspected in 2018 (the report was published in 2019). During the 2018 inspection, the service was found to be in breach of Regulation 18: Staffing due to not having the required numbers of nursing staff to keep patients safe.

During this inspection, we again found safety concerns in relation to nurse staffing. This was a breach of the Health and Social Care Act (2008) (Regulated Activities) Regulations: Regulation 18 Staffing. We also found evidence of a breach of Regulation 12: Safe Care and Treatment.

Following this inspection, we did not re-rate all key questions inspected. We have only re-rated key questions where we identified a breach of regulation.

During our inspection we found:

• The service did not have enough nursing staff with the right qualifications, skills, training, and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels however this did not resolve the low numbers of registered nurses present on wards. Staff sickness rates and nurse vacancy rates were high. This resulted in some tasks being rushed, not enough staff to observe patients at high risks of falls, and some patients having to wait to be supported with eating meals. Ward staff did not have the capacity to meet the individual needs of all patients living with dementia.
• Staff completed VTE risk assessments for each patient but did not always review these in line with the trust policy. Staff did not follow the trust policy consistently when discharging patients.
• The service did not always control infection risk well. Staff did not always wear appropriate personal protective equipment as designed.
• Not all staff could access patient records. Some assessments such as ReSPECT forms were not fully completed or updated.
• Staff were not familiar with or aware of serious incidents or never events which had occurred across the trust.
• Not all staff had received or updated training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.
• Staff did not all feel respected, supported, or valued by the wider trust.
• Processes were in place to manage identified risks, however some actions such as those in relation to managing staffing, were not enough to mitigate the risk to patient safety.
• Not all risk registers accurately captured risks to the service. Some actions such as those in relation to managing staffing, were not enough to mitigate the risk to patient safety.

However, we also found areas of good practice:

• Staff were passionate about helping patients and wanted to have the capacity to do more.
• Staff had training on how to recognise and report abuse.
• Staff kept the premises visibly clean.
• The design of the premises kept people safe.
• VTE medicines were mostly prescribed in line with national standards.
• Staff recognised and reported most incidents and near misses. Managers investigated local incidents and shared lessons learned with the local team.
• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service adjusted for patients’ religious, cultural, and other needs.
• Patients with a learning disability could access the site based team to get support. Staff supported patients to choose food based upon dietary preferences.
• Divisional leaders operated effective governance processes, throughout the service. Staff at senior levels had regular opportunities to meet, discuss and learn from the performance of the service.