Phlebotomy (Venepuncture)

University Hospitals Birmingham NHS Foundation Trust is one of the largest teaching hospital trusts in England, serving a regional, national and international population. It includes running four major hospitals: Birmingham Heartlands Hospital, the Queen Elizabeth Hospital Birmingham, Solihull Hospital, and Good Hope Hospital. It also runs a number of community services, including the Birmingham Chest Clinic, the Norman Power Centre and the Washwood Heath Community Diagnostic Centre.

The trust sees and treats more than 2.2 million people every year and employs around 24,600 members of staff.

The trust is a regional centre for cancer, trauma, renal dialysis, burns and plastics, HIV and AIDS, as well as respiratory conditions like cystic fibrosis. It also provides services in premature baby care, bone marrow transplants and thoracic surgery and has the largest solid organ transplantation programme in Europe. It also provides specialist cardiac, liver and neurosurgery services to patients from across the UK.

The Queen Elizabeth Hospital Birmingham has been designated both a level 1 trauma centre and host of the UK’s National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC).

This was a trust which had been through a period of substantial change in recent years. This has included the merger (by acquisition) in 2018 of two large NHS Birmingham-based trusts to form University Hospitals Birmingham NHS Foundation Trust. A new Chief Executive Officer took the interim role in January 2023 and was confirmed into post in July 2023.

Other executives have left the organisation this year, or will leave in the course of 2023. There is therefore a relatively new and changing board of directors and a number of the non-executive directors are recent appointments. A new Chief Operating Officer has been appointed but not yet taken up their post.

A couple of the long-standing non-executive directors are coming to the end of their term, so more new appointments are expected. The Chief Medical Officer will step down from their role to take up a nephrology and research role in the trust later in 2023 and recruitment was underway for their replacement.

To add to these changes, the trust is at the beginning of a major transformation of its operating model. The trust board recognised that the governance of a trust of this size being based around seven cross-cutting divisional structures needed to be revised. The trust is now in the early stages of the new structure, rolled out in phase one at the start of October 2023.

This will place the responsibility for local governance, quality and safety with a hospital-based leadership model. Each hospital will have its own senior leadership team, led by an executive director.

These teams will have devolved responsibilities from the main trust board (to be known as the ‘group’ board) to run and manage most clinical services at site level. Some teams will remain reporting through to the group board and not devolved to hospital level with some services remaining on a shared-service basis such as pharmacy and pathology.

The trust has been subject to some intense media scrutiny in the past couple of years, mostly around areas of culture, bullying and harassment. This culminated in the recent publication (September 2023) of a culture review by an external company commissioned by the trust chair.

The trust has undergone an extensive capital investment programme including seven new hospital wards, a new cardiology daycase unit at Good Hope Hospital, and a treatment centre at Heartlands Hospital for 1,500 patients to be treated every day. It has opened an improved treatment centre in Solihull and a diagnostic centre in Washwood Heath, due to open in January 2024.

Our inspection in August and October 2023 included a focused review of critical care services at the Queen Elizabeth Hospital Birmingham, and a focused review of well-led. Critical care was limited to the key lines of enquiry around safety and leadership (well-led). Our well-led inspection focused on four of our key lines of enquiry, namely leadership; culture; governance; and management of risk, issues and performance.

We recognise the trust would have provided evidence of groundbreaking and innovative care and treatment had we explored our other key lines of enquiry. However, this review was limited to these four specific areas following serious concerns raised by stakeholders and recent culture reports.

We carried out core-service inspections between February and July 2023 in maternity services, urgent and emergency care, medical care, and two focused inspections of specialist services (cancer and neurological services). In these inspections we rated as follows:

At the Queen Elizabeth Hospital Birmingham we inspected and rated:

• Urgent and emergency care rated as requires improvement overall with an inadequate rating for safe. Effective, responsive and well-led were requires improvement and caring was good.

• Neurological services rated as requires improvement overall with an inadequate rating for well-led. Safe, effective and responsive were requires improvement, and caring was good.

• Cancer services (focused inspection) rated as require improvement overall. We inspected safe and well-led, both of which were rated as requires improvement.

• Critical care (focused inspection) rated as requires improvement overall. We inspected safe and well-led, both of which were rated as requires improvement.

At Birmingham Heartlands Hospital:

• Urgent and emergency care rated as requires improvement overall (revised from an inadequate rating) with an inadequate rating remaining for safe. Effective, responsive and well-led were requires improvement and caring was good (improved from requires improvement).

• Maternity services (focused inspection) rated as inadequate overall. This was a follow-up inspection from a warning notice served and did not change the ratings.

At Good Hope Hospital:

• Urgent and emergency care rated as inadequate overall with inadequate ratings for safe and well-led. Effective, caring and responsive were requires improvement.

• Medical care (focused inspection) rated as inadequate overall with inadequate ratings for safety and well-led. Well-led was revised from requires improvement to inadequate at this inspection.

During our focused well-led inspection, we spoke with many of the trust executive directors, almost all of the non-executive directors, in a group call, and held focus groups and interviews with staff and network leaders. A number of staff contacted us both prior to, during and after the inspection with information of concern.

However, despite this inspection being announced several weeks in advance, we were disappointed with the number of staff who chose to come and meet with us, either face-to-face or on a web-based call. We were told by the staff we did meet, that many of their colleagues were not aware of the meetings or they had been unable to join due to it clashing with other responsibilities.

A number of staff also told us they did not have access to computers or an office where they could have a private conversation. Nevertheless, we recognised staff were busy, may have been unable to make one of the limited times on offer, and we were also only available face-to-face on one site due to time and resource pressures.