Major NHS trust downgraded by care watchdog amid safety fears

One of the largest hospital trusts in England has been downgraded by the care watchdog amid safety fears and criticism that bosses did not act on staff concerns.

The Care Quality Commission said it found bedpans covered in faeces, urine and hair during 10 visits to wards at University Hospitals Birmingham Trust in June.

Staff in A&E told inspectors they were put under pressure to nurse patients in corridors.

At one stage 20 ambulances were queuing outside Heartlands Hospital with patients waiting outside.

The CQC said staff felt “disconnected from leaders” who didn’t show an understanding of the pressures they were under.

Consultants to the regulator staff were experiencing fatigue and they felt executives at the trust “were no longer interested in staff welfare”.

In its inspection report, the CQC said staff did not always clean equipment and said labels for when items were last cleaned were being applied incorrectly.

It said: “Across the service, the use of ‘I am clean’ labels were inconsistent, with them used on some wards, but not on others. Some labels showed equipment had been cleaned recently, while others were dated May 2021.

“On ward 412, we found a commode with a label to say it was clean dated 19 May 2021, however it was visibly dirty with urine and hair. We also found a bedpan which was covered in faeces, and the bladder scan was visibly very dirty with a label to say it was cleaned 24 May 2021.”

The Midlands trust is one of the largest hospital groups in the country and has been stretched throughout the summer, repeatedly cancelling operations, including for cancer patients, and experiencing long delays in people being handed over from ambulances.

The CQC has downgraded the trust from good to requires improvement. The inspection looked at urgent and emergency care at Good Hope Hospital, Birmingham Heartlands Hospital and Queen Elizabeth Hospital in Birmingham city centre. It also assessed medical care, surgery and cancer services.

Fiona Allinson, deputy chief inspector of hospitals at the watchdog, said there were concerns about how well risk was appreciated by bosses and the steps taken to support staff.

She added: “We also found variation in the extent to which staff felt respected, valued and supported to carry out their roles, with some staff telling us their concerns about patient care were not listened to or acted upon by the trust’s leadership.”

The trust took over the Heart of England Trust in 2018 and some staff said this had affected patient safety. But she added that despite the challenges the staff were “unwavering” in their focus on patient care.

The CQC said patients were waiting too long to be seen without being monitored in A&E and safety checks of equipment were not being completed.

It added that when a lack of space in A&E meant patients waiting in ambulances, the trust did not take steps to keep patients safe despite the concerns of staff.

At Good Hope Hospital, medical care, including older people’s care, suffered from long-standing staffing pressures. It did not have enough nursing and support staff, the CQC said, to keep patients safe from avoidable harm.

Inspectors also identified outstanding practice, especially in Queen Elizabeth Hospital Birmingham’s cancer services. Its haematology department demonstrated European-leading therapies and shared its knowledge with other services, the regulator added.

David Rosser, chief executive of the trust said: “The findings of the report reinforce the challenges we are aware of, and are actively addressing, particularly in supporting our emergency departments, where we continue to experience extraordinary demand that has a knock-on impact in all areas of our trust, including urgent and elective surgery.

“The trust has needed to ask far more of the workforce than we ever would in ordinary circumstances, in terms of the hours they have worked, the pressure they have worked under and the amount of very short notice change they have supported and endured. It is only by this extraordinary and sustained effort from the entire team that we have been able to ensure that Covid patients and emergency patients have been able to receive the care and treatment that they required.”

The trust said that there were now routinely 1,250 attendances in A&E per day compared to 850 to 950 before the pandemic.

It has created a dedicated support team for A&E and is expanding capacity on all its sites to create 150 extra beds for patients.