Birmingham Children's Hospital has improved services but further progress is required, according to regulator
Birmingham Children’s Hospital NHS Foundation Trust (BCH) has made significant
improvements in the quality of some areas of specialist care, according to the
Care Quality Commission (CQC)'s report published today .
The report examines the hospital’s progress in implementing recommendations
made in March 2009 by the regulator’s predecessor, the Healthcare Commission.
A review at that time found the trust was struggling to meet rising demands,
resulting in delays in treatment, less than optimum care, and children being
redirected to other services.
CQC completed its assessment of the progress made at the trust in November
2009. It commended improvements made in making services more accessible, creating
and improving management systems, purchasing more equipment and recruiting and
training additional staff. The remaining challenges to be faced are in managing
long-term demand for services and ensuring that all local NHS bodies work together
to provide the best possible specialist care for children, according to the
The trust had fully met six of the 12 recommendations made in March 2009 and
had made progress in the remaining six. CQC commended the progress made in:
- Recommendation 5: Access to interventional radiology,
a minimally invasive diagnostic procedure. Concerns were raised that poor
access to these services meant children were undergoing more invasive procedures
than necessary. The trust has now recruited two additional interventional
radiology consultants and allocated more time for elective treatments. No
open procedures have been performed when interventional radiology would have
been more appropriate and the waiting time for treatment has decreased from
over a year to six to ten weeks.
- Recommendation 6: Support for surgeons conducting urgent
renal transplants and neurosurgery. This has included additional trained nurses
available to work in theatres.
- Recommendation 7: Working with the University Hospitals
Birmingham NHS Foundation Trust (UHB) to resolve concerns about lack of specialist
equipment. Concerns were previously raised by consultants from UHB who carry
out surgery at BCH. Additional equipment has been bought.
- Recommendation 9: Agreeing a clear plan to ensure craniofacial
patients will be treated at the appropriate age and that any delays will be
minimised. The trust checked its waiting list to give an up-to-date picture
of numbers and waiting times, informing a workforce and capacity plan. The
National Commissioning Group then agreed funding to clear the waiting list
of 18 patients.
- Recommendation 10: Agreeing and clarifying the level of
input the trust requires from UHB staff, enabling greater and formal involvement
of its consultants in clinical governance and management structures at the
trust. The trust is holding regular meetings with senior managers and clinicians
where these arrangements are reviewed.
- Recommendation 11: Creating job plans and accounting for
the time spent by UHB consultants at the trust. The trust has clarified and
agreed with UHB the level of input it requires from UHB staff and job plans
have been developed.
CQC also commended progress made in the following areas but said they still
require improvement and will continue to be monitored:
- Recommendation 1: Monitoring demand and capacity for children’s
services, including information about patients the trust has not been able
to admit. The trust has recruited extra ward clerks to improve accuracy of
its data, added indicators to its performance report and some individual specialities
are collecting their own performance data. But at the time of assessment,
the trust had not yet developed a system for collecting, aggregating and monitoring
speciality and trust-wide data around unmet demand, including assessing delays
- Recommendation 2: Reviewing strategies and policies to
improve management of admissions and beds. The trust has a programme to improve
its bed management and patient flow. While it has undertaken a range of initiatives,
CQC has not yet seen sufficient evidence that the trust has improved its ability
to admit neurosurgery and liver patients in a timely way.
- Recommendation 3: Managing demand and provision of services
at the trust. The trust has involved NHS Interim Management and Support to
better understand its capacity, demand and complexities around case mix, patient
flows and length of stay. Regular meetings are now held between the trust
and clinical leads to review demand and provision. But there remains concern
that there is a shortage of beds in the neurosurgery ward.
- Recommendation 4: Reviewing the way the trust organises
capacity and prioritises cases within theatres. To increase capacity, the
trust is to build new theatre(s). But construction time means it could take
up to two years before there’s more theatre space. Some surgery cases
are being cancelled to allow urgent and emergency surgery cases timely access
to theatres, but performance has recently improved with cancellations decreasing.
- Recommendation 8: Reviewing the arrangements for Hospital
at Night with senior clinical staff to ensure any concerns are addressed.
Specifically in relation to liver patients, consultants felt registrars would
not be suitably familiar with these specialist conditions. Two additional
surgeons and a fellow from the Royal College of Surgeons have been recruited.
Most liver patients are now taken as surgical patients for the first three
months, and thus subject to greater levels of observation.
- Recommendation 12: The trust and UHB agreeing and implementing
a model of care for delivering high-quality paediatric services, in line with
the requirements of the foundation trust regulator, Monitor. The trust, UHB
and Monitor have agreed a set of outcomes that the two trusts will work towards.
Progress on the action plan devised to lead to these outcomes is communicated
to Monitor via monthly reports.
The review covers paediatrics tertiary care services in the specialty areas
of renal transplant, liver transplant, craniofacial surgery, neurosurgery, interventional
radiology and cardiac services.
Andrea Gordon, West Midlands regional director for CQC said:
“ Birmingham Children’s Hospital faces real challenges in
meeting the rising demand for services. That's why it is so important for
it to work effectively with neighbouring trusts to manage demand and ensure
children receive urgent specialist care when they need it. There is no question
that the trust has made significant progress, particularly in the way it works
with University Hospitals Birmingham and in providing more staff for some
specialist services. But there is more to do in managing capacity and improving
the way it prioritises children needing urgent surgery.
We will continue to monitor the trust through our tough new registration
system, which requires the NHS to meet essential standards of quality and
safety. So far, we have been satisfied with the progress at Birmingham Children's
Hospital and I want to be clear that we have not identified any breaches of
the standards. This is about managing long-term demand for services and ensuring
that all local NHS bodies work together to provide the best possible specialist
care for children."