Statement on Care Quality Commission (CQC) report into University Hospitals Birmingham NHS Foundation Trust (UHB)
In some respects, the latest Care Quality Commission (CQC) report into University Hospitals Birmingham NHS Foundation Trust (UHB) is a picture of the NHS in microcosm. Staff shortages, long waits in emergency departments and lack of adequate equipment for example, will be unfortunately all too familiar to many people using NHS services at this time of unprecedented demand.
We cannot, however, ignore the fact that many of these problems are more severe at UHB, or that they and a number of other issues identified are longstanding and can’t be blamed on the current pressures across the NHS or the Covid-19 pandemic. Healthwatch Birmingham and Healthwatch Solihull have long been concerned about the culture and governance at UHB, which is why we called for independent reviews of the trust when serious allegations about the treatment of whistleblowers were exposed in late 2022. Prior to this, we had also raised concerns about the increase in complaints and negative feedback from patients we were receiving.
While the current CQC report is based on visits undertaken before all of the three independent reviews commissioned by the NHS were complete, it does show that many of the problems more specific to UHB had been inadequately addressed in the interim, and the scale of the uphill struggle the trust still faces.
Among the most worrying findings, from Healthwatch’s perspective, is the fact that patients are not always protected from harm at UHB, due to a number of factors including low numbers of staff, staff training and inadequate safeguarding procedures. These problems have been compounded by the fact that – although many patient safety incidents are escalated and investigated – feedback and lessons learned are not always shared with the staff effectively, meaning opportunities for improvement are lost. This emphasizes the importance of greater transparency from UHB management, to reassure staff and patients that they are being properly listened to and that the trust is learning from mistakes.
This report also provides more insight into the toxic culture reported by Professor Mike Bewick and his team and also in the independent culture review, particularly in cancer services and neurosurgery at Queen Elizabeth Hospital. The atmosphere of bullying, racism and misogyny reported affects not just staff on a personal level but also their ability to provide essential care to seriously ill patients: it is difficult to believe that the high number of ‘never’ events in haematology, for example, are not connected to the dysfunction within the service itself. In contrast, where other departments, such as emergency care at Heartlands, had fostered a supportive and inclusive staff culture, the service rating on certain measures had improved. Learning from and extending this positive culture across the whole trust must now be an immediate priority.
UHB has undergone significant organizational change since the dates of these CQC inspections and the publication of the independent reviews, and the new leadership has made commitments to tackle the toxic culture that had previously been allowed to take hold. Healthwatch recognizes that it will take time for some changes to take effect, but will be closely monitoring UHB for solid evidence of sustained change. However, the fact that these CQC reports show the trust had failed to satisfactorily resolve some of the points raised in previous warning notices means there is now even greater pressure and scrutiny for UHB to deliver on both its promises to staff and patients and statutory commitments. Healthwatch will be pressing the trust to provide a clear update on actions taken and progress made since these CQC investigations and the independent reviews, and will both hold UHB to account and help the trust to make the urgent and vital improvements required.
– Richard Burden, Chair, Healthwatch Birmingham and Healthwatch Solihull
* Image by N Chadwick, CC BY-SA 2.0
