Damning report catalogues failings at Birmingham Children's Hospital
Health Correspondent Alison Dayani looks at the findings of the Healthcare Commission’s report into the Children’s Hospital.
Delays in coping with the high numbers of patients, lack of training and management planning all led to “less than optimum care” according to the Healthcare Commission report on Birmingham Children’s Hospital.
Visiting surgeons from University Hospital Birmingham Trust (UHB), in Edgbaston, who regularly carried out complex operations at the trust, raised concerns over what they saw as issues that could eventually cost lives.
Knowledge of theatre staff about specific procedures and equipment also caused concern, according to the report, particularly in the case of renal transplants and brain or spinal surgery, which the trust said was due to not many of those operations being carried out.
Investigators said they found services at the Children’s Hospital had also been affected by a combination of vacancies in management roles, high turnover, and a lack of skills within key positions at middle management level.
No deaths were reported at the hospital and the Commission found no evidence of patients harmed, with the NHS Blood and Transplant figures showing no evidence of any difference in short-term outcomes comparing Birmingham with the rest of the UK for the past three years.
Main findings in the report:
* The Commission found it deeply concerning that a situation was allowed to arise whereby, over several months, serious concerns about clinical care were raised but were not properly or rapidly addressed and may have been the cause of alarm and anxiety amongst patients, families and the public.
* It was clear that UHB and the Children’s Hospital had not been communicating effectively since the concerns were raised by consultants during the first half of 2008. There had not been a culture of sharing information. There were examples of miscommunication about the location for providing paediatric services, which had distracted from the actual concerns of the UHB consultants.
* An increase in general surgical workload put pressure on the entire system in terms of theatre space, wards, beds and admissions. In April, 2008, the average bed occupancy at the trust was 98 per cent and, for 15 days in that month, 99 per cent or higher.
* Many of the staff interviewed raised concerns about difficulties in admitting patients needing emergency and urgent care due to the unavailability of beds. The lack of access to beds led to delays in admission, and patients having to be transferred to other hospitals further away from their home.
* A review into capacity at the trust, conducted by KPMG, reported that efficiencies in theatre capacity could be achieved by three theatre sessions a day and allow some additional emergency surgery to be carried out.
* Almost all of the consultants interviewed raised concerns about the lack of access to interventional radiology even though demand for it rose from 803 procedures in 2002/2003 to 1,186 last year. They were concerned that the theatre list for this service was poorly organised. Patients who needed relatively simple procedures had to wait for several days.
* The trust had struggled to ensure that it had sufficient capacity to meet the increased demand for its services, due to a steady rise in referrals from general hospitals. The trust had not, in the past, responded to this increased demand with sufficient urgency, nor were there effective systems to monitor what happened to those patients who were unable to receive services from the trust due to lack of capacity.
* Craniofacial surgeons raised concerns over lack of leadership on Ward 10, and the impact that this could have had on safety. Most of the staff interviewed on Ward 10 said leadership on the ward since 2006 had been inadequate. A number of experienced ward nurses also resigned from the ward, leading to low staff morale.
To read the full Healthcare Commission report click here >
The Healthcare Commission's 12 recommendations:
* The trust needs to ensure that it actively monitors the demand and capacity for children’s services, including information about those patients it has not been able to admit.
* It needs to review its strategies and policies to improve its management of admissions and beds, and ensure that staff throughout the trust keep to these. It also needs to work with its consultants to ensure that patients needing urgent care are admitted in a timely manner.
* The trust and commissioners of paediatric tertiary services must continue to manage the demand and provision of paediatric services.
* It needs to review the way it organises capacity and prioritises cases within theatres, to ensure that patients requiring urgent and emergency surgery gain access to theatres in a timely manner.
* It needs to urgently agree a clear plan to ensure that it has the capacity and systems in place to provide sufficient and timely access to elective and emergency/out-of-hours interventional radiology.
* It must ensure that it provides, for urgent renal transplants and neurosurgery, an appropriate and sustainable level of support available within operating theatres at all times. This needs to be informed by discussions with the surgeons involved about the standards of support required from theatre staff.
* There should be clarity with University Hospital Birmingham Trust consultants over what specialist paediatric services they will provide and what equipment they need.
* The trust needs to review urgently the arrangements for Hospital at Night with senior clinical staff, to ensure that any outstanding concerns have been properly addressed.
* It must agree, together with relevant consultants and its commissioners, a clear plan setting out actions being taken to ensure that craniofacial patients will be treated at the appropriate age and that any delays will be minimised.
* The trust must develop better, formal, communication with UHB consultants undertaking work at the trust, to ensure that any concerns are identified and addressed in a timely manner.
* It needs to agree a level of input it requires from UHB staff and job plans.
* The trust and UHB, with the support of the commissioners, must agree on and implement a model of care delivering high-quality paediatric services.
