The first of three reviews into University Hospitals Birmingham NHS Foundation Trust have been published by NHS Birmingham and Solihull Integrated Care Board (ICB). The aim of the review was to address some of the concerns raised and to assure that the services at the Trust remain safe, with patients and service users continuing to access care when needed with confidence.
Why the review?
Concerns regarding leadership, patient safety, culture and governance that stemmed from December 2022, led to the commissioning of the patient safety review. On Thursday 1st December 2022, University Hospitals Birmingham (UHB) was informed by Health Birmingham that Richard Burden, the Chair, would be featuring on BBC Newsnight. During the programme, both former and current staff from UHB participated in a series of interviews and statements relating to a series of concerns regarding leadership, governance, and culture at UHB that have impacted patient care.
In addition to the programme featured on BBC Newsnight, the suicide of a junior doctor who was working at UHB had also concluded. Despite the coroner concluding that no blame should be placed on UHB, naturally this attracted significant media attention. Following the aftermath, The Chair of Healthwatch Birmingham released a further statement raising concerns over bullying and patient safety trust.
What is the Integrated Care Board response to patient safety concerns
In response to these concerns, the NHS Birmingham and Solihull ICB revealed that the Patient safety and governance, Well-Led review of leadership and governance and culture (Bewick Review) were the main topics of their three independent reviews. All three of those independent reviews have been commissioned by the ICB, NHS England and externally by UHB’s Interim Chair respectively. Highlighted in the full report, the initial focus also discusses the composition of the organisation, its leadership, the professional allegations made against it and its reputation.
To bring the conclusions and recommendations of these two pieces of work together and provide additional independent assurance, Professor Mike Bewick was commissioned to support the review and will provide support on implementing the recommendations following the safety review.
Recommendations made following patient safety concerns
Regarding the review published today, the independent review team set out two concerns and four groups of recommendations and has emphasised that their overview is that “the Trust is a safe place to receive care.” The main factors highlighted were firstly a better understanding of Hospital Standard Mortality Rates and the level of staffing, particularly at Good Hope Hospital. Furthermore, the team has found that “any continuance of a culture that is corrosively affecting morale and in particular threatens long term staff recruitment and retention will put at risk the care of patients”, this point was supported by feedback from the Trust’s Medical Staff Committee.
- A specific review of mortality should be conducted by an external specialist in this field with support from a governance lead. The terms of reference should include:
- An independent retrospective review of all the deaths first analysed by Dr Nikolousis to establish any lessons learned.
- Consideration as to whether there an outstanding DoC responsibility relating to this patient cohort.
- All deaths in the year 2021/22
- An assessment of how integrated the department is following the merger in 2018 with a focus on how leadership and accountability of the service currently functions.
The NHS Birmingham and Solihull ICB also confirmed that the Cross-Party Reference Group, which is chaired by Edgbaston MP, Preet Kaur Gill, will continue to work with Professor Mick Bewick throughout the remainder of the process.
Lead Reviewer, Professor Mike Bewick, said:
“Our rapid review has found that services at University Hospitals Birmingham are safe, and patients should be confident when using them.
“We have, however, confirmed some, but not all, of the concerns made on the Newsnight programme in December of last year. In response to their concerns and those raised by Healthwatch, Preet Gill and many other individuals who have come forward, we have made several recommendations for further investigation and action.”
Chief Executive at NHS Birmingham and Solihull, David Melbourne also said:
“The review makes for difficult reading and sets out a number of important issues that need to be addressed. This report, and the ones that will follow later this year, are intended to create the conditions for University Hospitals Birmingham to move on, improve and develop the culture, environment and governance that will benefit staff, patients and our system.
“I speak on behalf of our Integrated Care System in offering our support and encouragement to staff at University Hospitals Birmingham, as well as a commitment to work with the Trust in a positive way to address the issues raised.”
The next stages of the patient safety review will continue to confront the underlying cultural and organisational issues. This will run alongside the well-led and culture reviews with an aim of reporting in summer 2023.
Following the publication of the Francis Report following the Mid Staffs NHS scandal in 2013, the Government promised to reform NHS culture.
The report into UHB by Professor Bewick, is shocking in many similar ways to Mid Staffs. The questions surrounding culture remain a decade on. The question for policy makers is how to stop events like these from happening in the future. How will change become embedded within the system.
It is critical that urgent changes are made, and the recommendations are implemented in full. Co-chaired by Professor Bewick, independent policy institute, Curia will be launching an NHS workforce inquiry later this year. To find out more contact Harry Blacklock