Date Published: 20 March 2009

Action to improve specialist care at Birmingham children's hospital

The Healthcare Commission today (Friday) called for action to address concerns about the quality of some specialist care at Birmingham Children's Hospital NHS Foundation Trust (BCH).

The Commission published a report of the Trust's services, carried out at the request of Health Secretary Alan Johnson in response to an article in The Observer newspaper in November.

The Observer had obtained an internal report raising the serious concerns of consultants at University Hospitals Birmingham NHS Foundation Trust (UHB), who carry out surgical work at BCH, as well as consultants at BCH.

The watchdog's report looked at paediatric tertiary care services in the speciality areas of renal transplant, liver transplant, craniofacial surgery, neurosurgery, interventional radiology and cardiac services.

The Commission found that the Trust was struggling to meet rising demands. This has resulted in delays in treatment, less than optimum care, and children being redirected to other services.

The watchdog makes 12 recommendations to address issues within those specialities such as:

* lack of access to beds, theatres and interventional radiology (radiology for both diagnosis and treatment);
* poor support to surgeons undertaking operations with concerns including the knowledge and skills of theatre staff and the availability of equipment; and
* ineffective partnership working between the BCH and the UHB.

The Commission says the Trust had at times in the past not responded with sufficient urgency to concerns - first raised in June 2008 - but had now begun to do so. It and Monitor will oversee progress with the recommendations, many of which BCH is already acting on.

Anna Walker, the Commission's Chief Executive, said:

"While we have no evidence of serious incidents causing harm to patients, the standard of care has not been as good as it should have been in some cases. The response to safety concerns has been slower than ideal. It is deeply concerning that serious issues were raised but not properly or rapidly addressed over several months. While I would not say there were ‘third-world' conditions, there were serious potential risks in the way care was provided.

The good news is that the Trust has now recognised the seriousness of these issues and begun to take action. It will need the right underpinning management structures to deliver agreed care. This must be backed by action from those commissioning services at BCH on behalf of children as the trust has been struggling with some very real problems with its ability to meet demands for the service.

Following the Trust's recent actions, we are reassured that there are no immediate safety concerns but there must be no delay in resolving the issues we have highlighted.

We were also concerned that BCH and UHB had not communicated as effectively as they could since concerns were first raised by UHB consultants in the first half of 2008. This needs to change on behalf of patients.

Monitor, the regulator of foundation trusts, has required both trusts to agree on and implement a model of care delivering high quality services. We - and our successor the Care Quality Commission - will work with Monitor and the trusts to ensure this model provides the best possible quality of care and is implemented quickly and effectively."

In the first six months of 2008, the trust admitted over 2,000 patients more than in the previous year. It had more than 10,000 additional outpatient attendances and at times had bed occupancy rates above 98%. Cancelled admissions due to lack of beds have risen in the last year.

The Commission found that the lack of access to beds had led to delays in admission, a particular concern for patients such as those with liver disease who need urgent treatment.

The Trust told investigators that it redirected some 70 children a month to other services, meaning they were treated further from home. But it did not routinely monitor what happened to patients sent elsewhere.

There were concerns about access to operating theatres, particularly for urgent but not life-threatening cases. With these operations scheduled only for specific days, staff worried that delays had the potential to harm patients.

The Commission was told by consultants that the number of interventional radiology sessions was no longer sufficient to meet rising demand. This had led to concerns about children undergoing surgery or being redirected to other hospitals.

The knowledge of theatre staff about specific procedures and equipment also caused concern, particularly in the case of renal transplants and neurosurgery. One reason was the relatively low number of procedures carried out- BCH does up to 12 renal transplants a year compared to 145 adult cases at UHB.

Other issues included: a lack of equipment for interventional radiology and renal transplants; a history of poor leadership on a neurosurgical ward; and lack of an effective procedure for UHB consultants to raise concerns.

The Commission said that BCH and UHB had not communicated as effectively as they could since concerns were first raised by UHB consultants in the first half of 2008.

It describes how UHB gave the report on the consultants' concerns to The Observer in response to a request made under the Freedom of Information Act. The report, which was not intended for publication, had not been finally agreed or shared with BCH for comment. After giving the document to the newspaper, UHB informed BCH that it had done so.

BCH is one of only four specialist children's hospitals in England, providing services in the West Midlands and nationally. With more than 200 beds, the Trust cared for 140,000 children in 2007/8, with some 45,000 attending the emergency department.


Source: The Healthcare Commission (England, UK).

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