St Andrew's Healthcare - Birmingham Also known as 1-121538294

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Staff were unable to describe how the values of the organisation related to their work and their role in achieving them. Staff did not feel their views were listened to.

Staff could not demonstrate they had a well-developed understanding of equality, diversity and human rights.

Most staff told us that managers above the general manager level were not visible in the hospital. They said ward managers and general managers valued their work and listened to them, but they seemed unable to ensure their views were listened to by the provider.

Governance processes were not effective in identifying and assessing risks to people who used the service.

However, there was a Freedom to Speak Up process and 6 Guardians were in post across the organisation, with one based in Birmingham. Staff we spoke to had not used the service however we saw evidence to show that staff had used the Freedom to Speak Up process.

The provider worked with commissioners on improvement plans for the hospital.

The provider had a coproduction strategy and had started to engage with some of the people who used the service.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they did not feel listened to and there was not a culture of trust and understanding between staff and senior managers within the organisation.

Staff were able to show us posters displayed on the wards that gave information on the provider’s values. However, they were unable to describe how these related to their work and their role in achieving them.

Ward managers told us they had identified that work was needed to improve the culture at the hospital. They said that staff turnover had reduced, and staff morale was improving. However, they needed to continue to improve staff supervision and development as some staff saw this as an additional task and not as part of their role and ongoing development.

Staff were unable to demonstrate they had a well-developed understanding of equality, diversity and human rights.

In June 2024 the provider had engaged with staff in a survey about working at the hospital. More staff had engaged with this across the Charity than in previous years and was at 60%. However, only 45% of staff at Birmingham had engaged. 61% of staff at Birmingham who responded said they were motivated to help St Andrews achieve their goals and enthusiastic about their job. 38% of staff said they were proud to work for St Andrews and would recommend it as a place to work. 40% of staff who responded said they were optimistic about the future of St Andrews and working there in 12 months’ time. The provider told us following this survey local action planning and discussions were taking place to respond to this. Actions identified would be placed on each ward’s quality improvement plans to ensure ongoing oversight.

The provider had trained staff in equality, diversity and human rights. However, this did not seem to impact staff understanding this and how they could use their learning to promote equality within their role.

Most staff told us that general managers were good, and ward managers said they gave them authority to do their jobs. Staff said that managers above the general manager level were not visible. Night staff said they did not see managers at night apart from the night site coordinator who were often at deputy ward manager level. However, the provider told us there was an out of hours rota with all senior members of the Birmingham team, and all wards had scheduled monthly visits.

Ward managers understood the issues and priorities for the quality of the service but could not access appropriate support in their role. However, the provider gave us evidence of their charity-wide Ward Manager Development programme, which commenced mid 2024 and is designed to support managers in carrying out all aspects of their role. Despite this ward managers told us they felt overloaded and did not have the support they needed from their deputies as they had to do mostly clinical work to cover the gaps in staffing. The ward managers did not have support from administrators to do some of their work. However, the provider gave us evidence that each ward and ward manager has allocated ward administrator resource. Ward managers had a monthly meeting with the director of nursing which they found supportive.

Ward managers had been asked to complete with healthcare assistants a skill scan. They told us they had not had time to complete this and this was an unrealistic expectation which they did not understand the reasoning behind.

Staff told us they valued the team they worked in and felt supported and respected by colleagues and the ward leadership.

Staff told us they had monthly staff meetings, but they were often reluctant to attend these as the same issues about staffing were discussed but nothing seemed to change.

Some staff said they were not supported if they were struggling at work. They said they had not been referred to Occupational Health despite requesting this on several occasions.

Permanent staff knew who the Freedom to Speak Up Guardian was and how to contact them. However, bank staff were unsure about the process and who to contact.

Staff told us they had not used the Freedom to Speak Up process. However, the provider gave us evidence that the Freedom to Speak Up process was being used by staff. Staff said they would speak to managers or other colleagues if they had any concerns or contact the Care Quality Commission to whistle blow.

There were 6 Freedom to Speak Up Guardians in post across the Charity at the time of our visit. All wards had up to date posters displayed with their contact information. One Guardian was based in Birmingham, but staff could contact any of the Guardians.

The provider told us that 17 contacts had been made from staff at Birmingham to the Freedom to Speak Up Guardians with themes of staffing levels, safe staffing allocations, the culture of the hospital including management fairness, staff feeling unsupported and leadership visibility. In response to this the provider told us action was taken. Several of the concerns had already fed into quality improvement plans, including work around the ‘Safer Staffing’ reviews, developing the ‘Ward Manager Training Programme’ and improving senior leadership visibility. They also said that where appropriate, support from human resources staff had been given, to help understand and resolve the concern through the correct process. Some concerns fed into the Patient Safety process, safeguarding and the lessons learnt group.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff were not clear about the ward governance processes and how these related to their roles and responsibilities .

The provider showed us their established governance process. However, staff did not feel involved in this and did not feel listened to.

Staff did not think their views about the risks of staffing levels had been listened to. They told us that they had identified risks related to the assessed staffing levels, but the provider had not listened to these. They said the information they provided was not used effectively to monitor and improve the quality of care. The provider did however give us evidence of their annual establishment review process, which is led by the ward clinical team and provided the opportunity to share views and actively contribute to any decisions in relation to staffing levels. The provider also gave us evidence of some staffing changes made as a direct result of staff feedback.

Governance systems had identified areas for improvement and the provider was addressing shortfalls in service provision. However, governance systems had not been effective in identifying infection control risks to people using the service or in ensuring that repairs were completed in a timely manner and the environment of the hospital was well maintained.

Governance systems had not been effective in ensuring that staff knew what to do if the electronic medicine record lost connectivity. A business continuity plan was in place to support staff with what to do if the electronic medicine record lost connectivity. However, some staff were not aware of this so did not maintain contemporaneous and accurate records for people’s medicines when the system was not connected.

However, notifications are consistently submitted to external organisations such as the Care Quality Commission and commissioners of the service.

Staff and leaders told us they shared information with their partners and relevant stakeholders. Leaders told us how they worked with partners to support care provision, service development and joined up care.

Local and regional commissioners shared with us their improvement plans for the hospital. They visited the hospital in June 2024 and shared their findings with us. These included some of the findings from this assessment. This included staffing levels impacting on people’s activities and leave, staff morale, staff feeling there were not enough staff which impacted on the quality of care delivered and people using the service raising issues about staffing levels which impacted on their experience of care. We found at this assessment that some of these improvements were still in progress.

Staff shared information about people before they were transferred to other services.

Managers told us they were working with commissioners on co-production work with people who used the service. Some people had volunteered to be Experts by Experience and to work with the commissioners to help co produce information and in an advisory capacity to help staff and partners understand what can be improved and involve people in a meaningful way.

Most staff were unable to provide examples of quality improvement initiatives within the hospital and were unaware of quality improvement methodology. However, the provider did submit evidence to show a number of staff had received quality improvement training.

Managers told us that the executive team had started the culture in care coaching project to encourage people who use the service to drive their care.

The hospital is a network member of Quality Network for Forensic Mental Health Services (QNFMHS). The provider told us that as a network member they engage with national quality improvement frameworks to foster a culture of continuous improvement. While not an accredited member, the hospital actively participates in developmental activities, peer reviews and benchmarking exercises. They said the organisation may consider pursuing full accreditation to strengthen its standing and further demonstrate its dedication to delivering high-quality forensic mental health services.

The provider had a co-production strategy with some examples of how this was implemented at Birmingham. Although there was only one example that staff could give of quality improvement work. On Moor Green ward a few of the people were involved in trialling completing a weekly summary to add to their notes. This included their thoughts, their mental state, what's been good or bad that week for them. The ward manager told us this was to promote people’s ownership of their care.