NHS Birmingham and Solihull Integrated Care Board has today published the first of three reviews into University Hospitals Birmingham NHS Foundation Trust.

Importantly, the review were assured that services at the Trust remain safe and patients and service users should continue to access care as needed with confidence. However, the review found a number of areas of concern, particularly with regards to governance and leadership, culture and staff welfare and has made a series of recommendations for further action.

The review was commissioned following concerns raised in December 2022 relating to patient safety, leadership, culture and governance. As part of this response, NHS Birmingham and Solihull (ICB) announced three independent reviews focusing on:

  • Patient safety and governance (Bewick Review) - commissioned by the ICB, overseen by experienced senior independent clinician, Professor Mike Bewick, former NHS England Deputy Medical Director.
  • Well-Led review of leadership and governance – in conjunction with NHS England, using established methodology. 
  • Culture - commissioned externally by UHB’s Interim Chair, incorporating findings from above.

In order to bring the conclusions and recommendations of these two pieces of work together and provide additional independent assurance, Professor Mike Bewick has been commissioned to support both remaining reviews and also return at a later date to update on progress on implementing the recommendations following this report. 

In the patient safety review, publishing today, the independent review team set out two concerns and four groups of recommendations. As part of this, they also make clear that their ‘overall view is that the Trust is a safe place to receive care’. 

The review team have highlighted the need for better understanding of raised Hospital Standard Mortality Rates, concerns regarding levels of staffing, particularly nursing at Good Hope Hospital. The review also finds 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 was supported by feedback from the Trust’s Medical Staff Committee.

The review team make 17 recommendations (available in the full report) across clinical safety, governance and leadership, staff welfare and culture, including:

  • Haemato-oncology:  
    • 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
  • That prospective appointments of senior medical, nursing, and managerial leadership are reviewed with a focus on developing core skills, including those required for leadership, collaborative working methods, professional interaction, and disciplinary processes.
  • In light of the tragic death by suicide of Dr Kumar - Together with HEE, a review of the processes to support doctors in training who are concerned about their mental health, ability to speak up freely about concerns with colleagues and a clear message that they will be listened to.
  • That the concerns of senior clinicians, expressed by the Medical Staff Committee in January 2023, are addressed specifically as part of the Phase 2 cultural review.
  • That the Trust commissions a partner to deliver awareness training on how to identify issues of bullying, coercion, intimidation and misogyny.

The review closely examined concerns regarding the appropriateness of GMC referrals. Contrary to reports, they found ‘nothing exceptional about the numbers or types of referrals or their eventual outcomes’ in 17 reviewed cases and that a number of these had resulted in serious action including criminal conviction and removal from the Medical Register.

The full report is available to view here.

NHS Birmingham and Solihull is also today confirming that the Cross Party Reference Group, chaired by Edgbaston MP, Preet Kaur Gill, will continue to work closely with Professor Bewick throughout the rest of the process. Terms of reference and membership of the group have been published alongside the patient safety review.

Professor Mike Bewick, Lead Reviewer, 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. 

“We have been disturbed by the consistent reporting of a bullying culture at the Trust and look forward to the next phase of the review where staff and patients will have the opportunity to speak freely and confidentially about their concerns. I know that Dame Yve Buckland, the Interim Chair at UHB, is already addressing these concerns and I thank her for her support during our review.” 

David Melbourne, Chief Executive at NHS Birmingham and Solihull, 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.

“I would like to thank Professor Bewick, his review team and the Reference Group led by Preet Gill MP for their work on this review and their commitment to the process going forward.”

Jonathan Brotherton, Chief Executive at University Hospitals Birmingham NHS Foundation Trust, said: “Patients can continue to be confident that the care and treatment provided at our hospitals is safe. We are pleased that Prof Bewick’s overall view ‘is that the Trust is a safe place to receive care’. 

“We fully accept his recommendations and welcome the additional assurance that has been asked for through further independent oversight.

“There are a number of significant concerns that we need to, and have started to, address; we will continue to learn from the past, as we move forward. 

“We want to develop a positive, inclusive work environment where people want to come to work, in a place that they are proud to work in, to do their very best for our patients. While we will not be able to fix things as quickly as I would like, we do need to do it as quickly as possible, for the benefit of patients and staff; I am committed to ensuring this happens.

“We must now focus on continuing to provide the best possible patient care, building a values-led culture and supporting our incredible colleagues.”

The next stages of the Patient Safety review will confront the persisting underlying cultural and organisational issues and run alongside. This will run alongside the well-led and culture reviews with an aim of reporting in summer 2023.