Child safety failings at a major Birmingham NHS body have been exposed by inspectors who witnessed chronic under-staffing and long waits for treatment.

The Care Quality Commission (CQC) has issued a warning to Birmingham Community Healthcare NHS Foundation Trust, which serves more than six million patients across the West Midlands, and rated the organisation as 'requires improvement' overall.

The biggest shortcomings were found in 'community health services for children and young people' which was handed an individual rating of 'inadequate'.

It provides a range of services in homes, schools and clinics supporting every child from birth to five years old.

A chart breaking down the CQC's ratings for the Birmingham Community Healthcare NHS Foundation Trust.
A chart breaking down the CQC's ratings for the Birmingham Community Healthcare NHS Foundation Trust.

It was revealed that health visitors were juggling caseloads of up to 500 children, double the recommendation set by the Community Practitioners and Health Visitors Association.

Additionally, the looked after children team had around 600 children per practitioner. The national guidance is for 100.

It was also feared some mothers requiring antenatal visits were slipping through the net because referrals that were turned down due to a lack of capacity did not appear to be recorded.

The responsiveness of the service was also criticised due to too many waiting time breaches.

Compassion of staff commended

In the six months to March this year only 36 per cent of patients were referred to the children's development centre within the required 18-week time-frame. The national target is 92 per cent.

Similarly, the benchmark was missed in occupational therapy, physiotherapy and speech and language therapy during the same period.

Only the category of 'caring' was rated 'good' where the compassion of staff was commended.

Community health services for children and young people was one of two core areas inspected along with community health inpatient services, which operates a range of treatment and care from a number of locations including West Midland Rehabilitation Centre, Moseley Hall Hospital, West Heath Hospital, Perry Trees Centre and Good Hope Hospital.

The service faired much better and was rated 'good'.

Good Hope Hospital in Sutton Coldfield

The the leadership throughout the entire trust was assessed and rated 'requires improvement' overall, dragged down by the problems in children and young people services.

Although inspectors also commented that investigations were not prioritised and staff concerns were occasionally met with 'negative responses' from trust managers.

Other core areas such as end of life care, dental, services, community health and disability were not inspected and maintained their 'good' ratings from 2014.

Overall the trust was rated 'good' in the areas of 'effective', 'caring' and 'responsive' and slipped down to 'requires improvement' in 'safe' and 'well-led'.

'We have room to improve'

Chief executive Richard Kirby acknowledged the failings in child services and vowed that staff would be better supported.

He said: “We welcome the CQC’s report which recognises the dedication of our staff by rating us ‘good’ in three of the five domains, including caring.

"Three of our five CQC domains, five of our six core services and 84 per cent of our service ratings are 'good' or above.

"We also welcome the report’s focus on areas for improvement and especially our children’s services.

"We know that our children’s teams are doing a difficult job in challenging circumstances and we have already begun to make the necessary improvements to ensure we provide better support to our staff and better care to our patients.

"It is, of course, disappointing to have dropped to a ‘requires improvement’ rating for the trust overall, but we recognise that we have room to improve in children’s services and areas including risk management and other systems and the freedom for staff to speak up.

"We are determined to make the necessary changes for the people we serve and are already working hard to implement them.

“While we accept the areas identified for improvement we are also pleased with those areas of our work which are rated as ‘good’, notably for our community inpatient services, and the overall rating for the trust’s care, effectiveness and responsiveness.

"There is much that we do well for our patients and the CQC have recognised this, giving us a platform on which to build for the future.

“Our community children’s services face significant challenges and there is much to do to support these teams going forward.

"I am confident that we are now working with those involved in a way that will enable us to make the improvement that is needed.

“There is also scope for improvement in the way we work across the trust: to identify and manage risk; to ensure we understand the experience of our colleagues and our patients; to improve the way we learn from incidents; and, importantly, to ensure that we are a truly inclusive organisation, one which values diversity and provides equality of opportunity.

"Tackling these issues will benefit all of our services as we move forward.

“Our ‘Fit for 2022’ work on our future vision and values, which we started six months ago, is designed to ensure that we are able to build on those areas where we are strong, and also address our areas for improvement as part of a clear strategy for the next 3-4 years.”

The full report can be read here - https://www.cqc.org.uk/provider/RYW