University Hospitals Birmingham NHS FT (UHB) Oversight Report of Phase 1,2 and 3 Reviews “Bewick 2”

We suggest that an evaluation of progress against the Phase1/2 and 3 review takes place no sooner than April 2024.This recommendation has been agreed by the trust and the ICB.

We recommend that the system (NHSE/CQC and the local ICB) formally acknowledges that the new Board is given time and space to make its improvements, recognising the significant load that all this analysis and review is placing on an already stretched hospital Trust. We note that a proposed well led review by CQC has now been delayed by 6 months.

Whilst not fully formed, we also will make recommendations on certain areas of management information that should be supplied to the Board, which should help it to assess progress on culture and which will improve challenge at the higher levels of the Trust.

That an external review of referrals to the GMC during the period 2014 -2022 is conducted led by a senior responsible officer supported by Dr Rebecca Mann.

Review the Executive Director portfolios to ensure clear accountability and ensure this is clearly communicated to all staff and relevant stakeholders. A national and transparent recruitment process should be started quickly to appoint a Chief Executive.

Review and refine the Trust Board development programme to ensure it addresses any areas for improvement identified from the safety and well-led reviews. This should specifically include the effective operation of a unitary Board.

Implement a mandated development programme for Governors from a recognised external provider.

Develop a Trust wide strategy in consultation with staff and system partners that reflects the current challenges and future opportunities faced by the Trust, which in turn shapes the Board and Board-committee agendas.

Ensure that staff can operate in environments that are psychologically safe where poor behaviours are consistently addressed and bullying and cronyism are eradicated at all levels of the organisation.

Improve the governance and accountability by improving systems, processes at meetings, to gain assurance against delivery of the strategic objectives.
o Review the workplans for the new and the existing committees to ensure they are driven by the strategic objectives and the agenda items provide assurance for the relevant BAF risk. Ensure that action logs are consistently used across the Trust.
o Review Terms of reference of the leadership meetings to ensure Divisional Directors of Nursing and Midwifery and senior AHPs are included and attend the meeting.
o Work with the NHS England FTSU team on the areas that need strengthening, as identified in December 2021 and commission the NHS England FTSU team to undertake an evaluation in Q4 23/24.
o Improve the governance process for external reviews. This needs to include timely discussion, oversight, and review of progress at the relevant Board sub-committee and or the Trust Board as appropriate. The Trust must also ensure learning from these reviews are effectively communicated to relevant staff.

Review and update the Board Assurance Framework following the refresh of a Trust wide strategy to reflect the new strategic objectives. The Trust should also take action to improve the quality of discussion on risks and how strategic risks drive Trust Board and sub-committee agenda.

Improve the effectiveness of information to support decision making such as Trust Board, sub-committee, and Divisional reports. Pay particular focus to how the information meets users’ needs and ensure it is accessible and understandable. Work with NHS England’s Making Data Count Team to adopt a best practice approach to information using statistical process control.

Review the analytical team resource within the Trust and ensure there is sufficient capacity and capability to support the production of high-quality information to enable effective decision making.

Trust Board Directors and senior leaders to engage more often and openly with all staff and foster a collaborative, inclusive and compassionate leadership culture.

Ensure that Trust Board meetings held in public create time for questions from members of public.

Trust Board to continue to improve relationships with external partners and foster a positive and open culture.

Ensure appropriate arrangements are in place for Governors to have their questions from constituents fully heard and act in accordance with the Code of Governance for NHS Provider Trusts

Ensure that all communication on websites and patient information is reflective of the most used languages in the community that the Trust serves.

Improve the support available to staff undertaking improvement work via a trust wide quality improvement approach.

Ensure all staff have adequate time, support, and encouragement to undertake learning and development.