Executive Summary  

The quality intervention was positive, demonstrating significant progress across all areas highlighted in the prior review. It was encouraging to see the department’s commitment to continuous improvement, and the visit highlighted multiple successes.

Areas working well and good practice identified:

• A notable strength identified during the visit was the implementation of the chief resident’s network, they play a pivotal role in fostering leadership and empowerment among resident doctors across departments.
• Regular monthly resident doctor’s forum meetings (RDFs) have been instrumental in supporting improvements.
• The teaching programme has received high praise, particularly in morphology.
• An improved induction programme (trust, department and role) with resident doctors involved in its planning and delivery in collaboration with the trust.
• The introduction of a cross-site on-call rota has improved the experience for resident doctors and led to greater cohesion and unity across all groups. Resident doctors with experience of the previous on-call system compared it to the current one and agreed it was a big improvement.

High level areas for improvement, including recommendations:

• Resident doctors and educators reported a lack of adequate space for clinics.
• While the implementation of the on-call rota has been reported as successful, continual monitoring and adjustments are needed to limit and mitigate the potential loss of learning opportunities.
• The induction for on-call, particularly for sites where haematology resident doctors are not based, needs improvement. This includes making sure system credentials and access are provided on time.
• There is a need for improved access to office space for individuals on-call overnight.

Overall, the visit confirmed that the haematology department is making excellent progress with evidence of good practice, effective leadership and a focus on development and well-being. All resident doctors would recommend the trust as a place to train and the haematology department as a place to receive care. NHS England are confident that the areas for further improvement highlighted, along with the additional recommendations in this report, will be carefully reviewed and addressed.

Based on the overall review findings, it is recommended that the item be de-escalated from Intensive Support Framework (ISF) category 3 to ISF 1. An improvement plan addressing the mandatory requirement outlined in this report will be necessary. 

Review Overview

Background to the review

Quality interventions have been held to address concerns raised in haematology with the first visit taking place in May 2021. The initial learner educator meeting reported a mixed experience for training and service provision at both Queen Elizabeth Hospital (QEH) and Birmingham Heartland Hospital (BHH). Some improvements were recorded at QEH, however, the same was not reflected on the Birmingham Heartlands Hospital site. Both sites reporting the reconfiguration of services having a detrimental impact on their training experience.

An improvement plan was put in place and the next review was held in April 2023, the outcomes of which led to the department being put under GMC enhanced monitoring. A follow-up visit was arranged for December 2024 to monitor progress against the improvement plan and assess the current clinical learning environment.

Who we met with

Learners

• resident doctors in haematology medicine

 Educators

• educators in haematology medicine 

Education team

• educational leads

Review Panel

• Quality Review Lead – Dr Fiona Sellens, Primary Care Dean and Deputy Post-Graduate Dean, NHS England
• External Specialty Expert – Dr Frances Wadelin, Specialty Training Programme Director (East Midlands – North), NHS England
• Training Programme Director – Quality – Dr Amie Burbridge, NHS England
• General Medical Council (GMC) – Jamie Field, Education Quality Assurance Programme Manager
• Quality Manager – Raj Sunner, NHS England
• Deputy Quality Manager – Joycelyn Boyce, NHS England

Review findings

Induction

The main August induction was well-regarded, however, the experience of out-of-sync starters was less favourable. The trust is working to improve the out-of-sync induction process, in collaboration with resident doctors.

Resident doctors were not formally inducted into the cross-site on-call rota and reported issues with log-ins and access. Plans are in place for a unified on-call induction experience with resident doctor feedback being incorporated into the February 2025 induction. Chief residents are involved in the planning and delivery of the induction. 

Resident doctors reported feeling well supported and were able to easily contact their educational supervisors, who provided work schedules and opportunities for educational development. They also reported feeling supported by consultants during on-call shifts. During initial meetings, supervisors reviewed both clinical and generic capabilities with resident doctors and discussed how to achieve them throughout their training. 

Birmingham Heartlands Hospital provides resident doctors with an induction handbook and a Competencies in Practice (CIP)-level plan for the year. Resident doctors were introduced to their educational supervisors early on and had clear expectations about their training. 

Rota

The rota system is generally functioning well, with improvements noted since major changes were implemented. Resident doctors receive their rotas ahead of time, typically two to three months in advance, and no later than six weeks before their start date. Initial challenges with the cross-cover rota have largely been resolved, and the system is now running more smoothly, particularly for day shifts. Increased staffing levels were considered a key factor that has contributed to the overall improvement in the department since the previous review.

While the unified on-call rota has been reported as working optimally, some adjustments are still needed to minimise and mitigate the potential loss of learning opportunities. The trust confirmed it was continually monitoring and improving the rota in view of feedback.

Educational and clinical supervision 

Educational leads and supervisors were fully aware of the department’s improvement plan and were closely involved in progressing actions. Clinical leads and operational managers have worked closely with trainers to ensure job plans include dedicated time for supervision and this was considered to be working well, despite the competing demands of the consultant position.

Supervisors were provided study leave to become accredited educational supervisors, with the postgraduate department supporting this development by sharing information about available courses.

Supervisors recognised that further work was needed to improve the quality of portfolio documentation to best capture the interactions and support they routinely provide to resident doctors.

Continuity of care and pathways

A system is in place for continuity of care during inter-hospital transfers and communication between sites is reported as effective. Resident doctors reported feeling supported and consultants are accessible both in-person and by phone. Bed capacity is the primary issue and securing beds on the Cohort Ward (Acute Medical Unit) can be a challenge, especially in view of persistent winter pressures. The effort to create a dedicated space for haematology patients at BHH was acknowledged against the backdrop of winter pressures and securing a suitable nursing skill-mix.

Clinics

Resident doctors reported challenges with clinic attendance, and this was deemed as one of the main outstanding issues. Trainers also acknowledged the need for greater clinic exposure, including more time and dedicated space for clinics.

The trust has plans to create a dedicated area for haematology clinics, which is expected to provide sufficient space for both resident doctors and clinical nurse specialists to see patients alongside consultants.

Facilities

In addition to the lack of space for conducting clinics, resident doctors reported a lack of access to office space while on-call overnight. Resident doctors reported a lack of rooms and computers for on-call staff at QEH, although BHH had adequate computer access.

Teaching and training

Significant improvements in the teaching programme and overall learning opportunities were reported. Resident doctors advised that increased staffing levels in the daytime has led to more learning opportunities being open to them. Teaching was not bleep free, but it was deemed manageable, and weekly teaching sessions have been introduced to provide a more consistent and structured learning environment.

Resident doctors were able to have their assessments signed off in a timely manner and received feedback on their performance but indicated a desire for more frequent feedback.  Resident doctors felt supported with their laboratory work, with dedicated morphology sessions in place that were well received.

Culture

Resident doctors reported feeling well supported, including when on-call. Trainers equally felt well supported by the trust. Both resident doctors and trainers were cohesive groups, and the cross-site unity reflects the work undertaken by the trust to address the issues in Haematology.

Resident doctors who had returned to the trust noted the significant changes and improvements to the training environment. They considered enhanced staffing levels to be a key factor in the dramatic turnaround.

Resident doctors felt comfortable raising concerns and regular monthly haematology resident doctor forums were held, and the network of chief residents was functioning well. The multi-professional working relationship was reported as positive, with staff feeling supported and valued.

No patient safety concerns were identified during the visit, and all resident doctors would recommend the trust as a place to train and the haematology department as a place to receive care.

Areas that are working well

Good practice

Areas for improvement

Mandatory requirements

Recommendations

Report approval

Report completed by: Joycelyn Boyce, Deputy Quality Manager

Review lead: Dr Fiona Sellens, West Midlands Deputy Postgraduate Dean

Date approved by review lead: 20 January 2025

NHS England authorised signature: Prof. Andy Whallett, West Midlands Postgraduate Dean

Date authorised: 29 January 2025

Final report submitted to organisation: 26 March 2025