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Solihull Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 1 June 2015

Heart of England Foundation Trust is a large NHS provider of acute hospital and community services in Birmingham and Solihull. The hospitals are in the East and North of Birmingham and one smaller site in Solihull West Midlands. There is also the Birmingham Chest Clinic which is in the centre of Birmingham The trust has some community services in Solihull. We did not inspect the community services or the Chest Clinic. The three acute sites are Birmingham Heartlands Hospital, Good Hope Hospital and Solihull Hospital. Along with the community service the trust serves approximately 1.2m people. The Birmingham Heartlands site is where the trust headquarters are located.

We carried out this unannounced responsive inspection because the trust was in breach with regulators Monitor, and we had received intelligence which warranted our response and so we arranged the inspection. The inspection took place between 08 and 11 December 2014. We had inspected the service in November 2013 and the trust was still working through compliance action plans.

This inspection was an unannounced responsive inspection and as such we will not be rating the service. The purpose of the report is to share with the trust and the public the evidence we gathered during that inspection. It is also important to note that at the time the trust was in transition with many changes within the trust executive team, some of whom were in interim posts. This had been precipitated by the previous Chief Executive resigning in November 2014.

Our key findings were as follows:

  • Widespread learning from incidents needed to be improved.
  • Appraisals for staff were not widely undertaken achieving 38% compliance at the time of our inspection.
  • Staffing sickness and attrition rates were impacting negatively on existing staff.
  • The congestion within the hospital was having negative impacts across all the core areas we inspected. For instance the number of patients having to wait in recovery more than 30 minutes was high.
  • Discharge arrangements required improvement; we saw that only 35% of patients were discharged on or before their planned date of discharge.
  • The care of the deteriorating patient was generally managed well.
  • Arrangements for patients with reduced cognitive function were not always effective. This meant that some patients did not receive the level of care and support they required.
  • The leadership was in a transition phase with many in interim posts.
  • The culture within the trust was one of uncertainty due to the number of changes which had occurred.
  • Staff could not communicate the trust vision and strategy.
  • Governance arrangements needed to be strengthened to ensure more effective delivery.
  • IT reporting needed to be improved to ensure reporting was accurate.

We saw several areas of outstanding practice including:

  • Areas of good practice related to the AMU short stay senior sister who had been recognised as a ‘leading light’ for Compassion in Care.
  • The Practice Placement team provided excellent links between the trust and the University in supporting more than 600 student nurses across all three hospital sites.

However, there were also areas of poor practice where the trust needs to make improvements.

  • Feedback from incidents and learning from them needed to improve for staff and patient outcomes.

Importantly, the trust must:

  • The trust must ensure all fire doors and exits are free from clutter.
  • The trust must improve arrangements regarding patients following surgery having to wait in recovery over 30 minutes.
  • The trust must replace or repair essential equipment in a timely manner.
  • The hospital must improve the information available to departments to ensure that these are monitored and action taken to improve services through audit, trending and learning.

There were also areas of practice where the trust should take action, and these are identified in the report.

As a result of this, the trust will be subject to regulatory action as requirement notices and a comprehensive inspection will be carried out to confirm this.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 1 June 2015

Effective

Updated 14 January 2014

Services demonstrated good evidence-based practice, with staff involved in developing protocols and guidelines. There were dementia champions in some areas.

Caring

Updated 14 January 2014

Patients reported positively that the services and staff were caring and focused on the needs of patients. The trust is below the national average in the Friends and Family Tests introduced in both A&E and inpatients.This means that patients the numbers of patients who were likely to recommend the trust to a family member or friend was low. This was in contrast to the positive feedback from patients during the inspection, who felt that, overall, care was responsive and provided in a sensitive and dignified manner, despite caring staff being busy.. Staff we spoke to offered patient-centred care.

Responsive

Requires improvement

Updated 1 June 2015

Well-led

Requires improvement

Updated 1 June 2015

Checks on specific services

Maternity and gynaecology

Requires improvement

Updated 1 June 2015

The Netherbrook birth unit was appropriately staffed with a good skill mix. The checking of emergency equipment needed to be improved and arrangements for evacuating women from the birth pool.

The unit would have benefitted from more staff involvement in future service provision. However, the service was flexible in catering to women’s needs and accommodated partners.

Good local leadership was displayed and was staffed by a motivated team who supported and welcomed midwives who rotated into the unit.

Medical care

Requires improvement

Updated 1 June 2015

Medical care (including older people’s care)

Good

Updated 1 August 2017

We rated this service as good because:

  • We observed care to be good, especially on the stroke and elderly care wards and patients told us that the staff went the extra mile to look after them

  • Staff could tell us about the duty of candour procedures and spoke about the importance of addressing issues in an open and transparent way

  • The culture overall was a positive one with patient care a high priority for staff and they were proud to talk about the hospital

  • Staff understood the incident reporting system and there was a good culture of reporting incidents

  • We saw examples of staff treating patients with dignity and compassion, particularly those with dementia

  • We saw good discharge process with a multi-disciplinary team involved in the process

  • There was a positive vision for the hospital, particularly around elderly care

However:

  • Staffing was inconsistent across Solihull hospital. Some wards had actual staffing the same as planned levels, but others were short staffed and relied on bank or agency

  • Some staff members said that Solihull hospital seemed less important to the board than the other sites.

Urgent and emergency services (A&E)

Good

Updated 1 August 2017

We rated this service as good because:

  • There were clearly defined and embedded systems to keep people safe.

  • Staff were aware of their responsibilities to report incidents and had received feedback on these incidents. Learning from incidents had taken place. Improvements to safety were made and the resulting changes monitored.

  • Patients had comprehensive assessments of their needs and were appropriately monitored. With the exception of reception staff, clinical staff demonstrated a very good understanding of the early identification of patients whose condition might deteriorate.

  • Staff adhered to infection prevention and control practices, safe management of medicines and the secure management of patient records.

  • Staff knew how to assess and respond to patient risks, including safeguarding.
  • Staff had access to up to date guidance and protocols. Staff were supported through clinical supervision and they were aware of the consultant lead for the MIU.
  • We saw a high standard of care and treatment delivered by competent, caring and compassionate staff.
  • We particularly noted the social interactions, kindness and professional demeanour of a healthcare support worker working in the department. She took time to introduce herself, explain what was happening, what would happen next, and left “response time” for the patient or family to reply or to ask questions. This was in line with the Trust values of “Caring/Honest/Accountable and Supportive”.
  • Feedback from patients, relatives and carers was mainly positive.
  • Complaints were responded to and investigated in a timely manner.
  • There was evidence of comprehensive learning from complaints and incidents, and this was widely disseminated in an internal newsletter.
  • Despite a local management-sharing arrangement, both managers had worked together to ensure departmental staff felt suitably informed and supported.
  • Staff we spoke with were happy to work for the service, and felt enabled and valued by their local managers.

However:

  • There was a lack of clarity in the local population around the scope of the department, and as a result it was not possible to ensure patients did not self-present with potentially life threatening illness, which would be more suitably treated elsewhere.
  • We had concerns that reception staff were not fully aware of procedures for dealing with patients presenting with specific symptoms. In particular, patients who required rapid referral to the appropriate staff, for initial assessment and treatment.
  • The location of the children’s waiting area and ease of access to the front door increased the safety and security risks for children attending the service.
  • The location of the area where patients give personal detail information at the reception desk meant that patients providing personal details and discussing their condition could be overheard by others.   

Surgery

Good

Updated 1 August 2017

We rated this service good overall;

  • Procedures and systems were available to help keep patients safe. There was an open and honest culture, and the trust told people who used the service when something went wrong.

  • Teamwork was strong on the surgical wards, but some staff told us communication between theatre and ward staff was lacking and required strengthening to ensure the service ran effectively and efficiently.

  • Patient areas were visibly clean and equipment was checked to make sure it was safe for use; including the resuscitation trolley was checked regularly.

  • Patient care and treatment was delivered in line with current evidence based guidance, standards, best practice and legislation.

However:

  • Medication management required further input to ensure medicines were stored and checked effectively.

  • Venous thromboembolism (VTE) assessment was inconsistent with uncertainty of who was responsible for carrying these out.

  • During the unannounced visit, we saw that Ward 15 had issues with shortages of staff, which caused some delays in theatres.When we arrived for the announced inspection, staffing had improved.

Intensive/critical care

Requires improvement

Updated 14 January 2014

Following concerns raised by the Quality Safety Group last year, the high dependency unit had closed and the activity transferred to the critical care unit. As mentioned previously, this can admit one patient with high dependency needs. The only training the nursing staff received in looking after these potentially very unwell patients was through a short rotation to the Birmingham Heartlands Hospital. We were concerned that this solution did not provide enough training for the nursing staff on this unit. The staff said that they felt able to cope with cardiology patients, but were also expected to care for complex surgical and medically unwell patients, for whom they had less experience of nursing. The unit also monitored the heart rate and rhythm of up to six patients on the cardiology ward. On the evening we inspected, we found that there were only two nurses on duty in the unit. This meant that, while they were busy providing care, there was no one to observe the monitors. There was a central 24-hour, seven-day a week critical care outreach team to support the medical and surgical wards. The team provide support to staff looking after critically ill patients, but it did not provide support for nurses in the critical care unit or routinely review patients there.

Outpatients

Good

Updated 1 August 2017