Solihull Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The service mostly ensured people could access treatment in a timely manner when they needed it. The service provided person-centred care and made adjustments to help people access services.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

During our onsite assessment, we spoke with patients who told us they had been involved in their treatment and involved in decision making. No concerns were reported.

The service was inclusive and took account of patients’ individual needs and preferences. They coordinated care with other services and providers. The unit was designed to meet the needs of patients. Staff understood communication needs of patients with a disability or sensory loss. There was a vulnerability policy which set out the principles and framework for the management of patients with a learning disability, autism, mental health needs, dementia, and those with a hearing/visual impairment or loss. Staff made sure patients, and carers could get help from interpreters or signers when needed. One staff member had trained in sign language to ensure they could communicate with patients from the deaf community. There was a ‘wobble’ room which was used for patients who had neurosensitivity, autism, learning disabilities or someone who needed a quiet space. It was a quiet room with comfortable chairs. Staff also used this room if they needed a quiet space. People were supported during transfers between services and discharge. Ambulances were arranged for people who were not well enough to make their own way to another hospital. There were reasonable adjustments made so that people with a disability could access and use services on an equal basis to others.

We observed staff treating patients as individuals and ensuring person-centred care. Staff included them in the decisions and provided advice about the care and treatment they needed.

We did not gather enough evidence to rate this, but no concerns were raised.

Staff did not always do an initial assessment on patients before sending them away to another service. We found that if a patient was not appropriate for the MIU, they were turned away without a medical check despite having an injury or illness which could have been life threatening. We raised this with the managers who told us they were reviewing the current policy in place to ensure there was a clear process for these patients who were not suitable but still needed medical attention. However, the staff mostly understood the needs of the local community and patients were seen promptly. They made appropriate referrals between services. Managers told us they had targeted recruitment programmes within the Solihull location to try and entice staff to work with them who were from the local community and therefore had a good understanding of the people they were treating.

We spoke with an advanced nurse practitioner in the minor illness department who said the services were mainly well co-ordinated. They each had their own receptionist who streamed the patients into the right service. All patients who attended with a minor illness required an appointment but patients with a minor injury could walk into the service. This meant if a patient attended with a minor illness without an appointment and was triaged by the minor injury team, there could be delays with transferring their care over to the minor illness team due to a lack of appointments. Managers told us they had had recent discussions about this, and a policy was being brought in which allowed patients to be seen by the minor illness team without an appointment if needed.

There was a draft policy which was awaiting ratification to ensure that all patients who attended the department had a chosen pathway which was appropriate. We saw this was discussed in the joint meeting with the ICB, minor illness managers and the minor injuries team.

Patients told us they were informed about their care. They all knew what the next steps were. Patients raised no concerns about the information they were provided.

Staff ensured people who used the service were provided with information that was accessible and supported their choices. Information was tailored to the individual need. There were reasonable adjustments for people who did not speak English as a first language and for deaf people who used British Sign Language. Information that was collected about people met data protection legislation requirements. There were 3 different computer systems used within the unit. There were 2 computer systems for adult patients and a different system for paediatric patients. All paediatric notes were handwritten and scanned onto the system. All notes were locked away at the end of the day. The trust was working towards 1 system for paediatric and adult patients. It was on their risk register.

We saw the staff using a few online and paperwork systems to record patient activity. This took longer than necessary and the staff were looking forward to when the trust was able to create a system which was suitable.

The service gathered information from the child protection information sharing service for each child who attended the department and acted appropriately on the information they received. There was a Data Protection, Confidentiality and Disclosure Policy which staff followed whilst we were on site. Information governance training was included in the mandatory training programme; 88% of staff had completed this. All staff had completed accessible information standard training. Whilst this was not mandated, it was essential for all clinical staff within the MIU. Compliance for this was poor; 66.66% of HCAs, 40% of EP’s and 0% of assessments nurses had completed this training. The matron and lead EP have allocated time for the staff to complete this training after our assessment.

All 5 patients we spoke to felt listened to by staff. Information was displayed in the waiting room about how to make a complaint but patients had not noticed this whilst they were waiting. However, all patients we spoke to were happy and did not want to raise any concerns. We saw within governance meetings that patient feedback was discussed. Patients had raised there was a lack of food and drink while in the waiting room. In July 2024, a vending machine had been installed and drinks were available in the waiting room.

It was easy for patients to give feedback about the service. There was a Friends and Family Test and patients were encouraged to fill this in. Information was displayed about how to make a complaint in the waiting room. Managers told us their main complaint theme was lack of communication regarding waiting time and the differentiation between the 2 services provided in the urgent treatment centre. The minor illness patients required an appointment, and the injury service was mostly a walk-in service. This meant minor illness patients could be seen before the minor injury service. This, on occasion, caused aggravation from patients as they did not understand that there were 2 different services running from the unit. Managers told us they were going to install a display screen in the waiting room and add intermittent messages about this and waiting times. The reception staff informed patients about the different services and waiting times.

The trust had a clear policy for complaints management and staff followed this. There was a monthly governance meeting where complaints were discussed as well as a quality and safety meeting and directorate meeting. There had been 2 formal complaints since the service had opened in June 2023. Managers investigated complaints. Staff knew how to acknowledge complaints and patients received feedback from managers after the investigation into their complaint. Managers shared feedback from complaints with staff and learning was used to improve the service. We saw clear actions implemented following the complaints received in the service. Staff could give examples of how they used patient feedback to improve daily practice. For example, there was a complaint where a patient overheard a staff member questioning how to give a medication. The managers had retrained all staff members and ensured all staff had re-read the policy on the administration of this medication.

Patients told us their needs were met and most patients we spoke to were waiting for an x-ray to confirm their treatment plan.

People were able to access the service when they needed it and received the right care mostly in line with national standards. Where treatment within the unit was not suitable, they asked patients to attend an appropriate service. Managers monitored waiting times and made sure patients could access services when needed and mostly received treatment within agreed timeframes and national standards. The trust had a target that 95% of patients were seen, treated and discharged within 4 hours of their time of arrival; 98.62% of patients between January and June 2024 were discharged by 4 hours after arrival. There was a national standard for all walk-in patients to receive an initial triage assessment within 15 minutes of arrival to the department. Patients who attend via 111 did not require a nurse assessment within 15 minutes. Compliance between January and June 2024 was 41.91%. We were told this was difficult to achieve as they had low staffing levels for assessment nurses and only had 1 on duty at any time. They often had a queue of patients waiting to be seen when they opened at 8am and this meant from the beginning of the day, there was a delay to the triage. We were told on average it took between 27 and 29 minutes until patients were triaged. All patients we looked at were seen by an EP within 60 minutes of arrival which was in line with national guidelines. We saw that these time metrics and outcomes were discussed in the March 2024 team meeting with staff so they were aware of their compliance to the standards. Actions were created to make improvements.

The MIU was open 8am until 8pm and operated an open access policy. Their standard operating procedure stated that every patient deserved to have an assessment. However, we did find that some patients were turned away without assessment which was against policy. We discussed this with the manager who was looking at the standard operating procedure to make it clear what was expected regarding assessing patients regardless of whether they were in the right location. The unit remained open until 10pm but did not admit patients after 8pm. They had plans in place to ensure patients who were still in the department at 9pm had a plan and they could mostly close and discharge all patients by 10pm. They saw patients over the age of 1 year. If a child’s injury required further assistance from a medical team, they were transferred to another hospital. There was a process where 3 patients per hour could be given an appointment via ‘111’. We were told these were underutilised.

We did not gather enough evidence to rate this, but no concerns were raised.

Staff told us they did not discriminate against anyone. It was a walk-in service and all patients were given the same treatment. Their standard operating procedure stated they endeavoured to make an honest speedy assessment of any minor injury with no discrimination with regards to gender, race or religion.

Staff told us their EP team was a diverse team and people with different protected characteristics had equity within the workplace. Managers did not discriminate against gender, race or religion when they recruited. Staff told us that their diverse workforce meant they understood patients’ rights and listened to their views and did not discriminate. The service gathered data on reattendance rates. Between June 2023 and June 2024, 1.96% of patients had reattended the department within 7 days with the same diagnosis as their previous attendance. Data showed 0.14% of patients had attended an emergency department within 7 days of discharge from the MIU with the same diagnosis.

We did not gather enough evidence to rate this as all patients we spoke to were discharged before 4 hours and were independent, but no concerns were raised.

Staff worked well as an effective multidisciplinary team to discuss patients and improve their care. There was therapy available for patients who required support to return home after acute injury. Patients could be seen whilst they were in hospital or have support from the community team who did home visits if the patients were suitable for discharge prior to therapy.