Solihull Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Leaders ran services well and supported staff to develop their skills. Staff mostly felt respected, supported, and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and all staff were committed to improving services continually.

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.

Staff mostly felt respected, supported, and valued. They were focused on the needs of patients receiving treatment and worked well together to ensure they achieved good outcomes for patients. Staff were positive and proud to work in the organisation. The culture was centred on the needs and experience of people who used services. There was mostly a positive, compassionate, and listening culture within the service. Almost all staff we spoke to told us this. Most staff had a good relationship with each other and were not afraid to raise concerns. Staff rotated across 3 urgent treatment centres and worked with staff across the different hospitals. However, some staff told us that they felt there were strained relationships at times within the EP team. There was a shared vision and a 3-year strategy for the department which all staff were aware of and were working towards. This was an item on the agenda and discussed in monthly specialty meetings.

There was a 3-year strategy. The main ambition was to deliver a minor injury, nurse led service, provided by the trust in an interface with community providers for minor illness services. They had set goals for people, patients, progress, and place and had core strategies to achieve this. They were on track to achieve their priorities for year 1 with actions created to ensure they did. At the time of the assessment, they were not a fully nurse led service. There was still consultant input required for governance and processes as the managers were not trained to tier 4 or 5 master’s level in advanced practice. This was needed to run the unit and not all staff had completed all elements of the EP training.

There was a quarterly staff survey titled “How does it feel to work at Solihull”. Results from April 2024 showed 8 staff had responded. Managers were acting on the comments made within the survey to make improvements. For example, there were comments about flexible working patterns being inconsistent. Managers held flexible working clinics to gather both positive and challenges of flexible working. These clinics were held in June 2024 and results will be shared with staff once recommendations and actions have been determined. Webinars were also held in June for managers of staff around flexible working.

Leaders had the experience, capabilities, and skills to run the service and ensure risks were well managed. Leaders were mostly visible, however, some staff felt that at the MIU, they were left to their own devices and leaders did not often attend site. Leaders understood and managed the priorities and issues the service faced. They supported staff to develop their skills and attend courses to further their role. Staff told us how they had progressed through the service and were supported by their managers to do this.

Managers wanted more of their leaders to attend leadership courses. They had booked their senior EPs onto a governance and policy course. One manager told us they had been on a master’s leadership course and funding had then been withdrawn by the trust in the middle of completing it which meant they had been unable to finish the course. There was a development programme for the EPs which was in line with the vision of a nurse-led unit. However, there were no managers who were trained or currently having the required level of management training to allow the consultants to step away for it to become a nurse-led unit.

Leaders fostered a positive culture where most people felt they could speak up and their voice would be heard. Staff and leaders mostly acted with openness, honesty, and transparency. Staff were encouraged to raise concerns with their managers. We were told the lead EP was very approachable and a problem solver. There was a Freedom to Speak Up Guardian, although most staff we spoke to were not aware of them. Leaders encouraged staff to raise concerns. Most staff we spoke to were confident their voices were being heard and felt able to raise any issues. However, a few staff told us they were not confident to speak up due to fear of detriment. Mostly, when concerns were raised, leaders investigated sensitively, and lessons were shared and acted upon.

There was a Freedom to Speak Up policy but staff we spoke to were not aware of it or who the guardian was. There was a whistleblowing policy and staff were aware of this. The service had a quarterly staff survey where comments were anonymous. This allowed staff to voice any concerns. We saw where comments were made, managers created actions to make improvements. For example, there was a comment about how difficult it was to park at the hospital which was affecting the staff, and they were considering leaving due to the time and stress taken to park. The managers recognised this and had created an additional 62 car parking spaces by the end of July 2024. They had also secured 300 spaces at a local car park which was a 3-minute walk away at a reduced daily rate.

Leaders acted to continually review and improve the culture of the organisation in the context of equality, diversity, and inclusion. The service promoted equality and diversity in daily work and provided opportunities for career development. Inclusion and diversity training was part of staff’s mandatory training programme; 100% of staff had completed this. Managers told us they encouraged recruitment within the local area to mirror the population of the people they were treating.

There were policies and processes in place to ensure the service was inclusive and valued diversity in their workforce. Leaders took action to improve any disparities in the experience of staff with protected characteristics. We spoke to several staff with protected characteristics, and they felt supported and included by their team and managers. The manager told us one of their transgender members of staff had told them they had never felt so much at home in a workplace. There was a civility study day which focused on bullying, behaviours, and equality. There was a ‘wise’ council which had been formed and anyone could join. They had fortnightly meetings and were focused on improving work for staff. Topics they had discussed included “how can we make induction better?”. Managers had sought international nurses from specific areas which they knew would be beneficial to their service and the people that they treated. The trust had staff networks available which they encouraged staff to join. They offered advice and support and the opportunity to be part of changes within the trust. Where staff needed adjustments at work, managers completed risk assessments to ensure they were able to complete their role.

All levels of governance and management functioned effectively and interacted with each other. Staff at all levels were clear about their roles and understood what they were accountable for, and to whom. Staff told us there were governance, management, and accountability arrangements in place, and that they understood their role and responsibilities, what they were accountable for, and to whom. There was a monthly governance meeting and monthly quality and safety site meetings where leaders reviewed incidents, complaints, audits, and risks. There was also a meeting with partners to ensure shared learning and policies and a monthly directorate meeting. We saw risks, actions, and audits were all discussed and there was shared learning across the directorate. Staff told us they received feedback from audits that were undertaken.

The unit had a clear management structure. Leaders monitored quality and operational processes and had systems to identify where action should be taken. However, we did not always see action plans for audits where improvements were needed. The service had a clear governance structure with various committees. There was a monthly specialty performance review meeting. We reviewed 3 sets of minutes which showed action plans were discussed and improvements were made. There were monthly meetings in collaboration with the minor illness service. We reviewed 2 sets of meeting minutes which showed there were effective processes in place to review risk and create improvements and share the learning between the partnerships. Learning was shared with staff using several avenues. We reviewed ward meeting minutes which showed staff were kept informed. There were arrangements for identifying, recording, and managing risks, issues, and mitigating actions. There were 2 risks on the risk register, 1 was the management of acutely ill patients at Solihull hospital and the other was the use of multiple clinical information systems. The management of acutely ill patients was a site wide risk but related to the unit as acutely unwell patients occasionally presented at the MIU as a medical emergency. There were mitigations in place including further training for clinical site practitioners to provide 24/7 cover and applying for additional funding for out of hours medical cover at the hospital. There was alignment between recorded risks and what staff said was ‘on their worry list’.

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

The staff worked well with the other services within the urgent treatment centre and across the trust. They shared good practice and learning. Staff gathered feedback from patients via the Friends and Family Test and any complaints made. They used this information to make changes in the department.

There was collaboration between the departments within the urgent treatment centre as they were commissioned by different providers. The MIU was run by the trust and the minor illness unit was commissioned by the ICB. They held monthly meetings to discuss risks, workforce, patient feedback and performance. They discussed actions at the meetings and we saw these were closed when complete.

All staff were committed to continually learning and improving services. They had a good understanding of how to make improvements happen. Leaders encouraged staff to speak up with ideas for improvement and actively invested time to listen and engage. The service had a strong external relationship with the ICB and meant there was a foundation to support any improvements needed together. For example, they had found there were not clear pathways for some patients in the department if they turned up without an appointment for the Minor Illness Unit. They were not able to be seen by Minor Injuries and this could cause issues. The services discussed this at their governance meeting and created a policy to ensure that there was a clear pathway for these patients to be seen. Staff told us they were encouraged to develop and were proud of the service. Feedback was gathered from staff via the quarterly staff survey. In April 2024, a comment within the survey was “I am proud of the service we provide for our patients and as a team we are always encouraged to improve the service and develop within my role and within the unit”.

There was a focus on continuously learning in the department. There was an education lead who supported staff to develop their skills. The unit was a training unit for the local university. This meant they supported trainee EPs to complete their training in minor injuries. EPs also rotated across the different sites so they could maintain competency in minor illness. All staff were training to be prescribers. They had a 4 year development programme where they took on band 6 paramedics and nurses and at the end of the programme they were band 7 level. There was a monthly trust newsletter called “risky business” developed by a consultant to share learning and reflections. One EP told us about a reflection they shared regarding a paediatric patient who presented with injuries that looked non-accidental and could be due to safeguarding issues. However, following further assessment, it was found that the patient’s mother had a history of brittle bone disease and it was likely the child did also. They felt this was an interesting reflection and learning for staff.