Solihull Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on the latest evidence and good practice. Staff gave people information to support healthy living. They made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to patients to make decisions in people’s best interests where they did not have capacity.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff used a range of tools to assess and review people’s health needs. The tools were standardised, so staff understood how to use them. The type of tools used to record and monitor people’s health depended on the clinic being held, and the individual needs of the patient. For example, blood glucose monitoring for patients with diabetes, and venous thromboembolism assessment for patients who were being considered for surgery.

At the daily safety huddle, staff routinely checked the electronic patient record system to assess if patients due in that day had additional needs, they should be aware of, or if staff needed to do something different to enable a reasonable adjustment to improve patient access to treatment. For example, if a patient needed a quiet area to wait in, or if someone require an interpretation service this was arranged when possible.

If staff had not been told about a communication issue or other access needs prior to the appointment they would endeavour to ensure the needs were met. For example, they would arrange for an interpreter at short notice.

The service planned and delivered people's care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. For example, the protocol for the clinical practise of compression bandaging for venous leg ulcers by nurses was written using up to date information on evidence-based practise for compression bandaging. The protocol had been reviewed every 3 years.

In patient consultations, we saw doctors discussing treatment options with patients, and collaboration between the doctor and patient to agree treatment plans.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff at all levels, including hospital leaders, told us that all staff worked together as a team. For example, when discussing patient harm as a result of long waits for outpatient treatment, a senior manager told us, "We work together as a team, patient harm isn't just a clinician's responsibility. We are all involved."

The performance team worked collaboratively with the specialist teams to bring about improvements in performance. One manager explained the multifactorial nature of each department were sometimes difficult to communicate but the performance team were willing to try and understand rather than impose unreasonable demands. They told us performance meetings kept a focus on patient care and the patient experience to ensure the hospital did not, "hit a target and miss a point."

Staff attended a safety huddle at the start of each day. Important patient messages were shared at this meeting. Staff starting work after the huddle were given the same messages at the beginning of their shift by a manager. Staff attended a monthly staff meeting. All staff were emailed minutes of the meeting, and a copy of the minutes were stored in a file in the matron's office which could be accessed by all members of the team.

We saw a patient move between departments after seeing a consultant when it was necessary to investigate concerns around their health. The patient was supported by a healthcare assistant who made the transfer seamless. They explained to the patient and their carer what was happening. They handed over all relevant information to the receiving department and fed back to the patient and carer when they were going to be seen and what to expect.

The service supported people to manage their health and wellbeing. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The trust’s vision was to build healthier lives. This was something staff had become committed to and frequently talked about. They understood their role was to work as part of a team providing a service to a range of people with different health needs who came from diverse backgrounds.

We saw displays on notice boards in the main outpatient department and in the speciality outpatient departments that were designed to provide health education to patients in a range of subjects. The displays included diabetes, urological conditions, and tissue viability. They contained information about why conditions occurred and the different ways people could help manage their condition, for example, through diet and exercise. The displays had been created by staff who were leads for the different topics. These leads, or link nurses, had received additional training in their subject and were able to provide training and support to their colleagues to give them skills and confidence needed to support patients to understand the key messages.

The service routinely monitored people's care and treatment to continuously improve it. Staff worked to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Due to the significant backlog nationally for the NHS, the service was not meeting NHS waiting times. Waiting times for consultation or treatment were a major factor in the effectiveness of patient outcomes.

The maximum number of weeks patients should wait to be seen by a doctor is set by the NHS Constitution to try and make sure people are seen in a timeframe that means their medical condition will not get worse while they are waiting. The longest time the Constitution says people should wait is 18 weeks for most non urgent referrals, and 2 weeks for suspected cancer. However, performance for patients with suspected cancer were now monitored using the 28-day faster diagnosis standard, the 31-day decision to treat standard, and the 62-day referral to treatment standard.

There were high numbers of patients waiting for a long time to be seen for their first appointment by some specialities and especially for those on an 18-week pathway. This was partly due to the COVID-19 pandemic when social distancing requirements meant people could either not be seen at all or could only be invited to attend in small numbers. In addition to this, it was recognised how the ageing population led to a growing number of people with health problems that required medical treatment. Also, advancements in medical treatments meant there were more and better ways conditions could be treated. These factors combined meant more people were waiting for more treatments leading to additional pressure from new and existing patients waiting for appointments.

The service continuously monitored waiting lists to find ways of reducing waits for treatment. Although it had already successfully reduced the length of time people had to wait for their first appointment, staff understood their responsibility to reduce waiting times further. The trust was aware of the potential for patients to suffer harm as a result of long waits and they were committed to reducing this risk by improving waiting times.

The 28-day faster diagnosis standard is used to ensure patients will be diagnosed or have cancer ruled out within 28 days of being referred urgently by their GP for suspected cancer. For patients who are diagnosed with cancer, it means their treatment can begin as soon as possible. For those who are not, they can have their minds put at rest more quickly. The NHS target is for 75% of patients with suspected cancer to be seen in this timeframe.

There were some good results for patients with suspected cancer in getting a fast appointment, and others needing to improve. From January to December 2024 the trust's 28-day faster diagnosis standard performance by cancer type was mixed. However, the trust's overall performance stood at 76% against the 75% standard. In specialities, those who received the service in 28-days included:

• The trust performed best (90% in 28-days) in the diagnosis of breast cancer, both for suspected cases and for cases with exhibited symptoms
• Suspected skin cancer at 84.4%
• Suspected testicular cancer at 81.9%
• Suspected brain or central nervous system tumours at 80.9%
• Suspected lung cancer at 80%
• Suspected upper gastrointestinal cancer at 75.6%
• Suspected head and neck cancer at 75.4%

However, people with many other suspected types of cancer were seen outside of this timeframe. For example, patients with a suspected sarcoma (67.5%), suspected gynaecological cancer (65.4%), suspected lower gastrointestinal cancer (62.1%). It was recognised by the service that more needed to be done to improve the waiting times for these patients.

There were mixed results from the other cancer standards, but progress was in a positive direction. The 31-day decision-to-treat to treatment standard is used to monitor patients who have a cancer diagnosis, and a decision to treat their cancer has been made, have started that treatment within 31 days. The NHS standard for patients is for 96% to have started their treatment. The trust's overall performance from January to December 2024 stood at 91.3%.

The 62-day referral-to-treatment standard means patients who have been referred for suspected cancer from any source and go on to receive a diagnosis should start treatment within 62 days of their referral. The NHS standard is 85%. The trust's overall performance from January to December 2024 stood at 62%.

There was an improvement in waiting times for patients in both the 52-week wait category and the 18-week waiting time standard. Patients referred for non-urgent treatment had their referral to treatment times monitored against the 18-week timeframe set by the NHS Constitution. The proportion of patients waiting 52 weeks or more for their appointment reduced from 5% in January to 4% by December 2024. Over the same time-period, the proportion of people waiting 18 weeks or less increased from 48% to 51%.

The performance team used an online NHS England tool to help monitor urgent and non-urgent waiting times. The tool included the ability to benchmark performance data against other hospitals or trusts as well as against its own data. The performance team shared the data with the speciality teams so they could see how well they were performing to help them plan improvements. The speciality teams used innovation to help them reduce waiting times.

Rather than a blanket approach each speciality team designed their own strategy to reduce waiting times. This was because each team understood its patient demographic and was able to make changes specific to their patient population.

The hospital leadership team recognised that as well as internal innovation they needed additional support to make and sustain improvements in the way they delivered care and treatment. They invited the Getting It Right First Time (GIRFT) team from NHS England to support them with this. The GIRFT team combines reviews of specialties by senior clinicians with data analysis to explore how things were being done and how they could be improved. GIRFT helps share best practice between hospitals to reduce the variation in the way services are delivered and reduce inefficiencies. GIRFT also involves benchmarking so hospitals can continue to see where improvements can be made. The GIRFT team were scheduled to review processes within the ophthalmology service in May 2025.

The service was meeting and exceeding many local and national achievements in its performance data. Benchmarking data was used to monitor performance against other trusts at a regional and national level. This enabled the trust to identify where it was performing well and where it needed to improve. It also showed the extent of progress when improvements had been made. The trust had actions plans for all performance areas that fell below regional and national averages and NHS England targets.

Benchmarking data for rheumatology for March 2025 about patient initiated follow up (PIFU) appointments showed 6.5% of patients were on this pathway compared to a regional average of 2.5%. Outpatient activity and capacity showed 31.6% of patients had a non-consultant-led first or follow up appointment compared to a regional average of 1.2%.

National benchmarking data for ophthalmology for March 2025 demonstrated PIFU utilisation was some distance from reaching the NHS England national target of 5%. Trust-wide data showed 0.3% of ophthalmology patients were on a PIFU pathway compared to regional average of 0.4%, and a national average of 0.6%. The trust had an improvement plan based on GIRFT `Further Faster' recommendations to improve performance and bring it closer to the 5% NHS England target. This included using a clinical algorithm to identify low risk patients who may be suitable for a PIFU pathway and expanding the range of conditions that could be considered suitable for PIFU utilisation.

Benchmarking data for outpatient activity and capacity for March 2025 in rheumatology showed 31.6% of patients had a non-consultant-led first or follow up appointment compared to a regional average of 1.2%. This demonstrated the trust were performing well under this metric. Data for pre-referral optimisation (clinical triage for all referrals and advice available for referrers) also for March 2025 demonstrated the trust were in the highest quartile with 88% of requests responded to within 2 days compared to a regional value of 80.7%.

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The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The patients we spoke to told us they had been asked to consent to treatment where this was applicable. For example, for patients who were going to be undergoing a surgical procedure as a result of their consultation. If a patient did not need to sign paperwork to show they had given their valid and considered consent, as the procedure might be non-invasive, for example, staff gathered consent verbally from the patient. For example, taking blood pressure, a blood test or other monitoring did not require written consent, but staff still needed to ensure the patient understood what was happening and gave their verbal or implied consent.

If a patient was identified as requiring an interpreter for a procedure, this was arranged by the booking team to support the patient with any questions around consent. The procedure would not go ahead until consent had been gained with the use of an interpreter. Unless it was an emergency, the service did not use family or friends for translation purposes and in line with NHS guidance, would not use a child or young person to provide translation.

A patient with a learning disability was unable to give consent to a procedure as they were assessed by staff as not having the mental capacity to make this decision. Staff were convening an urgent best interest meeting to record a multidisciplinary decision so the patient’s surgery could be booked.

There were no patients subject to the Mental Health Act (1983) using outpatient services at the time of our inspection. However, all the staff we spoke with were able to explain what steps they would take to ensure patients subject to the Act were provided with safe and equitable care and treatment.