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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

People were involved in decisions about their care. The service mostly provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it. Although waiting times were a national and local significant issue for the NHS, the service was working to reduce the amount of time some people had to wait to access the service, and to eliminate discrimination. People received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback.

This service scored 79 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in their needs.

At the beginning each day staff checked patient records to see if any patients had been flagged as requiring an interpreter or had other required reasonable adjustments so they could make necessary preparations. For example, for people who required extra time to ask questions or to process information or needed a quiet place to wait to be seen.

If a clinician identified an interpreter was required for future appointments this was raised with the administration team so they could complete an internal interpreter booking form.

Patients told us they had been involved in discussions about their treatment and staff had explained what would happen next.

Patients were given the opportunity to choose their appointment time or to rearrange it to a time suitable for them. Patients were sent a text message to remind them of their appointment date and time which they were able to respond to with a free text to confirm their attendance, let the hospital know they no longer needed their appointment, or request they were contacted to rearrange their appointment.

If a patient was experiencing a mental health or physical health crisis staff told us they would escalate this to a manager and call an ambulance for the person to be transferred to an accident and emergency department for urgent care.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff spoke at length about the diversity of people’s health and care needs and how they proposed to change the way they worked to ensure care provision could meet those needs. For example, in ophthalmology, staff were aware of the way people received communication from the hospital impacted on the continuity of their healthcare. People with sight problems, especially those living on their own, may not have been able to read appointment letters and older people may not have used mobile phones to receive text reminders about appointments.

Staff understood this group of patients was disadvantaged through standardised methods of communication. To address this staff were trying to improve the way they communicated with patients. They already sent out letters in larger font and were in the process of seeking approval to send letters out on coloured paper. Coloured paper can reduce glare and improve contrast making reading easier for people with some types of sight problems. They were also considering how they could increase the number of patients they contacted on landline telephones rather than relying on text messages.

Staff worked to reduce the number of appointments people needed to attend. Ophthalmology clinics for patients with glaucoma had historically run over 2 days with patients having to attend both clinics. The first clinic was to measure patients’ visual field and the second was to see a consultant. To improve the patient experience staff had made changes to clinics to ensure both appointments could be scheduled for the same day.

The service supplied appropriate, accurate and up-to-date information. However, some information was only available in English.

We spoke with a patient whose first language was not English she was being supported by her daughter. The patient's daughter had interpreted for her mother during her outpatient appointment. They told us they had not been offered an interpreter. We raised this as a concern and the trust provided us with assurance that the preference was to use professional interpreters, not friends or family members, when discussing treatment, care and medical or social issues with a patient. Immediately following our inspection all the outpatient clinic rooms and waiting areas were checked to ensure information about translation services was widely available

The trust website provided information on translation services and had accessibility icons that translated all information on the website into multiple language texts. The website could read the information on the website aloud for people with sight or literacy problems.

Letters sent to patients contained information about the interpreting service used by the trust and how to contact them. Letters also contained a direct contact number for patients to contact the trust if they required advice and support with translation services. However, this information was provided in English. The trust identified this process needed improvement and were looking at how information about this service could be made clearer within appointment letters.

Not all patient leaflets were available for people whose first language was not English. The ophthalmology team were working with a charity that supplied leaflets for people with macular deterioration, to get leaflets printed in different languages. They were also looking at alternative options for providing other information to patients whose first language was not English. For example, an eye care pathway had been created in collaboration with the internal equality and inclusion team to consider the diversity of the local population. The service was working towards some of the leaflets being translated into the 3 most spoken languages within the local community.

Staff were involved in analysing barriers to treatment for people who had failed to attend ophthalmology appointments. They had implemented a flagging system to highlight people with a vulnerability that stopped them from accessing treatment, including when language was a potential barrier. Vulnerable patients who had failed to attend appointments were followed up by letter or phone call to ascertain why they did not attend their appointment so staff could help to try and overcome their barriers to treatment.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The trust’s website provided clear information about how to make an online, written, or verbal complaint and how quickly people could expect a response. Outpatient staff were invited to complete a patient experience survey. The survey was made-up of 15 questions. It included questions designed to understand if patients had been given enough information, if they had been involved in making decisions about their care, if they had had the opportunity to ask questions, and about how they were treated by staff.

There were patient feedback boards in waiting areas that displayed ‘you said, we did’ posters. The posters demonstrated the hospital took patient feedback seriously and introduced changes as a result of the feedback.

The service had worked exceptionally hard to make successful progress at ensuring most people could access the care, support and treatment they needed when they needed it, or reduce the length of time they had to wait.

The hospital had made outstanding progress in reducing waiting times for non-urgent appointments in some specialities. At the end of the COVID-19 pandemic there was a national backlog of patients waiting for their first outpatient appointment or for a follow up outpatient appointment as part of an ongoing course of treatment. This was because rules around social distancing meant fewer people had been able to access treatment. At that time, Solihull Hospital and the other hospitals which form the University Hospitals Birmingham NHS Foundation Trust (one of the largest NHS trusts in the country) had some of the longest waits for outpatient appointments. This included a high level of people waiting over 104 weeks for their first appointment. Since that time University Hospitals Birmingham NHS Foundation Trust had made better progress than other trusts in reducing their waiting lists.

For example, in March 2020 (before the COVID-19 restrictions) the trust had a lower (worse) proportion of people waiting over 18-weeks on the dermatology waiting list than the national average. Completed pathways (patients who had been given an appointment and started treatment) were 16% against the national average of 22%. This position continued despite lifting of COVID-19 restrictions. By March 2023 12% of the trust’s patients had a completed dermatology pathway against a national average of 15%. However, by March 2024 the trust had a 16% completed dermatology pathway against a national average of 14%. This figure rose again to 18% by March 2025 against a stationary 14% national average.

The trust had made less progress in ophthalmology waiting times. From March 2020 to March 2023, the trust had a lower (worse) proportion of patients on the ophthalmology waiting list with a completed pathway (7% to 3%), when compared nationally (14% to 12%). In the same time period, the trust also had a higher (worse) proportion of patients on the ophthalmology waiting list, that had been waiting over 18 weeks. There was little movement in this metric since that time. In March 2025 6% of patients had a completed 18-week pathway against the national average of 14%. This is indicative of longer waiting times.

However, in the 12 months before our inspection there were no patients waiting for over 72 weeks for their first appointment with any speciality and senior leaders were working towards the next target of making sure nobody waited over 52 weeks for their first appointment.

Of the specialisms that had treated over 1,000 patients in December 2024, ophthalmology and the ear nose and throat (ENT) department had the highest proportion of patients who had waited 52 weeks or more before receiving treatment, 20% and 23% respectively. Both specialisms had seen improvements in this data over the course of the year, most notably in ENT where, in January 2024, 52% of patients had waited more than a year before receiving treatment, and by December this figure stood at 23%. Performance in ophthalmology was more changeable over the year, though there was a net improvement between January (32%) and December 2024 (20%).

Different specialities had different challenges with their waiting lists. For example, at the time of our inspection ophthalmology had the largest number of people waiting for a first appointment (20% of the whole waiting list) but they also had a high rate of patients (approximately 16%) who did not attend their appointment. The reasons people did not attend their appointments were varied. For example, a prisoner might not attend because there were not enough resources available for the prison to supply transport, or community transport did not arrive to pick up a patient in the community. The performance team were working with the ophthalmology team to look at how a reduction in unused appointments could be achieved.

In gynaecology, long-term staff sickness had impacted on the length of time people waiting for their first appointment had to wait. To reduce risk for people waiting, the department introduced development posts for clinical nurse specialists so they could increase nurse-led activity. There was also a plan to recruit into 3 replacement consultant posts. At the time of our inspection the plan was at the interview stage.

Patient choice about where or when they wanted to be seen also impacted on some of the lengths of time the hospital had to record as the timeframe people were seen within. For example, in gastroenterology the average wait for a first appointment on a non-urgent pathway was 14 weeks. However, because of patient choice, the longest outpatient waiter without a first appointment was 45 weeks.

The trust used clinical validation and non-clinical validation to reduce risks for people waiting a long time and to remove people from the waiting list who no longer needed their appointment. Clinicians undertook clinical validation to check to see if people’s symptoms were the same, had improved, or got worse. This allowed clinical teams to prioritise patients for appointments based on their clinical need. Non-clinical validation was carried out by a contracted external company using text messages. Each patient was sent a text reminder of their appointment. There was an option for the patient to respond with a free text to say if they would or would not be attending their appointment, or if they needed to be contacted to rearrange. There was a 77% response rate to texts, and this process had reduced the waiting list by 3%.

The service was performing better than the national averages for initial consultations with patients being held virtually. The NHS actively promoted the use of digital tools to improve access to care and reduce waiting times. To reduce waiting times for new and follow up appointments, some patients were given ‘virtual clinic’ appointments, this normally meant their appointment tool place over the telephone. These were the patients with the least complex health conditions. People who were more poorly and/or had complex health conditions were seen face to face. Patients seen in virtual clinics could be transferred to face-to-face clinics if their condition worsened. The trust’s use of virtual appointments (24.5%) was above the national value (18.7%). For first outpatient attendances, 35.4% were conducted remotely, more than double the national value of 14.6%. For follow-up attendances, the remote consultation rate was 20.2%, the same as the national value.

The service ran waiting list initiatives to increase the number of clinics available to see long waiters for new or follow up appointments. Clinics ran as part of a waiting list initiative were normally held at the weekend. For example, the breast care team frequently held Saturday clinics, and the ear, nose and throat team held a Saturday clinic at least twice a month. The waiting list initiatives included occasional ‘super weekends’ for long waiters and urgent patients. However, these relied on technical teams being available to carry out tests prior to patients being seen by consultant so they were more difficult to arrange and subsequently were held less frequently.

Patient initiated follow up (PIFU) was being used to reduce the number of appointments offered for follow up patients who were managing their condition and being monitored in the community. This allowed more flexibility in the booking system for appointments to be offered to new patients. Instead of being issued with a follow up appointment, PIFU patients were asked to contact their specialist team if there were changes in their condition and they needed to be seen by a doctor. Depending on their level of clinical need, some PIFU patients were advised they would be discharged after 6, 12, 18 or 24 months if they had not needed to be seen in that timeframe. Others were advised they would automatically be offered a follow up appointment after 6, 12, 18 or 24 months and at that point they may be considered for discharge. Poorly patients, especially those with complex conditions were not deemed suitable for PIFU.

Some specialties had a greater number of patients suitable for a PIFU pathway than others. For example, rheumatology consistently had approximately 5% of patients who were well enough for PIFU because they had long term conditions that were being managed well by medicines. Any monitoring, like blood tests, could be completed at their GP practice. In contrast ophthalmology had less patients whose condition could be monitored outside of a hospital setting.

In January 2022, approximately 1% of all patients requiring follow up appointments were PIFU patients. This increased by approximately 2% each year and represented 8% (1,253 patients) of patients by January 2025. With this relatively high number and because many PIFU patients would not require an appointment this meant more appointment slots could be used for new patients. This was especially those who had been waiting for a long time, urgent referrals, or other patients who required regular appointments.

All the staff we spoke with were committed to improving the patient’s experience through improved access to high quality care. Staff at all levels worked as a team and understood that some patient groups needed additional support to access treatment. For example, staff in ophthalmology were working on improving communication between the hospital and patients who were Blind or partially sighted. Rather than relying on letters they were looking at ways technology could be used to improve communication. They were also looking at how more traditional methods of communication, like landline phones, could be used to improve communication with people who did not want to use mobile phones and emails.

The service used an electronic booking system. The system insured there was oversight of when clinic rooms were free to ensure space was used as productively as possible. For example, if a clinic was cancelled by one of the specialities, managers would email staff in the other speciality teams to offer them the opportunity of holding an extra clinic. The main outpatient managers told us they never turned down the opportunity to hold additional clinics. If there was room availability and somebody wanted to use it they would ensure there was staff available to help facilitate the clinic. During February 2025, 86% of rooms were being used for clinics. Managers told us clinic rooms were not consistently being used on Friday afternoons by many of the specialities. However, there was a plan commencing in April 2025 that would mean more rooms would be used on Friday afternoons.

The performance team provided training to consultants so they understood their role in reducing waiting times and the different ways this could be achieved. For example, using patient-initiated follow ups.

Staff and leaders were innovative in how they listened to information about people who were most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide tailored care, support and treatment.

Gynaecology ‘did not attend’ (DNA) rates were improved by outpatient nurses contacting some groups of patients by phone to talk through what their procedure involved to help reduce a patient’s anxiety. Managers told us they had received feedback from patients to say this had improved their experience of care and it had also improved DNA rates.

Some patients had regular outpatient appointments for injections. The pharmacy improvement group were working on increasing injection load doses to see if they could safely reduce the number of appointments these patients needed so the clinic time could be used to see long waiters.

Appointment letters automatically went out in the language spoken by the patient, which was recorded in the patient’s records, including in Braille. However, the service was not yet able to send out text messages in any language other than English.

The performance team told us they were trying to minimise inequality by ensuring all the trust’s hospitals were performing equitably. The performance team had oversight of performance across the trust and worked to ensure support was accessed for a hospital or service performing less well than others so patients would not be disadvantaged in a place.

People were supported to plan for their future.

People were given time to ask questions about their treatment options and extra support to understand what the treatment options meant, to help them plan their future treatment.

When people were asked to consent to invasive treatment procedures, they were given information about all the risks involved in having the treatment and what not having the treatment was likely to mean.

Outpatients seen by cancer services were invited to complete a holistic needs self-assessment. This was designed to help staff understand worries or concerns people had about their illness and also identify information and support people may need in the future.