Solihull Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained. There were enough staff with the right skills, qualifications, and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care.

This service scored 78 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff knew what incidents to report and how to report them. They raised concerns and reported incidents and near misses in line with trust policy. Staff told us they received feedback from incidents they reported, and learning from incidents was shared in meetings and by email. We saw posters on the notice board in staff rooms with information about the current month’s incidents and lessons learnt, including details of actions taken.

The NHS Staff Survey results for the main outpatient department for 2024 showed 94.1% of staff said they were encouraged to report errors, near misses and incidents. This was higher than the response for the overall trust for 2024 which was 82.8%. When errors, near misses or incidents were reported 83.3% of staff said action was taken to ensure that they did not happen again (overall trust 63.7%). However, not all staff (68.8%) said they were given feedback about changes made in response to reported errors, near misses and incidents (overall trust 57%).

There was a process to ensure learning from incidents was communicated to staff. We saw feedback from incidents was given to staff at their monthly meetings, but staff did not have to attend the meeting if they were not rostered to work that day. Most staff said they read the meeting minutes and took learning from incidents.

If a patient had experienced harm from a delay in being offered an appointment, or as a result of their treatment staff recorded this as an incident. All new incidents were looked at fortnightly by department leads to ensure they had been correctly graded and to look at what actions were needed to prevent them from happening again. If an incident had resulted in severe harm to a patient, it was escalated to a ‘round table’ (team) discussion. This meant more time could be spent considering what had happened and the actions required to prevent a recurrence. If a patient had come to harm as a result of an incident they received a letter from the hospital under the duty of candour to apologise for the harm caused. The letter included an explanation of what went wrong and what actions would be taken to reduce the likelihood of it happening again.

The management of risk embodied the culture of safety, based on openness and honesty. We saw harm caused to patients as well as the potential for harm was recorded on risk registers, along with actions to mitigate risk. For example, the rheumatology risk register included details about a lack of capacity to offer patients follow up appointments within planned dates which had been added in February 2025. The register recorded 4,000 patients exposed to this risk. Of these 1,458 patients were overdue their nurse led clinic appointment by 1 month, and 836 were overdue by 6 months. A similar number were overdue their consultant appointment by 1 month (1,699), and 548 patients were overdue by 6 months. There were 12 actions listed to mitigate risk. Ten actions had been completed. They included, reviewing if any patients were appropriate for patient initiated follow up, close monitoring of clinics to ensure all available clinic time was used effectively, and clinical and non-clinical validation of the waiting list. The clinic templates had been redesigned to ensure dedicated slots for people overdue their appointment were introduced. One action, the recruitment of a consultant, was in progress. One action was overdue, this was a trial of a virtual review of patients.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different services.

Doctors sent letters to patients summarising what had happened at their appointment. A copy of this letter was sent to patient's GP. To ensure continuity of care discussions about patients that took place in multidisciplinary team meetings were recorded in patient notes.

Patient records could be viewed by others at the same time they were being updated, so people did not have to wait to view important information. The hospital used an electronic patient record (EPR) system. The EPR could only be accessed by authorised personnel. The EPR was a new system which enabled more than 1 member of staff to enter a patient record at a time.

There was good oversight of how long patients had been waiting to be seen for appointments and who needed to be seen urgently. Every patient, including new patients yet to be seen for a first appointment, had a partial booking summary on the EPR. This gave staff a clear view of all patients and where they were on their treatment pathway. This prevented patients being lost in the system and ensured they were followed up by the appropriate speciality team.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people's lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

All staff knew who the senior safeguarding leads were, as well as the people who had extended roles to champion safeguarding people. Staff were able to describe the safeguarding process, give examples of past cases, and explain how they escalated concerns.

Staff received training in safeguarding adults and safeguarding children to levels commensurate with their roles. All of the staff we spoke with, including volunteers, knew how to escalate a safeguarding concern. There were flow charts on the wall in some shared staff areas so staff could see the process they needed to follow if they had a concern about a person's welfare.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people's needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff used telephone calls instead of face-to-face meetings to monitor patients who had been assessed as safe to be seen in this way. These patients were typically the least complex patients at low risk of their condition worsening. Staff said if patients self-reported a worsening of their condition, they could easily be switched from telephone to face-to-face appointments.

Staff used appropriate tools to monitor patients' health. Patients could sometimes deteriorate while at the outpatient department. Some patients came to the outpatient department when they felt unwell because they believed staff would be able to help them. However, as there was no emergency department at this hospital, staff followed protocol by calling 999 for an ambulance for any deteriorating patient. They provided short term support to these unwell patients while they were waiting. They monitored patients using the National Early Warning Score (NEWS) 2 tool to measure important indicators of health and contacted the team at the hospital trained in advanced life support designated to respond to treat people requiring resuscitation when necessary. The main outpatient department team had won an award for their care of deteriorating patients.

Resuscitation trolleys were located throughout the main outpatient department and the speciality outpatient areas. Each trolley had tamper evident tags to ensure they could not be accessed by unauthorised people. The trolleys were fully equipped and checked regularly by staff. We saw emergency resuscitation equipment, including defibrillators, and anaphylaxis packs. Staff recorded when equipment was due to go out of date so it could be replaced in a timely manner.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

The service had enough suitable equipment to help them to safely care for patients, staff were trained in its use and kept equipment maintained. We saw portable electronic equipment had been safety tested, and evidence of when equipment was next due to be serviced was visible on equipment. Staff told us they checked equipment was in good working order at the start of each day.

The environment was visibly clean and clutter free with furnishings in a good state of repair.

Staff disposed of clinical waste safely. The domestic and clinical waste bins were clearly identified and emptied regularly. Sharps and hazardous waste bins were stored safely.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people's individual needs.

The main outpatient department had a low staff turnover rate. At the time of our assessment, there were no unfilled staff vacancies.

The trust had a `grow our own' staffing philosophy. As part of their succession planning the trust were committed to developing their internal staff to improve retention and reduce staff turnover. For example, staff in ophthalmology could access learning pathways to develop into specialist roles within the department either as a technician or go on to train as a nurse.

Staffing levels were arranged to coincide with the number of clinics being run. For example, in the main outpatient department, to allow the safe running of the clinics, some clinics were evaluated as requiring 1 nurse or healthcare assistant while others required 2 to run safely and effectively. Staff on shift reflected the number of nurses required and the number of clinics running. Staff absence was covered by substantively employed staff who volunteered to work extra hours or an extra shift.

Some of the outpatient clinics in the speciality outpatient departments sometimes used bank staff to cover absence. Whenever possible this would be a member of bank staff who was already familiar with the service.

All nurses and healthcare assistants had been provided with competency-based training to enable them to facilitate any of the clinics held in the main outpatient department. All new staff were supernumerary (not counted in the shift numbers) for a minimum of a month. During that time, they shadowed every clinic to gain experience of what they needed to do for each specialty. Solihull Hospital was trialling a new buddy system which had been a success. It was hoped this would be rolled out to all new starters. Being assigned a buddy meant new starters always had a named person they could approach to ask questions or seek support from.

The trust had identified pathways to reduce staff sickness. For example, by providing internal support for staff with painful ailments and for conditions like the menopause. Data demonstrated a reduction in sickness levels since the introduction of these and other initiatives.

At the time of our assessment, compliance with mandatory training in the main outpatient department was 97%, and compliance with annual appraisals was 100%. Staff told us they had regular appraisals where they were given the opportunity to discuss their learning and development needs. For example, healthcare assistants in the main outpatient department told us they were given development opportunities including training in phlebotomy, trauma and orthopaedics and wound management.

Volunteers received mandatory training, including safeguarding training, to ensure they had the right skills and knowledge to keep people safe in the department.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff understood the polices and processes for maintaining good infection prevention and control. For example, when handling urine samples for testing staff understood the important of using the correct personal protective equipment to protect themselves and others from cross infection.

Hand gel was available in all clinical areas and was also available for use by members of the public in all other areas. Patient and staff toilets were clean, and the cleaning schedules were on view and up to date.

A healthcare assistant was the lead for nasoscope cleaning and had implemented a process to ensure their decontamination and enough clean nasoscopes were available at the start of the ear nose and throat clinics.

Testing for Legionella's disease was performed twice a week and monitored by the infection prevention and control team.

Staff performed regular infection prevention and control audits including for staff uniform compliance, and observation of the environment.

We observed staff were bare below the elbow and followed correct hand hygiene procedures. Staff uniforms were visibly clean, and staff could explain what their role was in infection prevention and control. However, we saw 2 nurses in the main outpatient department wearing gel nail polish and another member of the team wearing nail polish. This contravened the uniform policy and was an infection prevention and control risk. When we raised this as a concern action was taken immediately to resolve the issue.

The service made sure medicines and treatments were safe and met people’s needs.

Staff stored and managed all medicines safely. A nurse performed a weekly stock check and ordered new supplies as needed from the hospital pharmacy. The hospital pharmacy team performed regular stock audits.

Medical gases were stored securely. Controlled drugs were managed in line with policy, this included all controlled drugs being signed for by 2 nurses. This was an improvement since our last inspection in 2017.

The temperature of refrigeration was monitored for those medicines requiring refrigerated storage.

Prescriptions were generated electronically and sent automatically to the pharmacy.