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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

The vision, strategy and culture were co-produced with staff, partners and people who used services. It closely reflected the challenges and met the needs of people who used the service and wider communities. The strategy and supporting objectives were stretching and challenging, but realistic and achievable. All staff and people felt psychologically safe to speak up and raise concerns to help learn and improve. Staff were highly motivated and consistently felt well-supported by leaders. Equality and diversity and human rights approaches were embedded in everything the service did and understood by all staff. Preventative action was quickly taken and embedded in response to any workforce inequality issues. All staff felt treated equally. Staff and leaders actively monitored and anticipated current and future risks to delivering the strategy, including relevant local factors. All staff understood these and were actively engaged in action plans to prevent and manage them.

This service scored 86 (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 clear shared vision, strategy and culture. This was based on transparency, equity, equality, inclusion, engagement, and a strong understanding of the challenges and the needs of people and their communities. The vision, strategy and culture were co-produced with staff, partners and people who used services. It closely reflected the challenges and met the needs of people who used the service and wider communities. The strategy and supporting objectives were stretching and challenging, but realistic and achievable.

Staff frequently spoke about the trust’s vision to build healthier lives through demonstrating the use of its values: ‘kind, connected, and bold.’ The use of the trust’s vision and values in their normal vocabulary demonstrated that staff understood, were invested in, and saw them as integral to their role of providing high quality healthcare.

The specialities that provided outpatient treatment had each developed a 3-year strategy designed to improve the patient experience including their access to treatment. These aligned to the overall trust strategy. All staff had been involved in developing their strategy. Staff at all levels were able to clearly articulate their departments strategy, tell us what progress had been made and give us information about their current priorities. Each strategy included details of how the challenges to accessing treatment for different communities could be overcome. Staff spoke with a sense of pride about the work they had done, and their current and future plans to progress their strategies.

Staff from the hospital’s leadership team were enthusiastic about the level of investment departmental staff had in the strategies, and the passion with which whole teams worked together to meet agreed monthly objectives. The leadership team were actively involved in reviewing departmental strategies and supporting staff to set and meet their monthly objectives. One manager told us, “What I am really proud of is how we use strategy and planning to enable the clinicians to take care of what they can take care of, and we can help them identify where they might need help.” As well as formal reviews of the strategies, senior leaders also offered informal meetings to support departmental staff with their strategy as required.

Managers told us the shared values, kind, connected, and bold shone through the staff. One manager told us, “In the last 18 months of working here, I have never come across such kind and compassionate people. They're always talking about our shared values and what we can do to improve care.”

Staff told us they enjoyed working at Solihull Hospital. They were supported by their immediate teams, which they described as being like a family, but also felt part of the wider hospital team.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff at all levels told us they had leaders who were visible, approachable and supportive. They described leaders as having an open-door policy and being ready to offer support when needed. Staff told us some senior leaders regularly visited their department to check in with staff and see if they needed anything.

Leaders modelled and regularly referenced the trust’s values when they spoke with staff. They demonstrated concern for the wellbeing of their staff and were focused on promoting a culture of high quality and safe patient centred care.

Managers told us the hospital leaders were committed to improving the patient experience and their passion for providing high quality patient care had filtered down to the wider staff team. One manager told us, “Patients are really important, and this hasn't always been my experience of trusts, and if you have that passion at the top it filters down. If you've got it right at the top, you'll get it right everywhere.”

Leaders understood the challenges to quality and sustainability and could identify the actions needed to address them. They used an inclusive, collaborative, and solution-focused approach to make improvements to the service.

The NHS Staff Survey results for the main outpatient department for 2024 showed 94.4% of staff felt their immediate manager took effective action to help them with problems they faced. This was significantly higher than the result for the overall trust of 64.3%. Eighty-three percent of staff said they felt their manager listened to and cared about their concerns, encouraged them, and gave clear feedback on their work. This was also significantly higher that the result for the overall trust of 67.1%.

Leaders had the skills, knowledge, experience to run the service. They were provided with opportunities to develop their leadership skills. For example, there was a leadership programme to provide a structured learning experience, and leadership mentorship for more personalised guidance and support.

Staff felt respected, supported and valued. They were encouraged to develop their skills and were given opportunities to take on more senior roles within their speciality.

There was a low staff turnover in the main outpatient department. Managers told us when staff left this was mainly due to development opportunities outside of outpatients. To help improve retention, nurse-led clinics had been introduced to provide development opportunities for nursing staff.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The majority of staff we spoke with told us they worked in a culture where speaking up was encouraged and valued.

Leaders and staff understood the importance of staff being able to raise concerns without fear of retribution. The freedom to speak up service was advertised across the hospital to encourage staff to share their concerns. Staff we spoke with told us they had not needed to use the service as they had been able to raise concerns within their teams, and these concerns had been listened to and dealt with.

However, the NHS Staff Survey results for the main outpatient department for 2024 showed only 64.7% of staff said they felt safe to speak up about anything that concerned them. However, this was better than the trust overall average of 54%. There was more confidence about being able to speak up about a clinical concern (77.8%, trust average 66%), although only 55.6% of staff thought action would be taken to address their concern which was closer to the trust average of 49.7%.

The service strongly valued diversity in their workforce. It had an inclusive and fair culture which had improved equality and equity for people who worked in the service.

Leaders worked to create an inclusive working environment. Staff were encouraged to have a workplace passport to ensure reasonable adjustments could be made for those who needed them. For example, people with a disability including people experiencing symptoms of the menopause were able to create workplace passports.

Staff with disabilities told us reasonable adjustments had been made so they could perform their duties effectively. For example, a member of staff who was neurodiverse told us they were mostly given tasks suited to their strengths, additional breaks if needed, and were able to use fidget toys during meetings to help with any anxiety.

A new electronic rota system was being introduced which gave staff the ability to choose their shifts through a mobile phone app. This was designed to give staff greater flexibility at work as they could chose the shifts most suited to their personal circumstances. One member of staff who did not use a mobile phone was being supported by their line managers to process their shift choices.

The NHS Staff Survey from 2024 had a response rate of 62% from staff working in the main outpatient department. The results showed most staff (88.9%) had not experienced discrimination from patients, their relatives, or members of the public, or from colleagues (94.4%). As part of the action plan to improve the experience of staff in the workplace, staff were reminded to escalate any form of discrimination to managers and record it as an incident so they could be fully investigated and managed. Staff were also reminded of the organisation’s staff networks for equality and diversity support.

The hospital’s Workforce Race Equality Standard (WRES) data from 2024 showed ethnic minority staff (25%) were more likely than their white counterparts (22%) to have experienced harassment bullying or abuse from other staff. The data also showed 40% of ethnic minority staff at the hospital believed the trust provided equal opportunities for career progression or promotion. This was lower than white staff (48%) and staff from the wider trust (46%). The trust recognised this disparity could suggest that ethnic minority staff perceived fewer equal opportunities compared to their white colleagues and staff from across the trust.

Ethnic minority representation within the staff group at the hospital was consistently increasing by around 3% each year and stood at 31% in October 2024. This was below the trust average of 40.3% and highlighted further action was needed to align with the trust’s WRES goals of increasing ethnic minority representation. Ethnic minority representation among medical staff was high at 58.9% and continued to increase steadily each year. In the Band 1 to 7 staffing structure ethnic minority representation was much lower than medical staff at 30.5%, although hospital leaders told us there had been a 10% increase in this figure since publication of the data. Representation from ethnic minority staff in the very senior managers roles was 33%. There had been little progression in representation in Band 8 roles. However, hospital leads explained there had been very low staff turnover rates in this strata of the workforce. The hospital had 10 recommended actions to improve workforce race equality to drive change and foster an inclusive culture and create equitable opportunities for all staff in line with the trusts overall WRES objectives. These included actions designed to increase representation, for example, through a mentoring and sponsorship scheme for ethnic minority to staff to support their career development and fair access to leadership opportunities.

To add more context to the WRES data it is important to consider the Census data from 2021 for Solihull, Solihull Hospital’s local community, showed Solihull had a much smaller population of people from ethnic minority groups (18%) than Birmingham (51%). This naturally impacted on the recruitment ethnic minority staff. However, in the 6 months since the WRES data was published, the representation of ethnic minority staff had increased to 41% (trust average: 44%) compared to 31% in October 2024 (trust average: 40.3%). This demonstrated the hospital was making significant progress in meeting the trust’s WRES objectives.

One member of staff described to us an incident of racism they had faced in the workplace from a patient. A colleague had witnessed the incident. Neither member of staff had challenged the patient about their behaviour. We raised this as a concern with the managers who immediately took action. They put up posters throughout the department to let people know racism and other forms of discrimination would not be tolerated. They discussed the incident in the daily safety huddle the next morning to request all staff escalate all instances of discrimination to managers and record them as an incident. They also directed staff to a training module that could help improve their confidence to challenge discrimination in the moment.

The trust had a disability equality network, a race equality network, and an LGBTQ+ network. The role of the networks included visible representation and acceptance of difference within the workforce, and safe space where people could access advice and information.

The hospital had a faith centre that could be used by staff wanting to pray or have space for quiet reflection.

At the time of our assessment some staff were celebrating Ramadan. Adjustments had been made to support staff who were fasting.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There were structures, processes and systems of accountability to support the delivery of the service. The service had a meeting structure which gave senior leaders and managers regular opportunities to discuss operational issues. Leaders were clear on the links to trust-wide groups and committees to escalate risks and issues. The reporting structure showed how information was fed up from staff and patients and included pathways to demonstrate how information was fed back down to people.

Governance was used to learn, improve and innovate. There was a good range of accurate data and information available to understand performance. This was shared with staff groups, including clinical staff, so strategies could be developed, and improvements could be made. For example, the performance team shared performance data with the speciality teams through a tracker so they had oversight of their performance. The tracker showed where progress had been made and when there were new challenges so the teams could see what areas they needed to be most responsive in.

They were quarterly governance meetings that all key stakeholders attended including representatives from finance, performance, and quality and safety. There were regular and effective meetings for the speciality leads. Minutes showed key areas of performance, risk, quality and safety, and culture and workforce were discussed monthly. Areas of concern were identified, and actions were taken to learn and improve.

The risk registers contained enough information for staff to understand the severity of risk and the level of potential or actual harm to people. We looked at the risk registers for ophthalmology, dermatology, rheumatology, gynaecology and gastroenterology. Each risk was assigned to an individual so there was a responsible person to ensure agreed actions were carried out and the level of risk reviewed regularly. The risk registers included risks to patient safety and risks to the sustainability of services offered due to staffing levels.

Specialties team leaders met regularly to review their risks and actions. The outcome of these meetings fed into monthly risk review meetings with the hospital senior leadership team to review and/or approve the highest rated risks and to identify actions to mitigate risk.

There was a programme of regular audits including, health and safety, infection prevention and control, privacy and dignity, and patient interactions. The findings of the audits were shared with staff and used to make improvements to the service.

Staff in the service understood their duty to collaborate and work in partnership, so services worked seamlessly for people. Staff shared information and learning with partners and collaborated for improvement.

Some of the speciality outpatient services offered at Solihull Hospital were led by other hospitals within the trust. Staff worked in partnership to ensure these services were delivered smoothly. For example, managers worked across multiple sites to ensure there was visible leadership at satellite locations like the inflammatory bowel disease (IBD) clinic which was led by the colorectal team at the trust’s Birmingham Heartlands Hospital. The IBD manager was onsite at Solihull Hospital satellite service 1 day each week.

The hospital also worked with their system partners to improve access to treatment for patients who were waiting a long time. For example, the ophthalmology team were working through the local Integrated Care Board to explore options for joint working with a children’s hospital to increase patient choice of where and when they could be seen for appointments.

The 3-year strategies for ophthalmology and rheumatology clearly identified the need to work in partnership with others and the communities they were serving. The ophthalmology strategy was to, ‘build healthier lives by creating transformational partnerships to deliver hospital- and system-wide solutions for ophthalmology patients, by collaboration, integration and innovation, reaching the heart of communities’. Under the strategy one of the ambitions was to ensure routine patients received care in the community or in their homes. To achieve this, identifying additional appropriate space within the community was a key strategic priority, as was working in collaboration with local partners to deliver system solutions. Year 2 of the rheumatology strategy included scoping suitable community venues to deliver services more locally for patients through engagement with primary care services.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contributed to safe, effective practice and research.

Staff were involved in developing and evolving improvement strategies for specialist services to improve patient care, including access to treatment.

The NHS Staff Survey from 2024 for staff working in the main outpatient department showed 77.8% of staff felt able to make suggestions to improve the work of their department, and 88.9% felt they had opportunities to show initiative in their role. However, only 50% of staff thought they were involved in decisions about changes to their role or in making improvements happen.

Staff were able to use a trust-designed patient record service to improve patient records and the consistent approach to care and treatment. The trust had built a patient electronic record system so they could make direct changes to the system as needed. Before the new system was introduced, patient records had been a combination of paper and electronic notes and there had been variation from hospital to hospital or service to service about the way things were recorded. To improve patient safety the new system only offered 1 way for each different thing to be recorded, so there could be no variation between hospitals or services. As some staff worked across multiple sites this meant they did not need to try and record things in lots of different ways.

The new system was still being rolled out across some areas of the hospital at the time of our inspection, including in some of the specialities offering outpatient services. Staff were surveyed throughout the rollout to check if staff thought the new system created any patient safety concerns. If there were any immediate patient safety concerns the system could be modified in response. Staff were also encouraged to incident report any problems with the system. This allowed the implementation team to identify where modification was required and or staff training was needed.

The new system also functioned as an early warning system. It contained algorithms that could detect the deterioration of patients and could check with clinicians about some of the decisions they were making especially in regard to medicines.