Solihull Hospital

Updated 13 February 2019

Solihull Hospital, based near to Solihull town centre, provides a range of outpatient, inpatient and emergency care services for its local community. It is also the regional centre for dermatology (the treatment of skin conditions).

Updated 13 February 2019

Solihull Hospital was previously managed by Heart of England NHS Foundation Trust. On 1 April 2018 a merger by acquisition took place of Heart of England NHS Foundation Trust by University Hospitals of Birmingham NHS Foundation Trust. As such Solihull Hospital is now part of University Hospitals of Birmingham NHS Foundation Trust.

We have not taken the previous ratings of services at Heart of England NHS Foundation Trust into account when aggregating the trust’s overall rating. CQC’s revised inspection methodology states when a trust acquires or merges with another service or trust in order to improve the quality and safety of care, we will not aggregate ratings from the previously separate services or providers at trust level for up to two years. During this time, we would expect the trust to demonstrate that they are taking appropriate action to improve quality and safety.

At this inspection we did not inspect all eight core services, therefore we are unable to provide an aggregated location rating. We will return in due course to carry out inspections of those core services we didn’t inspect this time. We will then aggregate all of the core service ratings to provide overall key question and location rating for Solihull Hospital.

For an overview of our findings at this inspection please see overall summary above.

Updated 13 February 2019

We rated it as good because:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Systems were in place to assess and monitor patient risk.

• The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors.

• The service generally managed patient safety incidents well. Staff recognised incidents and in general reported them appropriately.

• The service had systems in place to ensure that care and treatment was based on national guidance and evidence of its effectiveness. Patient care was delivered in line with trust policies and pathways based on national guidance including, National Institute for Health and Care Excellence (NICE) and Royal College of Physicians guidance.

• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

• Systems were in place to ensure staff were competent for their roles. Managers appraised staff’s work performance and completed competency assessments as required.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• The trust planned and provided services in a way that met the needs of local people. A new oncology day ward had been created at Solihull Hospital to improve the quality of care given to patients from across the trust.

• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. The staff at Solihull Hospital demonstrated a cohesive and caring attitude to their work.

• The service engaged well with patients and staff. We saw copies of the recent news @ UHB publication that was specific to Solihull Hospital and Community Services.

• We saw a garden attached to ward 8 that was designed to support patients in recovery. The area was maintained by the trust estates department and funded by the local garden centre that supplied equipment and plants to support the ward with the rehabilitation process.

• Staff on the oncology ward and day unit, had introduced resources to support children affected by cancer.

However;

• The service provided mandatory training in key skills to all staff, however, medical staff across Solihull Hospital only achieved the trust target in four out of the 12 subjects. Four subjects were below 70% compared to the trust target.

• Although systems were in place to assess risks to patients, we found on occasions that there was inconsistency in recording information about sepsis.

• The service did not always have sufficient numbers of suitably qualified permanent staff with the right qualifications, training and experience to keep people safe from avoidable harm and abuse.

Updated 13 February 2019

We rated it as good because:

• There were clearly defined and embedded systems and processes to keep women and babies safe and safeguard from abuse. Staff were aware of how to make a referral and where to access support if necessary.

• Women received risk assessments and the service responded appropriately to changing risks to women who used the services.

• Staffing levels and skill mix were planned and reviewed to keep women safe at all times. Unexpected staff shortages were reviewed and responded to.

• Staff understood their responsibilities to raise concerns and report incidents and near misses managers encouraged staff to do so.

• Staff we spoke to said learning from serious incidents was shared with staff in the maternity governance meeting, the newsletter and by email.

• Staff were assessing women and babies’ nutrition and hydration needs appropriately.

• Community midwives we spoke with told us they followed the guidelines for babies with jaundice and weight loss. They were able to check jaundice levels and baby weights in the community to prevent unnecessary admissions, midwives would refer any concerns or anomalies to the paediatricians in the hospital to ensure those babies had a medical review.

• Information about care and treatment was collected and monitored. The service benchmarked antenatal screening data against other maternity services. This information would be used to improve services if they were identified as an outlier.

• Women, babies and their families were supported and treated with dignity and respect.

• Staff treated women with kindness during all interactions we observed. They responded compassionately when women needed their support.

• Feedback form women who used the service was positive. Staff encouraged women to feedback their experiences.

• The service was planned and provided services in a way that met the needs of people. Staff were flexible with where appointments were held to suit the needs of the women and their families.

• Facilities and premises were appropriate for the services being delivered.

However:

• Some midwives informed us that the senior leadership team were not visible and some staff told us they had no idea who the key midwifery leaders were.

• Staff did not confirm that the executive team were visible and during the changes proposed regarding the future of the birth unit they had not visited during these difficult times.

• Staff we spoke with did not feel actively engaged or empowered.

• Most staff we spoke with described one key member of the senior leadership team as unapproachable, and following an initial introductory meeting felt their behaviours were dismissive and intimidating. Staff said that they would not be comfortable approaching this leader directly with a concern.

• The three sites have been merged for 12 years however there remains silo working for example the service did not hold joint clinical governance meetings. This meant that each site would not be aware of issues within their service and could lead to practices being different.

• Across the service there were a large number of incidents not graded appropriately which meant that they would not get the investigation and duty of candour that was required

Updated 13 February 2019

We rated it as good because:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. Mandatory training completion levels exceeded trust targets for both medical and nursing staff.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had a good knowledge of their responsibilities to report safeguarding concerns and make referrals. They were supported by the trust safeguarding team to do this.

• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. Audits were completed to ensure staff adhered to national guidance.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Audits were completed to make sure staff followed guidance

• Staff gave patients enough food and drink to meet their needs and improve their health. Patients had access to specialist advice and nutritional support as required.

• Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them. Performance in national outcome audits was mostly positive with good outcomes in the national vascular registry, the national bowel cancer audits and the national joint registry.

• The service made sure staff were competent for their roles. Managers appraised staff’s work performance to provide support and monitor the effectiveness of the service.

• Multidisciplinary team working was effective. Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide coordinated care. We observed therapies staff were based on some wards and staff communicated well with each other.

• Staff gained consent from patients to provide their care and treatment. Staff understood their responsibilities under the Mental Capacity Act (2005) and followed the trust’s policies and procedures when patients were not able to give their consent.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff maintained patients’ privacy and dignity and showed concern about their welfare.

• Staff provided emotional support to patients to minimise their distress. Patients had access to specialist nurses and a multi-faith chaplaincy service.

• Staff involved patients and those close to them in decisions about their care and treatment. Patients were aware of plans for their care and treatment and said they had been provided with the information they needed to help them make decisions about their care.

• Patients could access the service when they needed it. Waiting times from referral to treatment were approximately the same as the national average. The service had a plan in place for each specialty to improve referral to treatment times.

• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff. The number of complaints received for surgical services at Solihull hospital was low.

• The trust planned and provided services in a way that met the needs of local people. Following the merger of the two trusts the service was moving towards integration of surgical services whilst considering local needs.

• The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.

• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

• The service used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. We found examples of discussion at specialty and divisional level to identify improvements to the quality, safety and effectiveness of care.

• The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Risks were clearly identified in the divisional risk registers.

• The trust collected, analysed, managed and used information well to support its activities. Most records were paper based and when electronic systems were used, security safeguards were in place.

• The service was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

However:

• Our inspection identified some concerns with the suitability of the premises and equipment and maintenance. The airflow exchange in parts of the operating theatres did not meet with Department of Health guidance. Storage areas were limited and some pieces of equipment were found in corridors and spaces designed for patients. Equipment suitable for the care of bariatric patients was not available at Solihull hospital and therefore equipment had to be supplied from another of the trust hospital sites, or the patient cared for at an alternative site. We found some consumables stored on the wards that were past their expiry dates and a resuscitation trolley in the day procedures unit was not always checked daily when the unit was operational.

• Staff did not always complete the necessary risk assessments for each patient. Assessment of patient’s risk of venous thrombo-embolism (VTE) were not consistently completed. Staff adherence to the use and principles of the surgical safety checklist was variable and could be improved. The consistent use of the checklist is key to eliminating surgical errors.

• Medicines were not always managed safely. The temperature of refrigerators used for medicines storage on the wards were not monitored consistently and when they were above recommended limits, action was not always taken to report this to pharmacy. Systems in place for antibiotic stewardship were not fully established.

• Managers investigated incidents however, they did not always ensure that lessons learned were fully implemented.

• There was a lack of audit of practice in theatres against the national standards for safe per-operative practice.

• Patient feedback about the quality of the food and choice was variable and they told us this affected the amount they ate.

• There was limited access to a face to face interpreter and important information was communicated by telephone. Staff awareness of the adjustments that could be made for patients with complex needs was sometimes limited.

• However, complaints were not always closed within the 30 working day timeframe stipulated in the trust complaints policy.

• Staff above band seven were mainly based on other hospital sites and this sometimes impacted on their visibility and support.

• There was little engagement or understanding of governance issues below band seven level or by junior doctors.