Archived: Solihull Hospital

The ratings in this report were awarded as part of a pilot scheme to test CQC’s new approach to rating NHS hospitals and services.

Solihull Hospital is the smallest of the three hospital locations run by the Heart of England NHS Foundation Trust. It provides general and specialist hospital and community care for the people of East Birmingham, Solihull, Sutton Coldfield, Tamworth and South Staffordshire. Solihull Hospital has approximately 229 beds and provides elective surgery, general medical and minor injuries services on this site. Solihull Hospital also has the recognised stroke unit within the three hospitals, providing out-of-hours stroke treatment service. There are no children’s services on site; unwell children who present themselves to A&E are assessed and transferred to Birmingham Heartlands Hospital.

We inspected the Heart of England NHS Foundation Trust as part of our new in-depth hospital inspection programme. This programme is being tested at 18 NHS trusts across England, chosen to represent the variation in hospital care across England. Before the inspection, our ‘Intelligent Monitoring’ system indicated that the Heart of England NHS Foundation Trust was a medium-risk trust. The trust had a longstanding history of struggling with turnaround times in the accident and emergency (A&E) department. The management team had put initiatives in place to reduce the amount of time people were waiting in A&E but these had not yet had an impact.

Before the inspection, we looked at the wide range of information we held about the trust and asked other organisations to share their knowledge and experience of it. We carried out announced visits to the Heart of England NHS Foundation Trust between 11 and 15 November 2013. We looked at patient records of personal care or treatment, observed how staff were providing care, and talked with patients, carers, family members and staff. We reviewed information that we had asked the trust to provide. Before visiting, we met with four local groups of people to gain their experiences of the trust, and during the inspection we held three listening events, one near each hospital location, so that we could seek the views and experiences of people using the service. We spoke to more than 60 people through these listening events.

The Heart of England NHS Foundation Trust, across all the three sites, is below the national average in the Friends and Family Tests introduced in both A&E and inpatients. This means that patients the numbers of patients who were likely to recommend the trust to a family member or friend was low. This was in contrast to the positive feedback from patients during the inspection, who felt that, overall, care was responsive and provided in a sensitive and dignified manner, despite caring staff being busy.

This hospital has been inspected four times. The first inspection took place in August 2011 and was found to be not meeting the standard on management of medicines. There were two inspections in 2012 – in the second of these we found the hospital was not meeting the standard on respecting and involving patients. The last inspection was in March 2013 and the hospital was meeting all the standards we inspected.

We visited Solihull Hospital on 15 November 2013. The inspection team visited the A&E, medical and surgical wards, the critical care unit and the midwife-led maternity unit. Additionally, focus groups were held with consultants, junior doctors, nurses, allied healthcare professionals such as physiotherapists and occupational therapists and non-clinical staff. We carried out an unannounced visit to the hospital on the evening of Saturday, 23 November 2013. During this visit we inspected the A&E, acute medical unit, critical care unit and some of the medical wards.

The current arrangements for A&E services at Solihull Hospital is in effect a minor injuries unit and a medical assessment unit jointly bearing an A&E sign. The provider and commissioners should work with the local community and other stakeholders so that it is clear to the public what services are provided at Solihull Hospital, from a safety perspective this is particularly true around children's services. In view of the above we do not feel it would be appropriate to rate this service as an A&E department.

An acute medical unit (AMU) received ambulances and emergency medical patients and was run as a medical A&E unit. The local ambulance service was aware of this and thus diverted patients and children with non-medical conditions (that is, patients with suspected surgical complaints, children and trauma patients) to Birmingham Heartlands Hospital.

This department, while safe on the day we visited, had a lack of resources to be a medical A&E, was not staffed as an A&E (that is, it was run by medical doctors and nurses without specific A&E training) and did not undertake the monitoring that we would expect an A&E unit would. Unlike all A&E departments across the country, the acute medical unit is not ‘on the clock’. This means that the staff are not accountable to see and treat their patients within four hours. Although the standard operating procedure states that any patients who are in the unit for longer than four hours should be moved to a separate area (called AMU 2), when we visited, this area had been closed because of a lack of available nursing staff. Many of the patients we saw in the unit had been there longer than four hours, and it was not clear how this was being monitored on a daily basis. Doctors we spoke to said it was not uncommon for patients to wait longer than four hours to be seen and, although we had no direct evidence that this was unsafe because they would have regular observations performed, this was not a responsive or patient-centred service. Ambulances were sent to the unit with patients with chest pain and could potentially arrive with a condition that required surgical treatment when no complex surgery was undertaken at the unit. This patient would then be transferred to another hospital.

We also found that critical care services provided at Solihull Hospital were below the level they needed to be. While no complex surgery was carried out at the hospital, this three-bedded area provided level 2 care for two cardiology patients with one bed identified as a high dependency bed (suitable for patients requiring more intensive monitoring or single organ support). Although the staff were skilled at looking after cardiology patients, they did not appear to have had sufficient high dependency training for the type of patients that could potentially be admitted to the unit. The unit also admitted surgical patients who had patient-controlled or epidural anaesthesia despite the fact that not all of the staff were necessarily trained to look after this type of anaesthetic.

Patients were seen on a daily basis (at weekend by a registrar only) but, on the day we visited, we found that notes were not always clearly transcribed and staff were unclear as to who had written them and what time they had been reviewed. We also noted on our unannounced inspection that only 11 of the 25 members of staff on the list to have their competency training package completed had signed to state that they had begun working on this. A responsibility of the nurses on the critical care unit was also to observe the electronic monitoring of up to six patients on an adjoining ward. However, this was not always possible when providing care for patients within the critical care unit. These patients were on an adjoining ward with a full complement of staff.

Staff working on the Solihull site told us they were only given one opportunity to rotate within the wider critical care directorate to ensure that their skills were updated and enhanced, but that this was only for one week and it was not clear if it was a regular event or a one-off.