HCA Healthcare UK The Harborne 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

Leaders had created a positive and proactive culture of safety-based openness and honesty. Concerns about safety were fully investigated. The managers’ ensured lessons were learnt to identify and embed good practices. There was a very positive learning culture with staff managing incidents and safeguarding patients well. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. There were processes to ensure the service had enough staff with the right training, skills and qualifications to keep patients safe.

This is the first assessment for this service. This key question has been rated good. This meant patients were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff knew how to raise incidents and concerns and they were reported on an electronic system and managers were alerted immediately. Incidents and complaints were reviewed daily at the staff huddles and fully investigated. Lessons were learnt to continually identify and embed good practice.

Patients experienced care based on the latest updates and learning which followed national updates and safety incidents. Patients and staff were encouraged and supported to raise concerns. They felt confident they would be treated with compassion and understanding and would not be blamed or treated negatively if they did so.

Staff understood the duty of candour and applied this wherever necessary.

Between April and September 2025 there had been 61 incidents reported in the ICU. Themes included medication errors, unplanned admission to ICU and issues with blood samples that were sent to the local trust. We saw each incident was investigated, actions taken and lessons learnt to continually identify and embed good practice. Following an incident of a pressure ulcer in the ICU a shared learning presentation was developed, this included details of the incident, actions taken, patient management, lessons learnt and education on pressure ulcers. A weekly Complaints, Litigation, Incidents and Patient Experience (CLIP) meeting was held to review incidents and share lessons across the hospital and with external partners.

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.

Safety and continuity of care was a priority throughout patients’ care journey. This happened through a collaborative, joined-up approach to safety that involved patients along with staff and other partners in their care. Patients care was discussed with the multidisciplinary team and planned to ensure all needs were met. Patients were assessed at preoperative assessment and consultants and nursing staff would discuss the care of the patient throughout their stay. There was a standard operating procedure (SOP) for admissions to the intensive care unit (ICU) this included the different levels of care provided, admission criteria, transfer information, communication and medical management requirements.

The SOP for discharge from ICU, included roles of staff involved in the patient care, a discharge criteria and process. When patients were transferred back to the ward there was a verbal handover and written information. Nurses and the Resident Doctor (RD) from intensive care would hand over to the RD working on the ward and nursing staff on the ward.

Some patients were transferred in from NHS services that was not always the local trust. They made sure there was continuity of care, including when people moved between different services. The team ensured the suitability of the patient for the hospital and appropriate handover of the patient to ensure the safety of the patient.

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.

Staff understood their safeguarding responsibilities and knew how to take appropriate action when necessary. The provider had a clear safeguarding policy which was available for staff to access. The team had access to counselling services for patients if they felt frightened or vulnerable.

Staff received mandatory safeguarding children and adults training. All clinical staff were trained to level 3 safeguarding adults and level 2 children. The chief nurse and matron had Level 4 safeguarding training and staff knew to report any concerns directly to senior staff. They supported staff in escalating concerns and supported referral processes to the relevant local authorities.

Patients were supported to understand their rights, including their human rights, under the Mental Capacity Act 2005 and their rights under the Equality Act 2010. Staff understood the importance of supporting equality and diversity and ensured care and treatment was in accordance with the Act. Staff gave examples which demonstrated their understanding and showed how they had considered the needs of patients with protected characteristics.

There were no safeguarding incidents reported in the 12 months prior to our inspection.

Recruitment pathways and procedures were in place to ensure relevant recruitment checks had been completed for all staff. These included a disclosure and barring service (DBS) check, occupational health clearance, references and qualification and professional registration checks.

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.

Nurses worked in line with the UK Critical Care Nursing Alliance minimum standards. We observed level 2 patients (high dependency) receiving 1 to 1 nursing care with a supernumerary member of staff on duty.

Safety was a priority that involved everyone, including staff as well as people using the service. Staff made sure that people understood the care and treatment that was being provided.

We saw risk assessments such as venous thromboembolism (VTE), falls assessments and skin integrity were completed and documented in line with national guidelines.

Staff closely monitored patients so they could respond quickly if their health deteriorated. The service had a service level agreement (SLA) with the local trust to provide a critical care outreach team which attended when concerns were raised about patients care, this was in line with national guidance.

Nursing and medical staff working in the ICU all had advanced life support training (ALS). The RD had training in paediatric advanced life support (PALS), they also had training in difficult airways and experience of working in an intensive care environment. There was a dedicated resuscitation team that included the ICU nurse in charge, the ward nurse in charge, the ICU and ward RD on duty. In the event of an emergency the on-site resuscitation team would attend and the resuscitation team from the local trust would also attend.

Allied health professionals, such as physiotherapists attended the unit and were included in handovers to ensure that all staff involved in patient care were fully informed.

All staff had completed sepsis training; there was a corporate policy for recognition and management of sepsis and sepsis shock. In the last 12 months there had been no cases of sepsis reported. Staff we spoke with were aware of how to recognise sepsis and how and when to raise concerns.

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 suitable facilities to meet the needs of patients. The hospital was purpose built to meet the needs of patients. There was adequate car parking directly outside with access from the front and back of the building.

The hospital was adjacent to a local trust and there was a link corridor so staff had direct access to the Harborne Hospital and could attend quickly if there was an emergency.

The building was new; the ICU was on the second floor with access via lifts and stairs. There was a waiting area for relative outside the unit with refreshments available. There was no dedicated relatives room, a consultation room would be used when required.

Access throughout the hospital was restricted with swipe card access. The unit had 6 single rooms all with ensuite bathrooms. Two of the rooms had negative and positive pressure, to allow for appropriate isolation of infectious patients, these had not been required in the last 12 months. The unit provided mixed sex accommodation for patients requiring high dependency and intensive care. All rooms had smart glass windows with shutters that could be closed inside and outside the room for privacy.

There was an enhanced care unit with 6 high dependency beds in single ensuite rooms adjacent to the ICU. This area was fully equipped and cleaned daily. This area was currently not being used for patient care, therefore we did not inspect this during this assessment.

The unit was visibly clean and tidy with appropriate equipment available to maintain safe levels of care. Sharps bins were available at all bedsides and were labelled correctly. Disposable curtains were used, dated and changed in line with guidance. Medical equipment in the ward area had been appropriately tested and was within date. Sterile equipment was stored off the floor on appropriate shelving and when we checked expiry dates, all equipment was in date. The linen room, storeroom and dirty utility room were all visibly clean and tidy and equipment was stored correctly.

The service had undertaken water testing, including legionella, water outlets and sinks were flushed to reduce the risk of legionella build-up in line with Health and Safety Executive guidance. There had been 1 positive result from a staff toilet sink, which was Pseudomonas Aeruginosa the filters had been changed and increased daily flushing, there had been no more positive results following these interventions.

Fire extinguishers had within date service checks and there were signs pointing out fire exits throughout the service. There were dedicated fire wardens on duty daily.

Substances deemed hazardous to health were locked cupboards in the utility room. This meant people using the service did not have access to substances which could damage their health.

Staff carried out daily safety checks of specialist equipment, such as the resuscitation trolley. Resuscitation equipment was easily accessible and located in the unit. Resuscitation equipment had been checked daily and an up-to-date checklist confirmed all equipment was ready for use. The local trust carried out monthly audits to check resuscitation equipment.

The unit had a difficult airway trolley and chest drain trolley with equipment ready to be used. There was a patient transfer trolley if a patient required transfer to the local trust, where monitors and oxygen could be attached.

There was a process to manage the safety, maintenance and repair of facilities, premises and equipment.

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

The service had enough staff to keep patients safe. The service employed permanent and bank staff. Managers limited their use of bank staff and used regular staff familiar with the service. All staff had a period of induction, and supervision where required, on commencing work at the service.

All nursing staff working in the unit had a post registration critical care course qualification, this exceeded the UK Critical Care Nursing Alliance minimum standards, which states that 50% of staff must be in possession of a post registration critical care award.

Each day the unit was staffed with a minimum of 2 staff nurses, 1 supernumery manager and the RD, regardless of the number of patients on the unit. The RD had intensive care experience and was on duty 24 hours a day, they worked 12 or 24 hour shifts and had a dedicated room for rest periods. The consultant responsible for the patients overall care was available 24 hours a day via telephone. There was an on-call consultant intensivist 24 hours a day, who carried out ward rounds twice a day when patients were on the unit. Generally, the unit would have 1 or 2 patients on the unit at any one time, if numbers increased the staffing levels would increase to reflect this. If there were no patients on ICU, 1 nurse would be re deployed to the ward but would move back if a patient was admitted. Rotas were completed 8 weeks in advance and staffing levels were reviewed twice daily.

RDs employed by the hospital had a 3-month probation period, full induction and training and annual appraisals. There was a rota for RDs and they attended weekly meetings, they had access to the medical director and could raise any concerns. When there was a cardiac patient on the unit an additional RD with cardiac experience was on duty for 48 hours post procedure.

Every morning, there was a daily operational meeting attended by a representative from each department to discuss staffing levels, activity and capacity. Staff could raise concerns about staffing levels and patients care.

There was a manager on call every day and out of hours on call for theatre teams, executive, senior nurse, pharmacy and physiotherapy if required and to raise any concerns.

The unit had support from specialist teams such as physiotherapy, specialist nurses and dietitians. Staff from other HCA hospitals also attended the Harborne Hospital when required.

Nursing staff had completed their Nursing and Midwifery Council re-validation checks and updates to develop their competencies.

All consultants worked for the service under practising privileges. The granting of practising privileges is a well-established process within independent healthcare whereby a medical practitioner is granted permission to work in an independent hospital or clinic, in independent private practice, or within the provision of community services. Practising privileges were overseen and approved by the medical director (MD) and medical advisory committee. The consultant liaison manger ensured consultants records were updated annually, including training and appraisals. They would raise any concerns or out of date data directly to the MD.

There were robust and safe recruitment practices to make sure all staff were suitably experienced, competent and able to carry out their role. We reviewed 4 staff documentation and found recruitment processes were in line with schedule 3 of the HSCA (RA) Regs 2014.

Staff received training appropriate and relevant to their role. All staff had an induction, and staff were provided with appraisals and supervision as needed. Staff could access mandatory training online and some face to face sessions. Managers received a monthly report to show compliance with mandatory training. Training compliance data showed 100% of staff had completed their mandatory training.

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.

All areas were visibly clean, tidy and had suitable furnishings which were well-maintained. There were adequate storage facilities, no items were stored on the floor. Storage areas were tidy and free from clutter.

The environmental cleaning was provided by housekeeping staff who had enough equipment and daily checklist. Staff carried out daily cleaning of the equipment and environment, this was documented daily. We saw cleaning and alcohol wipes were available throughout the service.

The service had an up-to-date corporate infection prevention and control policy which included information on roles and responsibilities, monitoring, training and the Infection Control Committee.

There were SOPs for hand hygiene, cleaning, personal protective equipment (PPE), waste, and decontamination.

Staff followed infection control principles including the use PPE. Hand-washing and sanitising facilities were available for staff and visitors. We observed staff using hand sanitising gel appropriately during the inspection.

The service performed consistently to a high standard for infection prevention and control, hand hygiene, waste, and sharps management. Audits were completed quarterly, and consistently 100% compliance for environmental cleaning and hand hygiene. We saw an action plan was in place to replace tiles in a patients bathroom following the environmental audit and this action was completed quickly.

One of the registered nurses who worked on ICU unit was also the infection control nurse for the hospital. They carried out audits and spot checks, attended the local infection control committee meeting which fed into the corporate infection control committee. They could access the corporate infection control lead for advice and support.

There was an SLA in place to provide microbiology support 7 days a week, virtual and via the telephone.

There had been no infections such as MRSA, E Coli or C Difficile at the hospital in the last 12 months.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely. Patients’ medicines were appropriately prescribed, supplied and administered in line with the relevant legislation, current national guidance or best available evidence.

Processes were in place for managing medicines and safe storage. Staff completed regular checks of medications and controlled drugs in line with the policy. Medications were stored in an air-conditioned room that required swipe cards for access. Medication locked cupboards required fingerprint identification to gain access, this enabled monitoring of who had access.

There were appropriate arrangements for the safe management, use and oversight of controlled drugs (CDs). CDs are drugs that are subject to high levels of regulation as a result of government decisions about those drugs that are especially addictive and harmful.

Each patient room had a locked medication cupboard on the wall to store patient medication safely.

Fridge temperatures were monitored electronically, and staff checked to ensure these were within the required range. We saw evidence these were monitored and recorded daily.

Staff completed medicines records accurately and kept them up to date. We reviewed 6 patients prescription charts and found all medication had been prescribed correctly and all entries had been signed.

The hospital pharmacist would visit the unit daily to review medication charts and prepare discharge drugs. The pharmacy staff would be alerted to any alarms from fridges or temperature controls and had processes to manage these. They had oversight of any medication incidents; these would be discussed at the daily huddles and operational meetings and fully investigated. Between April and September 2025 there had been 4 medication incidents in ICU. Themes included expired drugs and prescribing errors. We saw each incident was investigated, actions taken and lessons learnt to continually identify and embed good practice. Incidents were reviewed and discussed at the weekly CLIP meeting lessons shared across the hospital.

Quarterly audits were carried out for prophylaxis usage, CD management and treatments. Results were consistently between 90-100% compliance. Action plans were in place when required to remind staff about documentation and to follow guidance. This was discussed with individual staff, at staff meetings and at CLIP.