HCA Healthcare UK The Harborne Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. We looked at four patient records and found that they had a comprehensive health assessment of the patient soon after admission. Care plans described the needs of the patient and how staff could assist the patient. Care plans were personalised and holistic. They were updated as necessary. There were notes of the visits by the oncology or general resident medical officer. However, there were no records of face-to-face consultant care in two of the records we reviewed.

Staff planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. There was a dietician available for all patients to assist them to stay at optimal nutrition and hydration. Staff were able to meet individual dietary needs of patients. However, patients were also enabled to supply their own food. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Staff came from a variety of backgrounds such as oncology and gastroenterology specialities. They shared their knowledge and experience with other nurses on duty. Managers provided new staff with appropriate induction and supervision. There were multidisciplinary meetings about cancer care and individual care requirements. This enabled all consultants to support their patients by reviewing all options of care. When unexpected events occurred, senior managers ensured that staff had time to reflect and acknowledge when times were difficult. Personal support was provided to staff. The senior team were very supportive of staff undertaking professional development. We heard that one member of staff wanted to be a clinical nurse specialist, and this was positively encouraged through support at course attendance.

Managers ensured that information flowed through to all staff. This occurred following the safety huddle twice a day on the ward. The safety meeting was held across the service and the ward leaders met with the ward team to disseminate the information from this. The percentage of staff that had had an appraisal in the last 12 months was 100%. However, staff did not feel that they had to wait for an appraisal to identify learning needs and managers provided them with opportunities to develop their skills and knowledge. There were a variety of online learning platforms that staff could use to develop their skills and experience to enhance their development. Managers dealt with poor staff performance or staff that did not fit with the organisation’s values promptly and effectively.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. There were mostly effective handover procedures when patients moved from day case treatment suite to inpatient or from the day case unit to the endoscopy unit. We spoke with one patient who had not experienced good access to advice following discharge and had been unable to access specialised care whilst an inpatient. The service was aware of this complaint and were dealing with this. All staff at the unit had good working relationships with other departments. We witnessed staff discussing a patient who would be transferred from one service to another and heard this encompassing all relevant information. Ward staff held handover meetings at the beginning and end of each shift. In endoscopy a World Health Organisation (WHO) checklist was completed for each patient. The specific needs of endoscopy patients were discussed alongside the expectations of the procedure. This ensured that equipment was prepared, and staff were aware of why the procedure was being undertaken.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. Patients had access to physiotherapy services, a dietician and other support services to promote people to maximise their wellbeing and independence. On pre-assessment patients were informed of issues they could address to improve their lives such as smoking cessation and improved diet. The endoscopy manager sent out information leaflets around healthier living to patients pre-admission and talked through these at pre-assessment. Patients were involved in planning their treatment and care and were able to chose options for care and treatment with the advice of the consultant and the hospital team.

Staff routinely monitored people’s care and treatment to ensure the best outcomes for individual patients. Staff used nationally recognised systems to identify when a patient may be deteriorating and acted upon this. An outreach service was contracted to review patients’ staff were concerned about. However, the hospitals intensive care unit staff also provided this function when able. An onsite resident doctor was available 24 hours a day and had access to the patient’s consultant whenever a patient had been admitted. A service level agreement was in place to undertake diagnostic tests not available on site and the results of these were made available in a timely manner. Due to radiotherapy being provided by a third party on site, the service had quick and easy access to this and other imaging services.

Policies and treatment guidelines that we reviewed were in line with national guidance and expectations.

Staff told people about their rights around consent and respected these when delivering person centred care and treatment. The chemotherapy day unit utilised the Cancer Research UK consent form for Systemic Anti-Cancer Therapy (SACT). Cancer Research UK produce national standardised SACT regimen-specific consent forms which are based on research and promote both best practice and safer administration of SACT.

The endoscopy unit used standardised consent forms for patients which were mostly completed prior to admission. The endoscopy manager spoke to patients prior to admission to answer any questions they may have. Patients generally asked about pain and were reassured that their comfort, sedation and/or pain relief was monitored during the procedure. The hospital operated a stop policy which meant that if a patient said stop during the procedure, the procedure would be paused and a discussion had with the patient.