HCA Healthcare UK The Harborne Hospital

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• 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated Good. This meant people 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 provider had a proactive and positive culture of safety, based on openness and honesty. We heard from multiple staff that when a new procedure was to be undertaken how the multidisciplinary team held a scenario-based meeting to walk through the steps involved so that all those involved were aware of the new procedure and their role in this. This also highlighted additional needs which could be met prior to the actual procedure taking place. Staff knew how to report incidents. Between April and September 2025 there had been 9 incidents reported in the chemotherapy day unit and 16 in medical patients within the in-patient wards since the hospital had been opened. 80% of the incidents were graded no harm and 20% low harm. Staff listened to concerns about safety and investigated. 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. Lessons were learnt to continually identify and embed good practice.

Staff understood the duty of candour and applied this wherever necessary. Whilst not relating to this service we heard about a time when this had been undertaken. The patient and family had been given a full explanation of the situation and actions taken. Staff told us and two meetings we attended discussed a medical patient who had died unexpectedly. Actions taken were reviewed and feedback given to external parties involved. Staff and the patients family were supported at the time. There was further support available to staff through a staff assistance process and there was further discussion about the use of a counsellor should staff wish to access this service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. The service requested from the consultant that a booking form was completed and a copy of the outpatient assessment was available prior to the patient being admitted. This meant that staff were fully aware of the requirements of individual patients. There was a central facility which managed routine and urgent admissions. They liaised with all appropriate people involved in the provision of care and the patients to ensure a seamless journey into the hospital. The senior nursing team supported the central team in determining that patients met the criteria for admission to this hospital. They made sure there was continuity of care, including when people moved between different services. Some patients were transferred in from NHS services. This was not always a local NHS service. 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 provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Within the medical service many patients were undergoing treatment for cancer. Staff spent time with them to understand how they were feeling and what their needs were to feel safe within the service and at home. The team had access to counselling services for patients if they felt frightened or vulnerable. 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. Staff were trained in safeguarding processes and able to identify patients who may be vulnerable. The provider shared concerns quickly and appropriately. We heard about a patient who attended with an elderly carer who due to the circumstances may be at risk of neglect. The staff referred this patient and their carer to the patients local social services safeguarding department for review and support.

Staff worked with people to understand and manage risks by thinking holistically. Nursing staff conducted an assessment of a patient on admission for treatment, highlighting what was normal for the patient and any current deviations from this. A plan of care was developed following this assessment. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Patient feedback forms were given to all patients. These demonstrated that 100% of patients using the chemotherapy day unit answered yes definitely or yes to some extent when asked the question about involvement. Staff discussed patients’ treatment with them and allowed them to make advanced decisions on care. These were reviewed as a patient’s condition changed or as required by the patient. Patients told us that the clinical nurse specialist and the person’s consultant were always available to discuss any concerns or queries they had. Sometimes this was undertaken remotely.

The provider detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care. We saw that there were appropriate planned preventative maintenance schedules in place and that equipment was checked regularly. Annual portable appliance testing occurred, and we saw labels on equipment stating the date of the last test. We saw that patient bedrooms had a solid door in place. Staff told us that they were able to observe patients remotely if on cardiac monitoring or they asked patients if they wanted the door left open. One patient told us that at times they felt isolated due to the door being closed. Nurses told us that they were frequently in and out of patient rooms so could observe patients. The service used several systems as described below to ensure that there were sufficient staff on duty. The ward team used a system where they made sure that the sickest patients were closest to the administration area of the ward so that they had line of sight of these patients. Patient rooms had integral bathrooms including some within the endoscopy suite. Call bells were provided in all areas, and we saw that these were responded to in a timely manner.

All leaders monitored staffing levels to make sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. There were twice daily staffing meetings to review the numbers and complexity of patients and the staff on duty. At this meeting the planned activity and staffing levels were reviewed to ensure that they meet the needs of the department. Staff took into consideration the number of patients currently on the ward, the number of admissions and discharges, the acuity of the patients and the number of patients that will be on the ward at midnight. The service reviewed nursing hours per patient day, and this highlighted how much time nurses spent on face-to-face patient duties. We saw that the patient to care giver ratio varied depending on the number of patients from 0.8 to 3 patients per care giver on day shifts and slightly more on night shifts. Care givers were all nursing staff when we inspected. The service used an IT platform to monitor activity over time. This allowed them to assess when they would require extra staff. Whilst the hospital had been commencing business the number of staff was flexed to meet the growing needs. This included the use of bank staff known to the hospital. However, all the senior team we spoke to recognised that the hospital was at a point where increased staffing had become necessary to meet the needs of growing numbers of patients The turnover rate in the past 12 months is 0%.

The service employed staff with additional experience in oncology. Five staff on the chemotherapy day unit had additional training to administer systemic anti-cancer therapy (SACT) therapy. The hospital had three clinical nurse specialists who focused on patients living with cancers and a matron with additional qualifications in oncology nursing. This meant that patients had access to experienced nurses who understood their care, treatment and any side effects that they may experience. All staff worked together well to provide safe care that met people’s individual needs. All staff shared their knowledge and experience with other nursing staff to ensure that patients could engage with any nurse on the inpatient ward.

The service assessed and managed the risk of infection. We saw cleaners in various areas and cleaning schedules for the ward area. Cleaning staff logged when they had cleaned an area and any issues with this. All areas were visibly clean and well maintained. They detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly. Patients had their own rooms and bathroom facilities and infectious diseases or patients who were immunosuppressed could be nursed in positive or negative pressured rooms, as there were two on site. Staff followed infection prevention and control (IPC) guidance, washed hands between patient contact and wore appropriate Personal Protective Equipment (PPE). All staff were bare below their elbows and items of equipment carried labels that informed staff and others that they had been cleaned. Data showed that there had been no infections such as MRSA, E Coli or C Difficile at the hospital.

Staff followed good practice in medicines management including transport, storage, dispensing, administration, medicines reconciliation, recording and disposal. They did it in line with national guidance. The service had a contract with the local NHS supplier of chemotherapy and other systemic anti-cancer therapy (SACT). They followed standard protocol of testing a patient’s bloods to ensure that patients were fit to have treatment. This consisted of near patient testing and sending bloods to the local pathology laboratory for further testing. Following this the patient’s individual treatment was made up. This was then transported to the chemotherapy day unit for administration. There were strict rules for the use of systemic anti-cancer therapy. New medicines and any deviation the providers formulary would have to have research evidence to support its use and be approved by the multidisciplinary team. The pharmacy department had a dedicated oncology pharmacist who reviewed all prescriptions. Cooling caps were available to patients’ receiving chemotherapy. Chemotherapy patients had a Systemic Anti-Cancer Therapy passport in case they were admitted elsewhere as an emergency.