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

This means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this outpatient service. This key question has been rated good.

This meant people were safe and protected from avoidable harm.

The service did not consistently demonstrate effective arrangements for the management of patient information or for maintaining service oversight. Consultants often took their handwritten notes off site, increasing risks to confidentiality. Oversight arrangements for patient bookings and waiting times were not robust, particularly where delays may adversely affect patient outcomes

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.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service investigated and documented complaints in accordance with the complaints policy, using them as opportunities for organisational learning. Complaints were resolved appropriately, and lessons learned were systematically identified, shared, and embedded into practice. Evidence of this learning culture was demonstrated through department-specific meeting minutes provided following the assessment, which showed reflection, discussion, and actions taken to improve the service.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong. Staff demonstrated clear awareness of which incidents to report and how to escalate them in accordance with hospital policy. They reported raising concerns appropriately and submitting incident and near-miss reports as required. Staff confirmed they received feedback on incidents they had raised, and that learning was disseminated through monthly governance meetings, daily safety huddles, and email communication.

Between April and September 2025, 20 incidents were reported in the outpatient department. All were categorised as low risk or “no harm caused.” Actions taken and lessons learned were clearly documented, providing assurance that learning has been embedded to reduce future risks.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

In outpatients, the service continued to rely on handwritten patient notes, although senior leaders told us that work was underway to transition to an electronic documentation system. Consultants often took their handwritten notes off site so their medical secretaries could type them up and return them via email. Staff reported that, while this process sometimes resulted in delays in receiving documented information, they mitigated this by contacting the consultant or their medical secretary directly whenever clarification was needed. This ensured staff could obtain essential clinical details, such as wound care instructions, even when typed notes had not yet been returned. Senior leaders acknowledged the challenges associated with handwritten documentation and confirmed that steps were being taken to reduce reliance on paper records.

Consultants operated with a high degree of independence, including having their medical secretaries manage their bookings. This arrangement limited the service’s oversight of patients’ care journeys and created inconsistencies in the flow of information. The service told us that they did not audit booking issues, long waits or delays. Although medical secretaries and consultants worked closely with the service’s call centre, which monitored cancellations, this did not provide full visibility of consultant-led bookings.

These factors increased the risk to safe systems, pathways and transitions because the service did not have sufficient oversight of consultants’ activity or real-time access to appointment details and documentation. Without this visibility, the service could not reliably monitor patient flow, identify delays or ensure that relevant information was available to staff at each stage of the patient journey.

During the assessment, we observed several examples illustrating the impact of this limited oversight. One patient waiting in outpatients had been given a different appointment time by the consultant’s secretary than the time recorded by the service. Staff promptly spoke with the patient, who agreed to return a little later. In another instance, a patient attended for an appointment arranged by a medical secretary but not entered into the booking system, meaning outpatient staff were unaware of their attendance until alerted. Once notified, the medical secretary updated the system and the patient was seen. Additionally, in March 2025, a patient complained after waiting 30 minutes for an appointment and subsequently learning that their consultant was not working that day and was unaware of the booking. The service handled this complaint appropriately and in line with their complaints policy.

As the service did not audit booking issues, long waits or delays, these incidents were not routinely captured, and leaders were not aware of the underlying causes. Without this information, the service could not identify patterns, understand recurring issues or implement targeted improvements. Staff told us that when appointment issues occurred, they always spoke with the patient to agree a suitable solution. If a patient wished to cancel their appointment on the day, staff offered to reschedule it at a time convenient for them.

In response to the concerns raised after the assessment, the service acted promptly and demonstrated a proactive approach to improvement by introducing routine audits of outpatient bookings and implementing an electronic system for securely storing patient notes.

As part of our review, we requested the patient experience dashboard. In September 2025, 89.2% of patients responded “yes” to the question, “Were you seen on time?” or reported being seen within 15 minutes of their scheduled appointment.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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.

Patients we spoke with during the assessment told us they knew how to raise concerns if they did not feel safe or were worried about the safety of others. They said they would feel comfortable approaching any member of staff if they had an issue and reported feeling safe and well supported in the environment.

Staff demonstrated a clear understanding of safeguarding and were able to explain how to raise a referral and who to inform if they had concerns. Nursing staff received role-specific training on recognising and reporting abuse. Following our assessment, the service provided an updated training matrix confirming that, as of September 2025, 95% of staff across Outpatients, the inpatient medical ward and the Chemotherapy Day Unit had completed the required online safeguarding training for adults and young people as part of their mandatory training. In addition, 93% of staff had completed the Oliver McGowan Mandatory Training on Learning Disability and Autism.

We reviewed the service’s safeguarding policy, which was in date and ratified. It outlined referral pathways and detailed the key indicators staff should look for when identifying potential safeguarding concerns. This was demonstrated in practice when outpatient staff identified a patient with additional care and safety needs, sensitively explored the situation, and escalated concerns to the safeguarding and site lead. They worked with the patient to put support in place, including a referral to the local authority, and stayed beyond their shift to ensure the patient was safe. This example highlights strong safeguarding awareness and a commitment to responsive, joined-up care.

We scored the service as 3. The evidence showed a good standard. 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.

Staff demonstrated a clear understanding of how to respond to a deteriorating patient and were able to identify where to locate the relevant deteriorating patient policy. At the time of assessment, 92% of staff had up-to-date training in Adult Basic Life Support (BLS), and 100% of non-clinical staff had completed the BLS e-learning module.

Outpatient nurses met twice daily, before the start of clinics, to review scheduled treatments, discuss capacity and staffing issues, and identify any pressures on the service.

Following the assessment, we requested the most recent audit reports for Outpatients. These included the WHO documentation checklist, which demonstrated 100% compliance.

Patients we spoke with told us they were involved in decisions about their treatment and felt well informed about the care they were due to receive or had already received. This aligned with our observations of outpatient appointments, where consultants allowed time for questions, did not rush consultations and clearly explained treatment options to support informed decision-making. Consultants also gathered relevant information from patients to assess risk and provided clear explanations about any associated risks.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment was visibly clean and largely clutter-free, with furnishings in good condition. The waiting area for outpatients was located outside the outpatient department, within a general area of the hospital. This meant clinical staff did not have direct sight of patients as they arrived, which presented a potential risk if a patient deteriorated or required immediate assistance. Although patients who attend outpatient appointments are typically not acutely unwell, the service had appropriate mitigations in place. Outpatient nurses were located nearby, and non-clinical staff overseeing the waiting area were trained to summon help in an emergency. Reception staff had access to a panic button to alert clinical teams, and emergency bags, equivalent to resuscitation trolleys, were positioned behind the desk for rapid access.

The service had sufficient and suitable equipment to support safe patient care. Staff were trained in its use, equipment was appropriately maintained, and consumables were in date. Most portable electrical equipment had been safety tested, and servicing schedules were clearly displayed.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff and consultants worked well together to provide safe care that met people’s individual needs. The service also operated a chaperone service to support patient dignity and safety. Staffing levels were planned in line with the number of clinics running each day, with daily huddles held to review staffing, clinic activity and any operational pressures.

The service did not routinely use agency or bank staff; however, staff told us that an induction process was in place for any temporary staff who had not previously worked at the service.

Leaders described robust governance processes for consultant recruitment and practising privileges. This included rigorous background checks, sign-off by the relevant specialty leads, and approval through the Medical Advisory Committee. Leaders also confirmed they do not appoint surgeons who have not been practising for at least two years.

At the time of our assessment, the outpatient department employed only registered nurses and was gradually increasing the number of clinics being delivered. Senior leaders recognised the associated staffing risks and told us they were preparing a business case to recruit healthcare assistants as activity continued to grow. In the interim, nurses from other departments, such as Urgent Care, supported outpatients when additional cover was required.

Compliance with appraisals was 100% at the time of our assessment. Staff reported receiving regular appraisals, which provided opportunities to discuss learning and development needs, and said they were supported to take study days.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Following the assessment, we reviewed cleaning logs for August and September 2025, which showed 100% compliance. However, during the assessment we observed that not all equipment displayed green “I am clean” stickers, meaning at first glance staff could not be assured that items had been cleaned between patients and were ready for use.

We observed effective infection prevention and control (IPC) practices, including appropriate management of hazardous waste and sharps. A dedicated housekeeping team-maintained cleanliness and hygiene across the environment. Good hand hygiene practice was embedded in daily routines and supported by regular training and auditing. Post-assessment, the service provided mandatory training data showing that 93% of clinical staff across Outpatients, the inpatient medical ward and the Chemotherapy Day Unit were compliant with IPC training, along with 100% of non-clinical staff.

Clinical waste was disposed of safely. Domestic and clinical waste bins were clearly labelled and emptied regularly, and sharps and hazardous waste containers were stored appropriately. However, due to the increasing volume of clinic activity, the outpatient area was becoming constrained for space.

Staff worked in line with a range of policies and standard operating procedures (SOPs), which supported consistent and safe practice. Policies were also in place to guide the management of outbreaks and emergencies.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

There were systems and processes in place to ensure medicines were prescribed safely for people attending outpatients. Patients received clear information about their medicines, including how and when to take them. The onsite pharmacy supported outpatient dispensing and provided advice to both staff and patients on prescribing, administration and potential side effects. All controlled drugs for outpatients were dispensed by the hospital pharmacy, ensuring appropriate oversight, governance and documentation. Staff told us they could escalate any medicines-related concerns and receive timely feedback through daily huddles, which supported safe and consistent practice.