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

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 Diagnostic Imaging service. This key question has been rated good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this. However, there were no formal systems in place to oversee patient bookings and waiting times, reducing assurance that delays which could impact patient outcomes were identified and addressed.

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 usually made sure patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Daily safety huddles were held at the start of each session to review the patient lists. During these meetings, staff discussed any additional requirements, such as mobility support, the need for a wheelchair, or whether patients required communication support where English was not their first language. This helped the team prepare and ensure appropriate support was available.

Referral information and safety questionnaires were reviewed before imaging procedures to confirm the requested scan was appropriate and to identify any risks or individual patient needs.

During the assessment we observed staff checking patients’ mobility and support needs prior to imaging. Patients were assisted with positioning and made comfortable before examinations began. For example, during an X-ray procedure that required the patient to stand, the radiographer confirmed that the patient was able to stand safely for the duration of the examination before proceeding.

Throughout the assessment, we observed consultants and radiographers checking with patients during procedures to ensure they remained comfortable and understood what was happening during their examination.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Policies and standard operating procedures supported evidence-based practice and the safe use of radiation within the diagnostic imaging service. Staff understood processes which were in place to ensure radiation exposure was optimised in line with national guidance.

Staff were encouraged to participate in continuing professional development (CPD). The department held clinical audit days and aligned learning opportunities with professional events such as Health and Care Professions Council CPD week.

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.

Radiology staff worked well with other professionals including consultants to support the delivery of patient care. Staff told us there was good communication within the team and that information about patients was shared during daily safety huddles to ensure staff were aware of any specific needs or operational pressures.

The radiology team also described positive working relationships with staff across the wider hospital. Staff gave an example of a period of heavy snowfall when some hospital staff were unable to travel to work. During this time, radiographers volunteered to support the housekeeping team with cleaning theatre areas to help ensure services could continue to operate.

Radiology staff held monthly team meetings where operational issues and service developments were discussed. Staff told us they felt comfortable raising concerns or suggestions during these meetings and felt their views were listened to.

Staff also described a flexible approach to working arrangements, which helped the team respond to changes in service demand and support the smooth running of the department.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Opportunities within diagnostic imaging to directly promote health and wellbeing were limited due to the nature and duration of patient interactions. However, during the assessment we observed staff offering health advice where appropriate.

The provider also promoted wider health education through public engagement events, such as the Upper and Lower Limb Patient Information Morning. These events included guest speakers who shared information on specialist topics, providing members of the public with opportunities to learn about specific conditions, preventative care and general wellbeing. Such initiatives supported the hospital’s aim to encourage proactive management of health within the community.

However, there were no noticeboards or health promotion leaflets available within the diagnostic imaging department. This limited opportunities to promote wider health awareness or provide patients with discreet access to information they could take home and review independently.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The service undertook a range of audits to support improvement within the diagnostic imaging department. These included a “grammatical quality audit”, which reviewed the quality of patient radiology reports and demonstrated 100% compliance and completeness in 2025. Patients were also given opportunities to provide feedback on their experience of the service. However, several areas had not yet been subject to audit, particularly those relating to appointment booking and scheduling processes. In addition, there was no formal departmental peer review process in place for radiology reporting. The radiologist lead told us that although there was no structured peer review programme, radiologists would seek a second opinion from another consultant if they were unsure of a finding. They described a supportive culture where colleagues were willing to provide advice and said this was an area the department could consider developing more formally. The provider told us that any discrepancies found in the images are recorded and logged as incidents. Breast screening mammograms are double reported, and if a discrepancy arises and the two consultants cannot agree, the case is referred to a third independent radiologist, who is not connected to the hospital, for a final decision.

The service monitored diagnostic reference levels (DRLs) to support optimisation of radiation doses. DRLs were audited and staff told us that learning from these audits had led to improvements in practice, including optimising the use of grids and reviewing imaging techniques to help reduce radiation exposure.

To support quality and continuous improvement, the department conducted multiple clinical audits. Examples included a mammography equipment audit with positive results and a CT cardiac contrast audit that was ongoing at the time of the assessment. Staff also described planned audit work, including a review of mobile chest X-rays carried out in the intensive care unit.

Additional audit activity included a quarterly ‘pause and check’ audit reviewing areas such as pregnancy checks, environmental safety, Patient Group Direction compliance and cannulation practice. The service also carried out regular checks of controlled area lighting and a biannual radiology report audit which reviewed elements of reporting quality such as scan phases, contrast use and conclusions. An annual inspection of lead protection equipment was also undertaken.

Following the assessment, the provider submitted information relating to complaints received within the diagnostic imaging service over the previous 12 months. This showed that two complaints had been received, both relating to the booking process. In addition, results from the Quarter 4 2025 patient survey indicated that the question “Please rate the ease of booking your imaging appointment” received 83.33% of respondents rating this as “excellent” or “very good” out of all valid responses.

Staff also told us that on occasion consultants would attend the department and request that their patients were accommodated outside of the usual booking process. Staff said they sometimes felt obliged to agree to these requests. They explained that this could impact the planned patient list, potentially causing delays for other patients and dissatisfaction where waiting times increased.

Staff told us they attempted to keep patients informed of any delays and offered alternative appointment times where patients were unable to wait. However, there were no formal audit processes in place to monitor booking accuracy, scheduling pressures or delays. In addition, the service had recently introduced a same-day scan pathway but did not have monitoring or audit processes in place to demonstrate whether this approach was effective. As a result, leaders had limited oversight of booking processes and were unable to identify trends or implement targeted improvements. However, leaders advised that if any issues arose in relation to booking, these would be formally recorded as incidents and subsequently investigated. They also confirmed that weekly meetings were held with booking team leaders to review booking activity.

The provider told us the diagnostic imaging department were operating below planned capacity which created gaps between scheduled appointments and enabled the department to accommodate walk-in patients, meaning patients were generally seen shortly after arrival. We were told wait times were minimal; however, wait times were not routinely monitored or audited.

The service told patient about their rights around consent and respected these when delivering person-centred care and treatment.

Staff told us they understood how to obtain informed verbal and written consent from patients before commencing imaging procedures. The service informed patients of their rights in relation to consent and respected these when providing person-centred care and treatment.

We reviewed patient records and found that consent was documented appropriately. During the assessment we also observed staff obtaining informed consent during patient interactions. For example, we observed radiology staff explain an ultrasound procedure to a patient and obtain consent before proceeding with the examination. Staff also asked whether the patient would like a chaperone. Similar practice was observed for other imaging procedures including CT, MRI and X-ray. In all cases, staff provided clear explanations about the procedure being undertaken before proceeding.

Training records showed that 100% of diagnostic imaging and surgical staff had completed training on the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).