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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

This was the first inspection for the service. The key question of safe has been rated as good. This meant people were safe and protected from avoidable harm. There was a positive and proactive culture around safety, patients were protected from the risk of bullying, harassment, abuse, discrimination and avoidable harm and neglect. Staffing levels met the needs of patients at that time although there had been significant turnover and some services raised concerns over their staffing levels. Staff understood risk factors, however, not all were assessed in line with policy. Staff ensured people were protected from the risk of infection. Medicines were managed in a safe way which met patients’ needs

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 listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Safety was a top priority that involved everyone. All staff knew what incidents to report and how to report them. Staff raised concerns and reported incidents and near misses in line with the service’s policy. Staff spoke confidently about the incident reporting policy and what incidents to report[SH1] . Staff received feedback from incidents they raised.

Data from the service showed there were 106 incidents across the surgical service between June 2025 and January 2026. The majority of these incidents were graded no harm (87 incidents). The most common theme within the incidents was in relation to access, admission, appointment, transfer or discharge of patients. There had been no serious incidents or never events during this time.

There was a culture of openness, transparency and learning. Staff understood the formal duty of candour process and implemented this when required. When things went wrong, staff apologised and provided a full explanation.

Lessons were learnt from safety incidents raised. Staff told us there was a weekly complaints, litigation, incidents and patient experience (CLIP) meeting which reviewed incidents and shared learning across the service and hospital as a whole.

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 which involved staff and care partners. The service had worked collaboratively with the local acute NHS trust to ensure any patients requiring a continuity of care had arrangements made for them.

Staff told us there were strong links with both internal and external partners. This enabled any transitions and continuity of care to be managed in a safe and effective way.

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.

There was a strong understanding of safeguarding and how to take appropriate action. Staff were aware of the relevant safeguarding policies, which were based on national guidance and legislation and followed them if they had concerns.

There was a commitment to taking immediate action to keep people safe from abuse and neglect, which included working with partners. Staff were aware of who the safeguarding leads were within the hospital and where they were able to get support from.

Staff told us they rarely had the need to raise any safeguarding concerns themselves. However, they were able to share examples of when they had to act to ensure patients were kept safe. They had involved the safeguarding lead for the hospital for support.

Staff received safeguarding training specific for their role on how to recognise and report abuse. Training information provided by the service showed not all staff were required to complete all levels of safeguarding adult training and only specific staff were required to complete level 2 safeguarding children’s training. Safeguarding adult level 3 training was recorded at 88% compliance which was above the 85% target set by the service. Safeguarding children level 2 training was recorded at 92%.

Staff had a comprehensive knowledge about Female Genital Mutilation and actions they were required to take if they identified any concerns relation to this.

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 were aware of the Mental Capacity Act 2005 and completed patient assessments when concerns were identified about their capacity to make decisions about their care. There was an understanding of the Deprivation of Liberty Safeguards, and staff used this when required in the best interests of their patients. Staff completed training in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards to support their knowledge.

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.

There was a balanced and proportionate approach to risk that supported people and respected the choices they made about their care. Risks were assessed and people and staff understood them. Staff completed comprehensive risk assessments for each patient during pre-assessment and admission using recognised tools and reviewed them regularly.

Staff used a nationally recognised tool to identify deteriorating patients and escalated them appropriately. The service used the National Early Warning Score 2 (NEWS2) for the detection of and response to deteriorating patients. We reviewed 7 complete sets of patient records and found observations were completed according to the frequency required for the patient and escalated according to policy. The service audited its compliance with escalating NEWS2 scores. Information received between October and December 2025 showed there had been no patients who had scored over a 1, and therefore no patients had required escalation.

There was a service level agreement with the local acute NHS hospital to support staff when they identified a patient who deteriorated. Staff who identified concerns over a patient were able to access the NHS trust’s critical care outreach team to review any patients where concerns were identified.

Staff were aware of sepsis and told us they completed sepsis screening for patients when concerns were raised. At the time of our inspection, we did not identify any patients who were showing signs of sepsis.

Risks were assessed and people and staff understood them. Staff completed risk assessments for each patient on admission, using recognised tools, and reviewed these regularly, including after any incidents. These risk assessments included, but were not limited to, a patient’s risk of skin damage, malnutrition risks, manual handling, venous thromboembolism (VTE – blood clots) risk, and falls risk. We reviewed the risk assessments completed for 7 patients and found all risk assessments were completed within the expected timeframe and where action was required, this had been taken. The service audited its compliance with VTE risk assessments. Between October and December 2025 compliance was recorded at 50% against the hospital’s own policy. Areas of improvement were identified and discussed at the complaints, litigation, incidents and patient experience (CLIP) and Medical Advisory Committee meetings. During our review of risk assessments, we found all patients had a VTE risk assessment completed. However, since our inspection, we have received a number of concerns and identified incidents about the ongoing challenges around VTE management.

There was good compliance with safety checks in the operating theatres. We observed staff completing the World Health Organisation (WHO) surgical safety checklist. Information showed the service achieved 100% compliance with the WHO safer surgery documentation and observational checklist audit completed between October and December 2025. In addition to the WHO checklist audits, the service also audited sedation practices and ‘stop before you block’ (a safety initiative to reduce the risk of wrong site blocks taking place). Information for October to December 2025 showed 100% compliance with the sedation audit and 100% compliance for the ‘stop before you block’ audit completed.

Patients who underwent pre-assessment had thorough reviews prior to surgery. Staff told us they had identified patients through these assessments who required further reviews with medical staff. There was also exclusion criteria to ensure only those patients suitable for care at the service were treated. Patients who could not be treated at the hospital were referred to the NHS.

Staff within the service completed basic life support (BLS) training. Compliance with this training was 93% at the time of our inspection. Some staff told us there had been challenges in accessing practical BLS training, however this was now being rectified. In addition to BLS, 3 staff members within theatres were advanced life support trained with the remaining staff completing immediate life support training.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

There were processes to ensure equipment and the environment were well maintained and safely met the needs of the patients. The service had suitable facilities to meet the needs of patients. The hospital had 50 inpatient beds available in total. However, only 1 ward was in use at the time of our inspection providing 25 single rooms, all with ensuite facilities. Rooms were equipped with wipeable furnishings and oxygen and suction ports. There were 4 theatres in total, 1 of which was a hybrid theatre (an operating theatre combining a traditional operating room and state-of-the-art equipment). The theatres also had a robot which was mostly used for gastrointestinal and gynaecology procedures.

The process for ensuring emergency equipment on the ward and in theatres were safe, well maintained and ready for use was effective. There were designated spaces which had signage above to indicate to all staff where the equipment was kept. There were also effective processes to ensure equipment was regularly checked with maintenance schedules. All staff we spoke to about equipment told us there was enough equipment to keep patients safe and for them to carry out their work.

Equipment used was in date. We reviewed a selection of consumable items including cannulas, dressings, airways, suction tubing, syringes and blood sample bottle and found they were in date.

Staff disposed of clinical waste safely. We observed staff correctly segregating clinical and domestic waste. Waste bins were enclosed and foot operated. Sharps bins were correctly assembled, and waste was below the fill line. The management and disposal of sharps and waste was completed in accordance with the service’s policy.

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

There were appropriate staffing levels and skill mix to make sure patients received consistently safe, good quality care which met their needs. The service used a staffing template to identify the levels of staffing required. This was based on the number of patients admitted on the ward. At the time of inspection, the planned staffing met actual staffing.

Staff told us there had been changes to staffing along the way, with comments including how at times it had felt “challenging” and a “sink or swim moment”. Reasons behind staff leaving in the early days of the hospital opening were related to professional development and staff identifying independent health services were not for them. Staff told us on some days they had high activity, but this could be completely different the next day with barely any patients admitted. This had therefore impacted the turnover rates of staff. At the time of our inspection, the turnover rate was 21.4% for the hospital. However, theatres had a lower turnover rate of 10.5%. Senior staff told us there was a sense of stabilisation among the workforce now and it was expected there would be further reductions in the turnover.

The service had low levels of staff sickness. The data reported the sickness rates were consistently low although had spiked during November 2025 due to seasonal infections.

Staff told us the service was proactive around staff recruitment. There were low levels of vacancies, with senior staff telling us there was always a good level of interest in any positions advertised. Within the last 3 months, the service had advertised 6 vacancies within theatres, with only 1 post being to replace a staff member. The additional 5 posts were created due to the increase in activity.

The service used bank and agency staff to fulfil shifts where required. There was mostly a core bank of staff used to increase staffing levels where required. Staff told us where agency staff were used, they tried to ensure the same staff were booked for consistency.

Day to day medical cover was delivered by resident doctors who were employed by the service. There was a designated lead who had oversight of the resident doctors. Consultants led and delivered the surgical service at the hospital under practising privileges. There was an effective system for recruiting new consultants and ensuring their practice and behaviours were in line with the service’s values and vision.

Staff received appropriate training to their role. Staff were required to complete and update mandatory training which was comprehensive and met the needs of the patients and staff. Staff we spoke with told us they had completed their training and managers told us there were processes for monitoring compliance with mandatory training. Data showed overall compliance for the service was 96% which was above the service’s target of 85%.

Staff received the support they needed to deliver safe care. Staff underwent annual assessments and mid-year ‘check ins’. At the time of our inspection, the service was still completing the end of year assessments which were all due before 16 March 2026. Data showed 100% of staff in the service had completed their mid-year check in. Staff told us they found their check ins useful as it enabled them to discuss career progression and training requirements. Staff told us the service was supportive of staff completing additional 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.

Staff protected patients from the risk of infection by maintaining the environment and equipment to ensure it was safe to use. Staff cleaned equipment after patient contact to reduce the risk of cross infection. We observed most areas we visited as visibly clean and tidy and saw domestic staff cleaning areas. We did, however, observe some items stored in boxes on the floor on the ward which prevented effective cleaning of the floor. We shared this with staff on the wards, and they addressed the issue straight away.

The service had an approach for assessing and managing the risk of infection. Patients underwent an infection prevention and control review during their pre-assessment appointment. Any areas of concern identified were escalated to the consultant in charge of the patient’s care. Patients were also screened for MRSA prior to surgery. Any patients identified as MRSA positive were given treatment to reduce the bacterial burden (amount of bacteria present on the surface of the skin) prior to undergoing their procedure. Thus reducing the risk of developing an infection. All patients regardless of any history of infection or colonisation with an organism were provided with an antiseptic washcloth which they were required to use on the days leading up to their procedure.

The service completed audits to provide assurance that patients were provided with safe care in line with infection prevention and control standards. Cleanliness audits for the period of October to December 2025 showed the wards had achieved 100% compliance and the surgical services achieved 92.7% compliance. Hand hygiene audits completed between October and December 2025 showed wards achieved 100% compliance and the surgical services achieved 90.5% compliance. During our onsite inspection, we observed all staff demonstrating good hand hygiene measures in accordance with the World Health Organisations (WHO) five moments for hand hygiene.

There was a service level agreement to carry out the decontamination of the used surgical equipment. There was an effective process to ensure all equipment required for surgical procedures was reprocessed and available in good time.

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.

The service’s approach to medicines reflected current and relevant evidence-based practice, professional guidance and relevant legislation. The service used an electronic system for dispensing medication for staff to administer to patients. The system provided oversight of the stock management of the medication maintained on the wards.

Medicine room storage and refrigerator temperatures were monitored. There was an automated service for monitoring refrigerator temperatures which alerted staff to any changes in temperatures. It provided details for the duration and the exact temperature so staff were able to determine what, if any action was required to ensure the medicines were safe.

There were appropriate arrangements for the safe management, use and oversight of controlled drugs (CDs). Controlled drugs were stored safely and securely with access restricted to authorised staff. Checks were undertaken and recorded by 2 staff twice a day. We reviewed documents for CD checks and found all details were correct. However, CD audits completed by the service showed it was not always compliant with the requirements for safe and secure management. Information showed between October and December 2025, the wards achieved 82.6% compliance on the CD audit. The anaesthetic rooms for the 4 theatres scored between 66.7% and 83.3% compliance and the recovery department achieved 94.4%. Action plans were completed identifying areas which required improvements and the audits would be repeated to determine if the changes were effective.

Accurate, up-to-date information about patients’ medicines was available, particularly when being admitted to or moving between healthcare settings. We reviewed 6 medication administration records on the electronic prescribing medicine administration system. Staff documented the route and time of medication administration and antibiotics had a review date and indication recorded.

The allergy status of patients was routinely recorded on all medicine records seen. Allergies were highlighted, and medicines could be prescribed safely. Weights of patients were recorded, which was needed to help support calculating weight-based medicines prescribing.

The service provided cytotoxic medication to patients. We observed a cytotoxic spill kit which was out of date as of December 25. We highlighted this to the staff on the ward who immediately took action to rectify this.