HCA Healthcare UK The Harborne Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

This is the first assessment for this service. This key question has been rated as good. This meant leaders were inclusive and capable and embodied the culture and values of the service. Staff worked collaboratively with key external agencies and partners. However, governance was not always effective, and the service did not always participate in driving improvements, innovation and research.

We have not awarded this service a score for Well-led.

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

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. However, some people did not feel their voice would be heard.

Leaders ensured there was a shared vision and strategy and that staff in all areas knew, understood and supported the vision. The vision, values and strategy were developed through a structured process, which involved the heads of the department. The hospital business strategy and objectives were reviewed annually. Information shared by the service showed the strategy for the year ahead was following a “north star”. This was described as a guiding principle, fixed purpose and source of inspiration to help individuals and organisations make decisions and achieve their goals. Staff within the service were aware of the shared direction and the values of the organisation. Staff told us that the overarching provider’s vision supported a culture of kindness and compassion and one of excellence.

Staff at all levels understood equality, diversity and human rights and they prioritised safe, high quality and compassionate care. At the time of our inspection, there were no concerns raised within the service about any types of bullying, harassment, or discriminative behaviours. However, since our onsite inspection, we received 4 cases raising concerns about the service, 1 of which highlighted a concern about a bullying culture. These were raised anonymously and brief in nature, however raised potential concerns about the culture.

Most of the staff survey results were positive but with some areas of concern. The most recent staff survey in Autumn 2025 identified an overall engagement index score of 83% which was an average of 3 key questions. These were “I would recommend this organisation to people I know as a great place to work”, “This organisation motivates me to contribute more than is required to complete my work” and “My work gives me a feeling of personal accomplishment”. In addition to this, the surgery services also scored strongly for “I feel as if I belong at this organisation” and “I feel physically safe while I am at work”. However, within this staff survey, 45% of staff felt uncomfortable of voicing their ideas and opinions, especially if they were different from others, and only 27% of staff believed a positive change would occur as a result of the survey.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the experience, capacity, capability and integrity to ensure the organisational vision could be delivered and risks were managed well. Following a period of high turnover which included some leadership posts, staff told us there was now much more stability to the leaders of the service. At the time of our onsite inspection, staff told us leaders were visible and supportive and demonstrated behaviours they looked up to. Staff discussed examples where the leaders of the service had led by example and worked with staff during periods of unprecedented pressures (1 example due to adverse weather and another example where unplanned admissions to intensive care were experienced). In addition to this, staff told us about the ‘Refreshment Fridays’ which were delivered by the chief executive and some of the executive team.

Leaders were knowledgeable about issues and priorities for the quality of the service provided and could access appropriate support and development to their role. Staff told us the service was very keen for staff development. Most staff we spoke with told us they had regular reviews with their managers to identify areas where they could develop.

Leaders were alert to examples of poor culture which had the potential to impact the quality of care patients received and the culture within the service. Staff discussed examples of how this was managed at the service. Where action was taken, this was completed in a sensitive but effective manner.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff and leaders acted with openness, honesty and transparency. Staff we spoke with told us their leaders acted in ways which they believed was honest and transparent and this empowered them to behave in the same way.

The provider had a Freedom to Speak Up Guardian who covered all locations. They were supported by champions at each location. Staff we spoke with were aware of the service, however, had not had the need to raise concerns. Staff told us they were comfortable raising any concerns directly with their local leaders.

When something went wrong, patients received a sincere and timely apology and were informed of any actions being taken to prevent the same happening again. Staff were open and honest with patients in their care and gave them and their families an apology and a full explanation if things went wrong.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders acted to continually review and improve the culture of the organisation in the context of equality, diversity and inclusion. Staff told us they were committed to fostering an inclusive environment that valued diversity and promoted equality for both staff and patients. The provider had hubs, groups and clubs all committed to promoting and improving diversity across the organisation. Staff within the service were aware of and involved in many of these activities.

Leaders took steps to remove bias from practices to ensure equality of opportunity. All staff were required to complete equality and diversity and inclusion training tailored to their roles and 100% of staff had completed this training.

Despite staff saying they felt valued by their colleagues and leaders, and had not experienced any harassment, bullying or discrimination, we received a concern after the onsite inspection which claimed there had been racial inequality which had resulted in a high turnover of staff from ethnic minority backgrounds.

The service had areas where governance systems were not as effective in recording patient outcomes and driving improvement. However, the service had identified responsibilities, roles, systems and accountability.

The service had no patient outcome data following over 2 years of operating and did not have an effective audit programme to collect clinical outcomes. This was despite staff discussing the collection of data which had been submitted to the Private Healthcare Information Network (PHIN) as well as discussing outcomes collected for specialities within the service. Our request for evidence at the time of inspection around outcomes was only responded to with data around returns to theatre. The service shared information about the use of the robotic equipment within theatres. However, this only identified other services and not the hospital we were inspecting. No information was shared by the service which identified how the service was collecting data for the patients who underwent surgery and any outcomes related to the surgery. Following factual accuracy, information was shared in relation to the early stages of collecting patient reported outcome measures (PROMs) data for 42 different surgical pathways from the beginning of 2026. No timeframes were given in relation to when the service would be able to analyse the data and use to improve patient care.

It was noted on the executive summary from the Heads of Department Away Day report that building on the foundations for reporting patient reported outcome measures and patient outcomes was an area of this document for “proving our value” in 2025. We discussed with our CQC internal data and insight team whether they were able to access any patient outcome data for the service. However, they were also unable to locate any data. The service therefore had no assurance to provide around good and effective patient outcomes which could drive improvement within the service or identified how it compared with similar services.

However, otherwise, there were clear and effective governance, management and accountability arrangements. Staff understood their role and responsibilities. Staff regularly attended the Clinical Learning and Improvement Plan (CLIP) meetings. The CLIP meetings had standardised agendas to ensure a consistent approach. Incidents were reviewed thoroughly each week and learning identified from them. Staff told us they had regular opportunities to meet formally and informally. There were regular ‘huddles’ where key updates and important messages were shared. The service also held monthly staff meetings which ensured key information and learning was shared.

The hospital had a Medical Advisory Committee (MAC) which advised the chief executive officer on key governance processes involving medical staff. This included granting or reviewing practising privileges, escalation of any clinical or consultant concerns, reviewing key medical policies, and clinical performance. Minutes from the MAC meetings followed a standard agenda. However, there appeared to be no set frequency around the meetings, something which was also confirmed by the MAC chair. Information received during factual accuracy indicated MAC meetings were held at regular quarterly intervals. However, the details around past meetings provided did not reflect this. The service had planned for 4 MAC meetings to be held in 2026.

Staff used a system to manage current and future performance and risks to the quality of the service and took a proportionate approach to managing risk. The service used a clinical dashboard for key performance indicators, some of which was seen in real time. This information informed key governance meetings at the service.

The risk registers mostly reflected the risks which staff discussed with us during the inspection, although some were absent. During an interview with a senior leader, we were told about the service’s biggest risk which was setting up further service level agreements (SLA) around emergency transfers, especially for patients who experienced a stroke. Although there was a process for transfer, we were told this was at times difficult to navigate and therefore further work on the SLA was required. However, this risk was not on any of the risk registers shared with the inspection team. In addition to this was a risk which was discussed around the impact of consultants undertaking private work during NHS contracted time. This meant a risk to the continuity of care for patients using the service. Again, this was not on any of the registers.

Staff mostly submitted data and notifications to external organisations as required. This included statutory notifications which the service was required to submit to CQC. Staff told us they submitted information to PHIN, however we were unable to view any information which they had submitted, and no information was shared with CQC when requested during the inspection.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. Staff share information and learning with partners and collaborate for improvement.

Staff and leaders engaged with people, communities and partners to share learning with each other which was intended to result in continuous improvements to the service. The service engaged regularly with the local NHS acute hospital where staff had developed a strong partnership with and where there were several service level agreements. Staff held regular meetings where any incidents and learning were shared. In addition to this, the service also shared learning with other locations run by the provider.

Leaders discussed how a large amount of work had occurred within the Birmingham region to establish and understand the needs of the local population when they were developing the service. This work informed which specialities would be beneficial to offer at the hospital. This work with partners continued to inform any additional services which were considered for introduction at the service.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. Staff did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. Staff did not always actively contribute to safe, effective practice and research.

Leaders at the hospital did not always have a strong focus on continued learning, innovation and improvement. However, leaders told us they engaged with quality improvement projects and research. Leaders discussed how the hospital was engaged with a research body and were due to implement trials at the hospital. However, most of the opportunities which staff discussed with the inspection team were related to medical care and not surgical services.

During the inspection process, we did not receive any information relating to clinical and patient outcomes for this service. There was therefore no specific evidence of a learning and improvement culture within the surgical services in relation to patient outcomes. Without data for the service to analyse, it was unclear how the service intended to learn and improve in this area. For example, information within the vision and strategy for 2026 identified the service intended to work towards gaining accreditation for an endometriosis service. However, it was unclear how the service would be able to achieve this without gathering any data in relation to the patients who had been treated at the service and any related outcomes reported.

Staff were proud to have introduced robotic surgery which was identified as a fairly unique aspect of the service. Information shared identified some data was being gathered about its effectiveness, but this was related to other hospital locations. Nevertheless, staff told us the impact on reducing the length of patient stay had been identified as an attractive option for patients requiring certain surgeries.

Staff told us they used patient feedback and learning from other services, both internal and external to the hospital to improve services. Staff told us they were able to use learning from other roles they held to improve the surgical service and the hospital. Examples of where they had done this were shared with the inspection team.