Spire Harpenden 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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work. 

At our last assessment we rated this key question good. At this assessment the rating has remained good.  This meant people’s outcomes were consistently good, and people’s feedback confirmed this. 

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 assessed and reviewed people’s needs to support safe and effective care across endoscopy and chemotherapy services. Staff worked with patients to understand their needs and used this information to plan care. 

Staff completed comprehensive assessments to ensure care and treatment were planned and delivered in line with patients' individual needs. We reviewed 9 patient records. Records showed staff completed assessments before treatment, including pre‑assessment for endoscopy procedures. In chemotherapy services, records showed staff carried out holistic assessments and reviewed these regularly to reflect changes in patients’ needs. 

Staff told us they reviewed assessments at regular intervals. They told us that because patients attended chemotherapy regularly, they were able to get to know them well, monitor nutritional needs and adapt care to meet their changing needs. 

Patients told us they felt involved in decisions about their care. They said they found the electronic app useful to review information discussed during appointments and used follow‑up contact numbers to ask further questions. 

We saw evidence of shared decision making in care records. We also observed good communication between staff during care, and patients told us staff responded to their needs during procedures, including managing pain and reducing distress. 

The service planned and delivered care in line with current evidence and best practice across endoscopy and chemotherapy services. Staff used up‑to‑date guidance and specialist training to provide safe and effective treatment. 

Chemotherapy services followed clear clinical protocols based on current evidence. Each treatment had a defined regimen and associated code, and systems prevented non-standard treatments from being used. Where information was missing from the protocols, staff consulted recognised sources, including Cancer Research guidance and guidance from the UK Systemic Anti-Cancer Therapy Board, to provide patients with evidence based care. 

Staff had the right skills and training to deliver effective care. All chemotherapy nurses held a UK Oncology Nursing Society Systemic Anti-Cancer Therapy passport. Some staff had completed additional non‑mandatory training, including postgraduate courses. Endoscopy staff were trained and assessed as competent through national frameworks. 

Staff told us they regularly assessed patients’ clinical needs using recognised tools. Records showed nutrition risks were assessed and monitored regularly, particularly in chemotherapy services. 

Holistic assessments supported staff to respond to patient needs, including adapting treatment plans where possible. 

Managers supported staff development, although appraisal rates varied. Compliance was 100% in chemotherapy services. Endoscopy staff were included within the wider theatre workforce, and a separate appraisal rate for endoscopy could not be identified. Appraisal compliance across the theatre workforce was 58% at the time of our inspection. Outstanding appraisals were underway at the time of our assessment. 

The service worked exceptionally well across endoscopy and chemotherapy services to deliver coordinated, person-centred care. Patient records evidenced a consistent multidisciplinary approach to care planning and delivery.  

Staff described a strong multidisciplinary approach, particularly within chemotherapy services, where consultants, cancer nurse specialists, pharmacists and healthcare assistants worked closely together to provide holistic care and respond promptly to changing patient needs. Patients consistently told us their care felt organised and well-coordinated. They said staff had a good understanding of their treatment journey and communicated effectively with one another, helping ensure care was delivered seamlessly and reducing the need for them to repeat information. 

Medical staff were supported to undertake observational learning with specialist colleagues working in other departments. This helped them develop their skills, knowledge and understanding of different areas of practice and ensured care was joined up across services, supporting people to move between teams and pathways with minimal disruption to their care. 

Staff described how clinical, administrative and housekeeping teams worked together to improve patient flow in endoscopy. Following identified delays in room turnaround, a room status section was introduced on the departmental board to show when rooms required cleaning and when cleaning had been completed. This improved communication between teams, reduced delays and improved the patient experience. 

We also saw strong partnership working with external NHS providers. Staff shared clinical information promptly, liaised directly with receiving clinicians and coordinated transfers for chemotherapy patients requiring specialist care. We observed evidence of a patient contacting the service remotely with concerns about their condition, staff advised the patient to attend the local NHS emergency department and contacted the receiving oncologist directly to share relevant clinical information. Staff subsequently received feedback and updates from the receiving consultant, which supported continuity of care and ongoing clinical oversight. This helped maintain continuity of care, avoid unnecessary delays and ensured patients experienced a seamless transition between services when specialist care was required. 

The service was effective in supporting people to manage their health and wellbeing during chemotherapy treatment. Staff took a holistic and personalised approach to care, helping people maintain their independence, choice and control throughout treatment. 

Records showed staff in chemotherapy completed regular holistic and wellness assessments which considered patients' physical, emotional and psychological wellbeing. Staff used this information to tailor support, identify additional needs and connect patients with services and resources that helped them manage the wider impact of cancer treatment. 

Staff worked proactively with patients to minimise the impact of treatment on their daily lives. Discussions included holidays, travel, family commitments and other activities that were important to people. We saw evidence of staff supporting a patient planning a holiday around their chemotherapy treatment, including considerations associated with treatment and ongoing support needs. This enabled the patient to continue with plans that were important to them while remaining supported throughout treatment. 

Where additional needs were identified, staff arranged timely access to further support and specialist services, including physiotherapy and other MDT input where required. This helped people manage the physical, emotional and practical effects of treatment, maintain mobility and independence, and reducing the risk of deterioration. This proactive approach supported people to remain as well as possible throughout treatment and helped them continue activities that were important to them. 

Chemotherapy patients told us this support enabled them to continue activities that mattered to them, maintain their independence and feel more in control of their lives despite the challenges of cancer treatment. This approach went beyond managing clinical needs and helped people maintain their wellbeing and quality of life throughout their treatment journey. 

The service regularly monitored performance through audits, governance processes and clinical outcome measures. Leaders used this information to identify opportunities for improvement and implement changes to improve patient care and operational efficiency. For example, revised Friday planning meetings enabled staggered admission times for older patients, patients with co-morbidities and those requiring longer procedures, improving patient flow and the overall patient experience. 

Endoscopy services monitored performance against Joint Advisory Group (JAG) standards, with most key performance indicators meeting or exceeding national standards. Leaders used this information to review performance and drive service improvement. For example, the service redesigned the endoscopy pathway so that endoscopy nurses completed pre-assessments and admissions for all patients. This improved the individualised patient experience and provided greater opportunities for patients to receive information and ask questions throughout their pathway. 

Leaders demonstrated how information was used to improve patient experience and outcomes. For example, a review of support available to patients receiving a suspected or confirmed cancer diagnosis identified an opportunity to strengthen the pathway. In response, a cancer nurse specialist was integrated into follow-up consultations where significant results were discussed. This ensured patients had immediate access to specialist guidance, information and emotional support, helping them better understand their diagnosis and the next steps in their care. 

Patient feedback was reviewed alongside performance and audit data to inform service improvements. Staff told us this helped them adapt practice and better meet patients' needs. 

The service supported people to understand their care and make informed decisions. Staff provided clear, accessible information and treated consent as an ongoing process throughout care. 

We spoke with 4 patients who told us they were fully involved in decisions about their care. A family member told us they were appropriately involved in discussions about their relative's care. Patients described feeling confident to ask questions and said staff took time to ensure they understood their options before making decisions about treatment. 

Patient feedback reflected these experiences. Survey results showed between June 2025 and 2026, 99% of endoscopy patients felt fully informed at all times and 99% felt valued as an individual. This demonstrated people felt supported to understand information, participate in decisions and make informed choices about their care. 

Language interpreters were available and used when required to support patients to understand information and give informed consent. 

We observed staff seeking verbal consent at key stages of care in endoscopy and checking patients' understanding throughout procedures. Staff gave patients opportunities to ask questions and ensured they remained informed and comfortable during their care. Written consent was completed and clearly recorded in patient records. Consent audit results between April 2025 and 2026, demonstrated high levels of compliance, achieving 100% compliance in endoscopy services and 99.25% compliance in chemotherapy services. 

In chemotherapy services, consultants discussed treatment options with patients before treatment commenced. Records showed staff considered patient’s capacity to make decisions and discussions included how treatment would be administered, the frequency of treatment, potential side effects, risks, benefits and alternative treatment options. Staff revisited this information throughout treatment to support informed decision-making as people's needs and circumstances changed. Records also showed consent discussions and decisions were clearly documented. 
 
Staff demonstrated an understanding of consent and capacity requirements and adapted decision-making processes to meet individual needs. Staff told us about an occasion when concerns were raised regarding a patient's capacity to consent. Staff sought additional support from a safeguarding lead, and a best-interest decision-making process was followed. This helped ensure appropriate decisions were made when patients were unable to make decisions for themselves.