Spire Harpenden 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.  

At our last assessment we rated this key question good. At this assessment the rating remains good. 

This meant people were safe and protected from avoidable harm. 

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 promoted a positive culture of safety, openness, learning and continuous improvement. Leaders encouraged staff to raise concerns, review safety issues and identify opportunities to improve care. Staff consistently told us they felt safe to speak up, challenge practice and contribute to service development. Staff described leaders as visible, supportive and responsive and said concerns were acted on promptly. Staff could also demonstrate how feedback had influenced changes in practice and service delivery. 

Leaders reviewed incidents, risks, staffing and emerging safety concerns through daily heads of department meetings involving clinical and non-clinical services. This enabled timely escalation of risks, prompt action when issues were identified and the routine sharing of learning across the hospital. Staff were involved in identifying solutions and contributing to improvements, supporting a proactive approach to managing safety and quality. 

Staff demonstrated how incidents, feedback and service monitoring resulted in changes to practice, additional staff training and improvements to patient care. For example, following a review of support available to patients receiving a suspected or confirmed cancer diagnosis, the service enhanced the patient pathway by introducing cancer specialist nurse involvement in follow-up consultations. This provided patients with timely access to specialist advice, information and emotional support. Leaders monitored the impact of changes to ensure improvements were embedded and sustained. 

During the previous 12 months, staff reported 91 incidents, including 4 in endoscopy and 87 in chemotherapy. No never events were reported. Incidents were managed using the patient safety incident response framework to support learning and improvement. Incidents, feedback and performance information were reviewed through governance processes, and key learning was routinely shared through departmental meetings, learning newsletters, safety bulletins and incident learning summaries. Incidents were also reviewed by specialists who had not been involved in the case, providing additional scrutiny and assurance that actions had been identified and implemented. Learning from incidents and service reviews improved care within the hospital and was shared across the wider hospital network to support improvement in other services. 

Staff proactively managed patient pathways and ensured continuity of care across endoscopy and chemotherapy services. Endoscopy and chemotherapy pathways were clearly defined and supported by effective pre-assessment, treatment and discharge processes that helped identify risks, coordinate care and ensure patients received treatment appropriate to their needs.  Staff carried out pre-assessments for all patients in line with the service's inclusion and exclusion criteria, helping ensure patients received care that could be delivered safely and appropriately. Staff described clear escalation arrangements for patients whose condition changed or whose needs fell outside the scope of the service. 

Chemotherapy services operated within a comprehensive and coordinated pathway that supported patients throughout their treatment journey. Patients had access to specialist advice and support 24 hours a day, and staff worked closely with consultants, clinical nurse specialists and resident medical officers to respond promptly to concerns and changes in clinical need. Established triage and escalation processes enabled patients to access specialist care quickly and supported safe decision-making. 

Staff worked effectively with external healthcare providers to maintain continuity of care. When patients required urgent assessment or treatment, staff arranged prompt transfer to local NHS services, shared relevant clinical information and liaised directly with receiving clinicians. This helped ensure patients experienced safe and coordinated transitions between services and minimised delays in accessing appropriate care. 

Administrative and clinical teams closely monitored referrals, bookings and capacity to maintain safe patient pathways. There were no incidents between June 2025 and 2026 where patients could not be accommodated, no chemotherapy treatment cancellations and only one endoscopy cancellation, which was clinically appropriate. Staff also adapted services to meet individual needs, including maintaining treatment continuity where care requirements extended beyond planned service hours. These arrangements helped minimise disruption to treatment and supported patients to remain on their planned care pathway. 

Patients described care as coordinated and easy to navigate, reporting they were able to access treatment and specialist advice when needed and experienced continuity throughout their treatment journey. Waiting times remained consistently short, with average waits of 13 days for endoscopy and 17 days for chemotherapy treatment. 

Staff understood how to protect people from abuse and worked effectively to keep people safe across endoscopy and chemotherapy services. Level 3 safeguarding training compliance was 95% for theatre staff, which included endoscopy staff, and 93% for ward staff, which included chemotherapy staff. While ward compliance was slightly below the provider target of 95%, staff we spoke with demonstrated a good understanding of safeguarding processes and their responsibilities. 

Staff knew how to recognise safeguarding concerns and how to raise them. Staff were able to describe examples where they had escalated concerns and involved the safeguarding champion. They told us they felt confident concerns would be taken seriously and acted on. 

The service had level 4 trained safeguarding leads in place who provided advice and support to staff. Staff knew who to contact for guidance. This helped ensure concerns were managed effectively and people were protected from harm. 

The service worked with people to understand and manage risks across endoscopy and chemotherapy services. Care and treatment met people’s needs in a way that was safe and supported them to make informed choices. 

Before attending the service, patients completed pre-appointment screening questionnaires. Staff used this information to identify risks, contraindications and any additional support needs before treatment, helping to ensure care was safe, appropriate and responsive to individual needs. Records also showed staff reviewed risks throughout the patient pathway and acted when risk levels changed. For example, we saw evidence of an endoscopy procedure being cancelled following the identification of changes in a patient's clinical risk profile, ensuring care was only provided when it was safe to do so. In chemotherapy services, staff undertook comprehensive pre-treatment assessments, including toxicity, venous thromboembolism (VTE) and nutritional screening, to assess patients’ suitability for treatment. Staff used recognised cancer triage tools and followed neutropenic sepsis pathways, supported by a dedicated neutropenic emergency box and clear escalation arrangements for unwell patients. Staff escalated deteriorating patients to the resident medical officer for assessment and, where required, onward transfer by ambulance to the local NHS hospital. These arrangements supported the early identification of deteriorating patients and ensured risks were managed promptly and appropriately. 

Patients could access an electronic app to review information discussed during appointments. Patients told us this helped them better understand their treatment and make informed decisions about their care. Staff explained information clearly and provided opportunities for people to ask questions and discuss any concerns. 

Records showed staff worked in partnership with patients to plan care. There was evidence of shared decision making and the use of additional resources to support people’s individual needs, preferences and treatment choices. Patients told us they felt involved in decisions about their care and understood the next steps in their treatment.

The service provided a safe environment for people receiving care in endoscopy and chemotherapy services. Staff managed environmental risks to support the safe delivery of care and treatment. 

We saw that clinical areas appeared clean, tidy and free from clutter in both departments. The service had passed an independent external audit of the environmental and engineering standards, providing further assurance that environmental and engineering standards were met. 

Equipment and facilities were well maintained and suitable for the type of care provided. We saw evidence that portable appliance testing had been completed and maintenance records were up to date. Endoscopy equipment was subject to regular checks and monitoring to ensure it remained safe for use. Staff understood how to report faults or equipment concerns and told us issues were escalated promptly to ensure risks were addressed. 

Leaders monitored environmental safety through regular audits and checks. This helped ensure standards were maintained and any concerns were identified and addressed.

The service had enough staff with the right skills and experience to provide safe care across endoscopy and chemotherapy services. Staff worked flexibly to meet patient needs and maintain safe service delivery. 

Leaders planned staffing to make sure there were enough staff available. Staffing data showed levels were stable across departments, and the chemotherapy service maintained a largely permanent workforce with minimal use of bank staff and no use of agency staff. Staff told us there were no concerns about staffing levels and said they were able to meet patients’ needs safely. 

The service used a flexible approach to staffing. Staff from surgical areas supported endoscopy when needed, which helped maintain safe staffing levels and continuity of care. Administrative staff monitored patient bookings and worked closely with clinical teams to optimise resources and manage demand. These arrangements helped ensure patients could access care when needed, and there had been no instances where either service was unable to accommodate a patient. 

Consultants were subject to practising privileges arrangements, which provided assurance that they remained appropriately qualified, experienced and competent to undertake the activities for which they were authorised. 

The service had a resident medical officer available, and chemotherapy patients had access to a 24-hour support line. This helped ensure patients could access medical advice and support when needed. 

Leaders had plans for workforce sustainability, including succession planning to support future staffing needs.

The service managed infection risks well across endoscopy and chemotherapy services. Staff used clear processes and equipment to protect patients, themselves and others from infection. 

Clinical areas we visited were clean, tidy and well maintained. Cleaning schedules were up to date in both endoscopy and chemotherapy areas. Cleaning audit results were consistently high, with most audits achieving 100% compliance and the lowest recorded result being 97% over the previous 6 months. 

Endoscopy services had clear systems for the management and decontamination of equipment. There were defined clean and dirty pathways for endoscopes, and we saw an effective flow for cleaning and decontamination. Records showed endoscope cleaning audits achieved 100% compliance, providing additional assurance that equipment was decontaminated safely and remained fit for use.  

Staff followed infection prevention procedures. Hand washing signage was clearly displayed, and personal protective equipment (PPE) was readily available and appropriately used by staff. This supported staff to follow safe practice and maintain high standards of infection control.

The service managed medicines safely across endoscopy and chemotherapy services. During the inspection, we observed one endoscopy clinic consisting of a single patient, where the consultant signed medicine administration records at the end of the procedure rather than immediately after administration. This meant medicines documentation was not completed contemporaneously and could increase the risk of inaccuracies in record keeping. However, we found no evidence that this had resulted in medicines incidents or patient harm, and we identified no other evidence to suggest a systemic or ongoing issue.

Staff followed processes to ensure medicines were stored, prepared and administered safely. Staff recorded fridge temperatures, maintained accurate controlled drugs records and stored medicines securely. Controlled drugs audit results were consistently high, achieving 100% compliance in most months and 98% in the most recent audit, providing assurance that medicines management arrangements were effective. Documentation was completed to support the safe use of medicines.

Chemotherapy medicines were prepared off site and delivered by courier. Staff checked these medicines before use, and pharmacy support was available on site and remotely. Chemotherapy treatment was administered in line with national standards and recognised treatment protocols. All nursing staff held a UK Oncology Nursing Society (UKONS) Systemic Anti-Cancer Therapy (SACT) Competence Passport, providing assurance they were trained and competent to administer treatment safely. There were clear protocols for chemotherapy treatments. Staff used an electronic prescribing system, which guided treatment plans and prevented non‑standard regimens from being used in error. Nurses completed checks before administering treatment to ensure it was safe.