Spire Harpenden 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. 

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. 

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good. 

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. 

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.

Leaders had a clear vision and strategy for the hospital and involved staff in delivering improvements across endoscopy and chemotherapy services. Staff understood the service's values and how their roles contributed to providing high-quality care. 

Senior leaders told us they recognised that changes in leadership had affected staff morale. They had taken action to improve engagement and support staff, and both leaders and staff told us relationships and morale had improved. Staff described a more positive culture and said they felt supported by local leaders. 

Heads of department were actively involved in developing local service strategies. Staff told us leaders explained the reasons behind changes and involved teams in implementing improvements. This helped staff understand how their work contributed to service objectives and encouraged engagement with change. 

Staff were able to describe the organisation's values and what delivering high-quality care meant in practice. They told us they were supported to take part in service improvement projects and contribute ideas to enhance patient care. 

Staff told us senior leaders were visible, approachable and responsive when concerns were raised. Staff said they felt comfortable raising concerns and challenging practice and were confident leaders would respond appropriately. Following changes within the senior leadership team, leaders introduced a corporate induction programme to promote consistency while maintaining local autonomy. Staff described improved communication and engagement and told us they felt better supported by senior leaders. 

Leaders demonstrated a strong commitment to staff development and succession planning. The service had a structured leadership pathway that enabled staff to develop competencies and prepare for more senior roles. Staff told us they understood the opportunities available to them and felt encouraged to develop their careers within the organisation. Records showed leaders actively identified and monitored development opportunities to support career progression and workforce sustainability. This helped staff progress within the organisation and supported the development of future leaders across the service. 

Leaders supported internationally recruited staff to gain professional registration and accreditation. Staff spoke positively about the support they received, with one member of staff describing how leaders had helped them settle into working in the UK and another highlighting how flexible working arrangements and support to move into a different role had enabled them to remain in employment during changing personal circumstances. 

In endoscopy, staff described how leaders recognised the challenges of working within a small team and took action to improve engagement and support. Staff told us relationships had improved, they no longer felt isolated and felt more able to seek help when needed. 

The service promoted an open culture where staff were encouraged to raise concerns and share feedback. Staff told us leaders were approachable and supportive, and they felt comfortable speaking up if they had concerns. 

The service had an open-door policy and a Freedom to Speak Up guardian supported by five trained ambassadors. Staff knew who these individuals were and how to access support if needed. 

The service also sought feedback from patients. Leaders held engagement and feedback sessions for chemotherapy patients and used feedback from patients and staff to support service improvement. 

The service valued diversity and promoted an inclusive and fair culture where staff felt respected and able to contribute to the organisation. Leaders took positive action to improve inclusion and remove barriers for staff and patients. The provider had invested in a range of initiatives to support equality, diversity and inclusion, including a dedicated Learning Disability Lead, a Special Educational Needs committee, and autism and learning disability champions. 

The service recognised and celebrated diversity. We saw a multi-faith prayer room available for staff, patients and visitors, providing a dedicated space for reflection, prayer and spiritual support. Staff and patients were supported to meet cultural, religious and dietary requirements, helping ensure individual preferences and beliefs were respected throughout their care. The provider also held staff events celebrating different cultures and experiences, promoting awareness, understanding and inclusion across the workforce. These arrangements helped create an environment where people from diverse backgrounds felt welcomed, respected and supported. 

Staff told us they felt included, respected and able to be themselves at work. They described a supportive culture where leaders were visible and approachable, staff felt able to speak up and ask for help, and flexible working arrangements were supported where needed. 

Governance meetings were held regularly and records showed leaders reviewed complaints, practising privileges, risks, staffing, health and safety and service performance. The governance structure included department-level meetings, speciality governance forums, the Medical Advisory Committee and hospital-wide governance oversight, providing clear lines of accountability and escalation. Information was shared across departments and used to drive improvements. 

Risk management was embedded throughout the service. Risk registers were up to date, and staff understood the risks and mitigations relevant to their departments. We observed comprehensive daily operational meetings where leaders reviewed risks, incidents, staffing and service pressures. Staff described how concerns could be escalated promptly and gave examples of staffing issues being identified and managed through established governance processes. 

The governance structure included a range of subgroups with responsibility for specific areas of oversight. This provided clear accountability and supported effective monitoring of quality, safety and performance. Leaders had also implemented incident reporting processes aligned to the Patient Safety Incident Response Framework to strengthen learning and improvement. 

Governance processes supported a culture of continuous learning. Evidence from audits, patient feedback and performance monitoring showed leaders used information effectively to identify opportunities for improvement and implement changes that enhanced patient care and service quality. 

The services remain safe and reflected current practice. The service had a Medical Advisory Committee which provided clinical oversight and advice to leaders on service delivery and clinical practice. This helped ensure services remained safe and reflected current practice. 

Staff told us they worked closely with external healthcare providers. Oncology staff described effective links with NHS services and clear referral pathways for patients who required specialist treatment or support outside of the hospital. Staff also referred patients to external services, including GPs, dietitians and community services when required. 

Leaders sought feedback from patients to help improve services. Patient feedback sessions had been arranged for chemotherapy patients, although attendance had been challenging due to the nature of patients’ conditions. Leaders continued to explore alternative ways of engaging with patients and gathering feedback to support service development. 

Overall, staff worked effectively with healthcare partners and used external relationships and patient feedback to support coordinated care and continuous improvement. 

Leaders and staff demonstrated a strong commitment to continuous learning, improvement and innovation across endoscopy and chemotherapy services. They used feedback, service reviews, quality improvement initiatives and service development projects to improve patient care, experience and outcomes. 

Senior leaders held bi-weekly meetings to review complaints and emerging themes, using learning to drive service improvements, including enhancements to processes for managing patients' own medicines. Outcomes and learning were shared monthly with departments to support organisational learning and improvement. 

Endoscopy services demonstrated a proactive approach to improvement through review of the patient pathway. Staff redesigned the admission process so endoscopy nurses completed both pre-assessments and admissions, improving continuity and providing greater opportunities for patients to receive information, ask questions and be supported throughout their care. 

Quality improvement work enhanced cancer pathways and continuity of care. Clinical nurse specialists were supported to develop enhanced clinical reasoning skills, enabling them to assess unwell chemotherapy patients and provide timely support. Further improvements enabled clinical nurse specialists to complete pre-procedure assessments, allowing holistic needs assessments to be undertaken earlier and supporting more personalised care. 

Staff told us they were actively involved in reviewing patient flow and introducing additional planning meetings and staggered admission times for patients with more complex needs. Staff told us these changes improved patient experience and supported better flow through the pathway. 

Consultant oncologists were also involved in research involving  patients from this service and contributed to the development of evidence-based practice within their specialties. This helped ensure patients received care informed by current research and emerging developments in cancer treatment. 

The service demonstrated a sustained commitment to improvement through maintaining an external cancer organisation accreditation for six years and investing in equipment and facilities to improve quality, safety and future service development. Staff described a culture where they were encouraged to identify opportunities for improvement and implement changes that enhanced patient experience, service quality and outcomes.