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 patients and communities had the best possible outcomes because their needs were assessed. We checked that patient’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring patient 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 patient’s outcomes were consistently good, and patient’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.

Staff shared key information to keep patients safe when handing over their care to others. Shift changes and handovers included all necessary key information to keep patients safe.

Staff with the appropriate level of seniority discussed patients’ preferences and wishes in the event of a deterioration in their condition. Decisions about care and treatment were made with due consideration of the patients’ wishes and, where appropriate, the views of their family or those important to them.

Staff assessed patients’ pain and used nationally recognised tools to do so. Staff gave pain relief in line with individual needs and best practice and assessed how effective this was. Patients’ pain was addressed before they left the operating theatre.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. All policies we looked at contained a creation and review date, and clear references to current national guidelines. There were systems to communicate changes in guidance through meetings and management newsletters. We saw notice boards displaying up to date guidance for staff.

Policies and processes took account of the Royal Colleges guidelines and National Institute for Health and Care Excellence (NICE) guidance. Including requirements specific to cosmetic surgery, such as the use of a pre-surgery information checklist and a minimum two‑week cooling‑off period between initial consent and the procedure. Compliance with these expectations was monitored through the Cosmetic Cooling Off Period audit, which had a compliance target of 95%. Audit results over the 6 months prior to our inspection demonstrated 100% compliance, exceeding the organisation’s compliance target.

We looked particularly at the pathway for people admitted for elective orthopaedic surgery, those treated through the NHS e‑referral (NHS Choices) route, and self‑pay/insured patients undergoing other surgical procedures. Across all pathways, we found a comprehensive pre‑operative assessment (POA) and preparation service in place to ensure patients were optimised and fit for surgery and anaesthesia. The POA process followed recognised standards (Clini 79 – Preoperative Assessment Standards) and was applied consistently regardless of payor type, demonstrating a standardised and equitable approach to patient preparation and safety.

We reviewed 5 sets of patient care records for evidence of completed care plans and risk assessments. We found that records were l completed well, with entries dated, timed and signed, and key risk assessments such as venous thromboembolism (VTE) and pre-operative assessments completed and reviewed on admission. Records also demonstrated completion of the World Health Organisation (WHO) surgical safety checklist.

Records we reviewed did not consistently demonstrate that patients were not left nil by mouth for longer than necessary, or that intravenous fluids were used to support pre-operative optimisation when required. Therefore, we could not be assured that these practices were being implemented consistently.

Staff used a nationally recognised screening tool to monitor patients at risk of malnutrition and used this to inform care planning and delivery. Patients requiring special diets for clinical reasons, were assessed and advice given.

Leaders reported information to the Private Healthcare Information Network (PHIN), with intelligence reports reviewed by service leaders. These included Patient Reported Outcome Measures (PROMs), which demonstrated strong outcomes. For hip replacement surgery, the mean post‑operative score was 41.9 with a health gain of 21.3, and 97.9% of patients improved (100% private; 96.5% NHS). For knee replacement surgery, the mean post‑operative score was 37.5 with a health gain of 16.3, and 96.5% of patients improved (98.1% private). Data was routinely submitted to PHIN and used to benchmark performance and support service improvement.

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

Staff reported healthy working relations across staff groups including between medical and nursing teams. We saw and heard examples of effective team working which was based on mutual respect and trust.

Staff ensured plans for discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Discharges were planned at an early stage to ensure they were safe and appropriate for the person’s needs.

Staff shared information across teams and services to support continuity of care. Multidisciplinary team meetings with local NHS partners, including a Teaching Hospital NHS Trust and neighbouring trusts, reflected a hub-based approach to shared governance. These meetings covered data sharing, mutual notification of practice restrictions, and intelligence relating to consultant practice, conduct, and wellbeing. Processes were in place to identify and escalate emerging concerns, with consultants working across both organisations supporting information sharing and consistent oversight.

Staff worked across health care disciplines and with other agencies when required to care for patients. For example, staff described working with physiotherapy and pharmacy teams, with physiotherapists attending regular specialist training and pharmacy governance supporting medicines management through prescribing and antimicrobial stewardship processes.

Staff also described escalation processes involving medical and emergency teams, including the use of a medical emergency team for deteriorating patients, and we saw evidence of patients being appropriately escalated and transferred to NHS services when required. Daily safety briefings included discussion of staffing, clinical risks, incidents and patient safety concerns across departments, demonstrating coordinated working between clinical, governance and operational teams.

Patient’s records demonstrated there had been input from a range of clinicians and that they shared information to ensure a consistent approach to care and treatment pathways.

Staff held regular and effective multidisciplinary meetings where required, to discuss treatment options for individual patients and improve their care.

Staff supported patients to manage their health and wellbeing so they could maximise their independence, choice and control. Staff supported them to live healthier lives and, where possible, to enable them to reduce their future needs for care and support.

For example, patients told us they received clear information about their procedures and felt involved in decisions about their care, including discussions with anaesthetists about treatment options. Patients reported good communication and felt reassured by staff, with support tailored to their individual needs following surgery.

Staff also described supporting patients with individual needs, including those with additional needs, and providing personalised care such as one-to-one support where required.

Staff worked with physiotherapy services and other disciplines to support recovery and rehabilitation, helping patients regain independence and optimise outcomes following treatment.

Patients undergoing elective operations had access to information about their condition, their treatment and how best to prepare for surgery. Staff spoke with them about how best to optimise their outcomes after surgery and how to modify their choices to ensure better health.

Staff monitored the effectiveness of care and treatment through audit and benchmarking to compare its performance with other similar services. The service used the findings to make improvements and achieve good outcomes for patients. The service participated in relevant provider-led clinical audits, including infection prevention and control audits, medicines management audits, and pre-operative assessment and fluid fasting audits during 2025/26.

Audit results demonstrated high levels of compliance. For example, the pre-operative fluid fasting audit exceeded the compliance target of 95% over the last three reporting periods, indicating effective pre-operative preparation processes. Infection prevention and control audits showed compliance rates mostly between 98% and 100%, and medicines storage and security audits demonstrated 100% compliance, providing assurance around key safety systems

All patients had a structured pre-operative assessment and there was an optimisation process in place regardless of funding pathway. This ensured patients were assessed and optimised prior to surgery, and where concerns were identified, patients were appropriately managed or surgery deferred. For example, where patients were identified as not fit for surgery, this was identified through the pre-operative assessment process, contributing to safe decision-making.

Staff recorded surgical site infection rate as low. Data for the 2025/26 reporting period showed 0% infection rates for hip and knee arthroplasty, with only a small number of infections reported across other procedures, indicating generally good clinical outcomes. Cancelled procedure data also supported this, showing that where surgery did not proceed, this was often due to patients being appropriately identified as not fit for surgery or unwell, demonstrating the effectiveness of pre-operative assessment processes. No cancellations in the last 12 months resulted in physical harm.

Staff considered health inequalities and took steps to ensure that outcomes across people with protected characteristics were in line with the wider community.

Leaders monitored and reacted to avoidable deaths and harms. Mortality and morbidity meetings were held regularly, and all deaths underwent a structured judgement review process.

Staff told us that all deaths were initially reviewed locally and then subject to further review by an Associate Medical Director, who completed a structured judgement review, including an avoidability score and overall care assessment. Findings were then presented to a group mortality committee, where themes and learning were identified at organisational level.

Staff ensured learning from these reviews was shared and acted upon through local governance structures. For example, staff described how incidents, deaths and learning were regularly reviewed through weekly rapid response meetings and quarterly safety, quality and risk committees, where trends, investigations, and action plans were discussed, and learning was disseminated across departments.

Staff used a key safety indicator review process, which brought teams together to review incidents such as unplanned readmissions, returns to theatre and transfers of care. These multidisciplinary reviews considered the patient journey in detail and determined whether incidents were avoidable, supporting learning and improvement.

Staff escalated incidents involving significant harm or emerging risks to a national governance team, where subject-matter experts provided independent oversight and challenge. This ensured that learning was shared more widely and that actions taken were robust and consistent.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff followed the services policies related to consent, mental capacity, deprivation of liberty and restrictive practice, as relevant.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Consent for surgery was sought by the most appropriate doctor and included discussion about the benefits, potential complications, the risks and alternative options. Patient consent was checked at various points before they went to the operating room and immediately prior to surgery. There were consent audits completed and outcomes shared with staff.

Patients told us they were involved in decision making about their care and treatment. They could describe the risks and benefits they were told about prior to surgery. Relatives told us they were kept informed about the care and treatment of their family member when they lacked capacity to consent to surgery.

We observed staff seeking verbal consent before providing care or treatment. People were involved in decision making at all levels. Housekeeping staff asked patients what they wanted to eat and drink.

Staff ensured specific requests made by patients, for a same gender health care professional or theatre team, was discussed and provided whenever possible. Chaperones were provided if requested.

Interpreters were used to support patients to give informed consent, including British Sign Language and face to face interpreting when necessary.

Staff sought permission before sharing patient information with family or friends.