Spire Harpenden Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that patients and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of patients and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that patient could access care in ways that met their personal circumstances and protected equality characteristics.

This is the first assessment for this service. This key question has been rated good. This meant patient’s needs were met through good organisation and delivery.

We have not awarded this service a score for Responsive.

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

The service had systems to support patients with complex healthcare needs, sensory impairment, mental health conditions, learning disabilities and dementia. Staff could access support through the Accessible Information Standard (AIS), which ensured patients received information in formats that met their individual needs, such as large print, braille or email. Communication support, including interpreters, was available when required. This helped ensure patients who were deaf, blind, had a learning disability, autism, dementia or experienced communication difficulties could access and understand information about their care.

Staff were aware that some patients aged 16 to 18 were children and adapted care accordingly, with assessments and consent processes undertaken as part of pre-operative assessment, ensuring that individual needs and circumstances were considered prior to treatment.

We reviewed five patient records and care plans and found evidence that staff took account of patients’ individual needs and circumstances when planning care. Care records reflected communication needs and wider social factors, supporting a person-centred approach and helping to ensure people were involved in decisions about their care and treatment.

Patients were given a choice of food and drink to meet their cultural and religious preferences, and catering services were able to adapt to meet individual requirements. The service also provided a multi-faith prayer facility, supporting patients’ spiritual and religious needs during their care.

Leaders planned and provided care in ways that met the needs of local people and the communities served. Staff described strong links with the wider system, and we saw evidence of good working relationships with NHS and other local health and social care partners, enabling the safe transfer of deteriorating patients and access to additional services when required.

Staff also worked collaboratively across sites within the wider organisation to plan care and improve access for patients. For example, leaders described shared working arrangements with other hospitals to maximise specialist services, including the introduction of new technology and shared consultant activity across locations.

Staff had systems in place to help care for patients in need of additional support or specialist intervention. For example, staff had access to high-observation beds on the ward, and deteriorating patients were appropriately identified and escalated, with clear pathways for transfer to NHS services when required.

Managers ensured that patients who did not attend appointments were followed up, with systems in place to maintain contact with patients and monitor access to care, including through governance processes and daily operational meetings where patient flow and activity were discussed.

Staff followed Royal College guidelines for private or self-pay patients. Patients were told about and knew all the planned and costs, including the costs of future surgery and dealing with complications. When a patient was responsible for paying the costs of their care or treatment (either in full or partially), they were provided with a statement specifying the terms and conditions. Outlining the services to be provided, including as to the amount and method of payment of fees. Where possible this was always provided in writing prior to the commencement of the services.

All patients were made aware of the arrangements the hospital had for emergency provision and intensive care. This was usually included in the preadmission information.

Staff provided patients with a range of information, including leaflets covering surgical procedures, diagnostic investigations, and advice on maintaining and improving their health. Information could be made available in alternative languages when required. Information was also accessible through the service’s website, and a designated member of staff was responsible for ensuring all patient information remained accurate and up to date.

Staff made it easy for people to provide feedback, share ideas, and raise complaints about their care, treatment and support. Patients were involved in decisions about their care and were well informed about treatment plans.

Leaders told us that patients knew how to give feedback about their experiences of care and support, including raising concerns or complaints through a range of accessible ways. Patients, families and carers could be confident that any concerns raised would be listened to, taken seriously and responded to in a compassionate and respectful way.

Staff investigated complaints and concerns thoroughly, and patients received a response in a timely manner. Complaints were managed in line with local policy and the Independent Sector Complaints Adjudication Service (ISCAS) code of practice, with most complaints acknowledged within 3 working days and all closed complaints responded to within 20 working days or appropriate holding timescales.

We reviewed 19 formal complaints received over a 6-month period and found they had been investigated and responded to within the timeframes set out in the local policy. Complaints were managed in an open and transparent way, with themes and learning shared through governance arrangements and disseminated across the organisation to support service improvement.

Patients were kept informed about how their feedback had been used to drive improvements. Feedback was routinely reviewed through governance processes, including daily safety briefings and patient experience meetings, ensuring learning was shared across the organisation.

Staff demonstrated a clear commitment to learning from feedback and making improvements. For example, patient feedback about limited access to evening physiotherapy appointments led to an increase in evening clinic availability, and concerns about an adverse reaction to a fragrance system in a waiting area resulted in the system being removed to improve patient comfort.

Patient feedback was actively encouraged and monitored and acted upon. High levels of satisfaction were consistently reflected in Friends and Family Test scores ranging between 95% and 99%, alongside a high number of compliments. These findings indicated that patients generally had positive experiences and that feedback mechanisms were effective in identifying both strengths and areas for improvement.

Learning from complaints and concerns was seen as an opportunity for improvement and leaders could give examples of how they incorporated learning into daily practice.

While there was strong evidence that patient feedback was used to improve services, we did not see clear evidence that patients were routinely involved in co-designing service improvements or formally measuring the impact of changes made.

Patients were able to access the service when they needed to and received the right care promptly. Waiting times from referral to treatment, as well as arrangements for admission, treatment and discharge were managed in line with national standards for NHS patients referred through the choose and book system. Where waiting lists were longer, these were monitored, with action taken to reduce them over time.

Staff managed bed occupancy and patient flow well.

Managers worked to keep the number of cancellations to a minimum. When patients had their appointments or operations cancelled at the last minute, managers made sure they were rearranged as soon as possible and within the timeframes of national targets and guidance.

Managers and staff worked to make sure patients did not stay longer than they needed to. Staff planned patients discharges carefully, particularly for those with complex mental health and social care needs. Staff liaised with GP’s and community services when patients had complex needs.

Staff monitored patient access and outcomes through a range of systems. Patient experience and feedback data, including Friends and Family Test scores of between 95% and 99%, were reviewed through governance processes to identify areas for improvement.

Staff demonstrated a flexible approach to service delivery to meet the needs of a diverse patient population. Access to care was supported through 7 -day MRI services, weekend outpatient clinics, and virtual consultations and pre-operative assessments, including evenings and weekends. These arrangements improved convenience, accessibility and choice for patients.

Staff identified patients with additional needs, including those with protected characteristics, at the pre-operative stage and ensured appropriate reasonable adjustments were made throughout their care. Individual arrangements were made to support patients with specific needs, such as neurodiversity, including providing quieter environments for consultations and care.

Leaders had systems in place to support continuity of care, with staff liaising with GPs and referring to community services such as district nursing where ongoing support was required. All patients received post-operative follow-up contact and clear information on how to access further support if needed.

People who did not speak English as their first language could access the service. Staff had access to interpreting services by telephone.

Discharge arrangements optimised the outcomes for all patients, including those with protected characteristics. Where necessary, carers and community services were involved to encourage and support a return to the patient’s pre-admission condition.

Patients were supported to make informed choices about their care and future treatment, with the support and involvement of their family or carer if they wished.

Staff provided advice and guidance to support recovery following treatment and discussed health lifestyle choices to promote wellbeing after discharge. They reinforced key information and gave written advice based on current best practice.

Patients who had undergone surgery that altered their body appearance or functions permanently, were provided with access to ongoing support and advice for managing their condition.

Staff provided patients with discharge summaries to take home, and copies were shared with their GP to support continuity of care. Follow up appointments were arranged before discharge to ensure ongoing monitoring and support where required.