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. Leaders had systems for identifying and responding to deteriorating patients on the wards, in the operating theatre and recovery. People received treatment and care to reduce the risk of avoidable harm, such as pressure damage, blood clots or falls. There were safety processes arranged before surgical procedures and operations started, with staff working together to ensure the right patient had the correct operation. Medicines were managed safely. Patients were safe from neglect, abuse and discrimination. Patient’s gave informed consent prior to procedures and where they were unable to consent, those close to them were involved in decisions made in their best interests.

At our last assessment we rated this key question good. At this assessment the rating has remained good. Patients 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 managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured actions from patient safety alerts were addressed and progress was monitored.

Staff had access to a current incident reporting and reviewing policy, which reflected the provider and national guidance.

Staff raised concerns and reported incidents and near misses in line with provider policy. We saw evidence of incidents having been investigated, and sufficient action taken to reduce the risk of recurrence. We looked at the system for managing incidents.

Over the last 6 months, staff reported a total of 365 clinical patient safety incidents, alongside 47 non-clinical incidents and 10 near misses.

Staff recorded incidents across a range of services, with staff reporting issues including medication incidents, documentation and patient information errors, theatre-related events, and perioperative complications. Additional examples included falls, infection control concerns, safeguarding issues, and unplanned readmissions within 31 days of discharge, demonstrating reporting across the full patient pathway.

Staff reported and documented near misses through the organisation’s reporting system, with learning identified and recorded where applicable to support ongoing improvements in patient safety.

Staff reported zero Never Events in the preceding 12 months. Never Events are serious, preventable patient safety incidents that should not occur if appropriate preventative measures are in place, such as wrong site surgery or retained foreign objects following a procedure

Incidents were analysed to identify trends or themes and potential links to individual practitioners.

Staff were able to identify and report risks, secure in the knowledge these would be addressed. For example, concerns were raised regarding behaviours in theatre that made both staff and patients feel uncomfortable. Staff also reported environmental issues such as clinical waste not being managed appropriately. These concerns were reported promptly, and appropriate action was taken to address them. Where there was an immediate risk of harm to patients or others, staff felt confident to intervene to prevent harms occurring.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation when things went wrong. Staff received feedback from the investigation of incidents, both internal and external to the service.

There was evidence that changes had been made because of feedback. Managers debriefed and supported staff after any serious incident.

The service provided mandatory training in key skills to all staff. Managers monitored mandatory training and alerted staff when they needed to complete updates.

All staff within the operating theatre service received and maintained mandatory training, with overall compliance largely high, most areas achieving between 90% and 100%. Compliance was particularly strong in duty of candour, data protection, safeguarding, medical devices, and health and safety, Basic Life Support resuscitation training all at or near 100%.

Theatre staff demonstrated strong overall compliance with mandatory training requirements. While compliance was lower for Immediate Life Support (78%) and controlled drugs training (84%), staff requiring updates had already been booked onto training courses. The service had recognised these gaps and was taking appropriate steps to improve compliance.

Managers used changes in national guidance, incidents, safeguarding and appraisals to identify gaps in learning.

Patients were assessed prior to surgery and findings considered when planning care and treatment. This included cancelling or delaying the surgery in cases where an underlying condition was identified.

Staff used an admission criterion for both private and NHS patients. These criteria set out where the service had limitations and therefore minimised risks by excluding some higher-risk patients. For example, patients who may be at increased risk of complications due to complex medical conditions, significant anaesthetic risk, or a high likelihood of requiring additional specialist support, critical care, or extended inpatient management were assessed on a case-by-case basis to ensure the hospital could safely meet their needs.

Patients requiring tests and investigations were provided with sufficient information to help them understand the procedure and make informed decisions about their care.

Staff used systems and processes to ensure the correct patients were treated throughout each patient’s journey. We walked the patient journey and tracked patient care from admission to the wards and through to the operating theatre. We observed handover of patient information including all related identification checking processes. Once in theatre, the World Health Organisation (WHO) surgical safety check list was used to avoid harm. We observed completion of the process. Staff confirmed the surgical safety standards such as a stop the line policy was understood by them in the event of any concerns raised. Staff transferred patients from the operating theatre to the recovery area, with the anaesthetist maintaining responsibility for assessing and confirming their readiness for transfer. Suitably skilled and qualified staff accompanied patients in all areas.

Patient records were maintained using a combination of electronic and paper-based systems and were stored securely. The IT connectivity was consistently available across the service, enabling staff access and complete records effectively.

Staff assessed whether patients were likely to require critical care support and, where necessary, made arrangements in advance. Responsibility for the care and treatment of patients transferred to another provider, such as an NHS service, was maintained throughout the transfer process. Effective communication between services supported safe, coordinated, and seamless transfers of care. Staff worked collaboratively with patients, partner organisations, and local communities to plan and deliver care in a way that promoted continuity and met individual needs.

Managers told us that staff understood how to protect patients from abuse and worked effectively with other agencies. They stated that all staff had received safeguarding training appropriate to their role. Training data confirmed 100% compliance for Level 1 safeguarding adults and children across all relevant departments.

Managers provided Level 3 compliance data, which showed 100% compliance in Pharmacy and Physiotherapy, exceeding the 95% target. In Pre-Operative Assessment, Theatres and Wards, compliance for both adult and children’s safeguarding ranged from 86% to 95%, with some areas achieving the 95% target and others remaining below it.

The service had up-to-date safeguarding policies for adults and children, aligned with national guidance, including consideration of visitors. There was an onsite Level 4 clinical safeguarding lead for both adults and paediatrics, supported by contingency central safeguarding leads across sites.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. Expert safeguarding advice was available to support staff from Monday to Friday and at weekends. Staff knew how to contact them. There was a named nurse and named doctor for adult and child safeguarding.

Young people aged 16 to 18 years were managed on the adult pathway, with appropriate safeguarding measures in place and clinically trained staff to ensure appropriate safeguarding oversight.

Safeguarding concerns were considered when an incident occurred and a referral or further advice sought, when necessary. There were links to external agencies and staff knew what happened when they raised concerns.

Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

The registered manager had oversight of safeguarding within the service. Where relevant, staff checked that people claiming Lasting Power of Attorney had the appropriate documents to support this. Discharge and follow up arrangements were organised safely. Patients knew what to expect and when they would be next seen by a nurse or doctor.

Staff followed safe procedures for visitors visiting the wards and patients we spoke to told us they felt safe.

Staff worked with patients to understand and manage risks. Treatment and care met patient needs in a way that was safe and supportive and enabled them to do the things that mattered to them.

We spoke with 4 patients and 1 family member during our assessment. They told us they felt listened to, that risks were clearly explained, and they were actively involved in decisions about their care and treatment, including sedation planning. Feedback was consistently positive, with patients describing staff as kind, compassionate, and reassuring, and reported they were treated with dignity and respect.

Patients said communication was clear and they had enough time to ask questions, helping them feel well informed before and after procedures. Patients felt supported further by helpful pre-procedure information, including a digital app. Timeliness of care was seen as good, with minimal delays, and practical aspects such as access and transport were not problematic. Overall, patients said they felt safe, comfortable, and well cared for, and would recommend the service.

Leaders ensured the design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use equipment and to manage different types of waste safely.

The design of the environment followed national guidance around the built environment. Where required, areas were secure and protected patients. Access was restricted by keypad with only approved staff provided with the codes.

Staff ensured the environment used for patient care reduced the risk of patient harm, and included, for example, safe flooring, handrails and window restrictors.

Staff ensured fire safety equipment was available and had been serviced. Fire exits were clear and free from obstruction.

Staff provided suitable equipment and ensured it was used correctly, such as for patients who were at increased risk of pressure damage or a blood clot developing. Staff carried out daily safety checks of specialist equipment. There was ready access to resuscitation equipment on the ward and in theatres.

Leaders maintained oversight of equipment to ensure it was safe and ready to use. Equipment audits were completed and outcomes shared with staff. Staff told us they had enough equipment to carry out their work safely and to support the treatment and care needs of patients. There were effective means of ensuring repair or replacement of broken or missing equipment.

Staff had access to specialist equipment used in the operating theatres, which was used in accordance with national guidance and regulatory requirements.

Patients could reach call bells. Call bells were positioned by patient beds, and staff showed patients how to use them to summon help. We saw call bells were responded to swiftly and the noise level from unanswered call bells was minimal.

The service had suitable facilities to meet the needs of patients’ families when necessary.

Staff disposed of clinical waste safely, both inside and outside the building. Waste was segregated and labelled in accordance with the service policy. The risk of sharps injuries was minimised because of the safe management of sharp implements.

Staff stored hazardous substances safely and information about products was available to staff. Patients reported that lighting was reduced at night, and the noise levels were minimised.

Leaders ensured the service had enough clinical staff including nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Staff were made aware of their shifts in advance and could make requests.

New staff had a full induction tailored to their role before they started work. Managers supported staff to develop through constructive recorded, annual appraisals and constructive clinical supervision of their work. Temporary bank and agency workers had a local induction to the area in which they were working.

Managers told us that theatre staffing was planned through a safe staffing tool aligned with Association for Perioperative Practice guidance. Data for March to May 2026 showed actual staffing fell below planned levels on 17, 19 and 27 March; 14 and 21 April; and 5, 15 and 28 May. These were reviewed at daily safety meetings with escalation in place. Managers confirmed services remained safely staffed and that the department head and theatre co-ordinator could provide clinical cover. Those roles were not included in the staffing tool.

Managers told us they did not monitor fill rates as staffing was flexed in line with activity. They reported no occasions in the previous 12 months where staffing was insufficient and said temporary staff familiar with the service were used to support service delivery.

In April 2026, theatre staffing totalled 56.44 Whole Time Equivalent (WTE), comprising 44.66 contracted staff (79.1%), 11.74 bank staff (20.8%), and 0.04 agency staff (0.1%). Bank usage therefore represented around one-fifth of the workforce, while agency use remained negligible.

Managers effectively monitored and managed staffing levels within the theatre department. Although theatre staff sickness absence was 7.0%, staffing gaps were covered through the use of bank staff and there was minimal reliance on agency staff. We were assured there were sufficient staff to meet patients' needs and maintain safe care.

Staff spoken to said they felt the service was safe. They were able to take breaks during their shift.

Patients we spoke with told us they felt their needs were met in a timely way. We saw patients were responded to in a kind and supportive way. Patients appeared comfortable and were engaged in conversations because there were sufficient staff.

The service supported the learning and development needs of staff and made sure staff received any specialist training for their role. Managers identified training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. For example, leaders actively invested in staff development across disciplines. This included funding the governance lead to undertake a master’s degree and supporting theatre staff to complete the Surgical First Assistant course.

Leaders also promoted leadership development, offering structured leadership programmes for heads of department and aspiring managers, and encouraging staff to apply. Managers described this approach as mutually beneficial, enhancing individual career development while also expanding the service’s skills base and ability to deliver a wider range of care.

Managers made sure staff attended team meetings or had access to the information shared, when they could not attend. We saw notes from team meetings and other general information was shared on notice boards.

Managers supported staff to develop through constructive recorded, annual appraisals of their work and regular clinical supervision. If poor staff performance was identified, this was dealt with in a supportive way, with a view to improvement.

Allied healthcare professionals formed an integral part of the patient care and treatment pathway and promoted recovery and rehabilitation.

Leaders ensured enough allied health professional staff were employed to keep patients safe and meet their needs. Patient pathways and their discharge was not delayed because of a lack of allied healthcare professional input.

There was oversight of medicines optimisation and ward-based support for staff from a pharmacist.

Allied healthcare professionals provided support, including diagnostic tests, 24 hours a day, 7 days a week.

Leaders had formal arrangements for a resident medical officer to be on-site when patients were receiving treatment and care.

Consultant surgeons and anaesthetists were subject to a full assessment through the practice privilege process. They were required to provide evidence of appraisal and re-validation.

Leaders ensured surgical procedures and clinical decisions were carried out by doctors with appropriate seniority and speciality training. Patients were clear who the doctors involved in their treatment were.

Leaders ensured the overnight and weekend provision was adequate, with access to the admitting consultant for advice or to attend, if necessary. The admitting consultant reviewed their patients regularly, including at weekends.

Staff told us that systems were in place to prevent and monitor infection in theatres, The service mostly protected people from the risk of infection through effective infection prevention and control systems, clean environments and high audit compliance.

An infection prevention control (IPC) lead was responsible for an audit programme. The lead included audits of cleanliness, hand hygiene, aseptic technique and standard precautions. Audit results for 2025/26 showed high levels of compliance, mostly between 98% and 100%, with one audit at 91% and theatre waste audit results at 99%. There were no concerns in relation to IPC in theatres. However, inspectors observed staff entering ward areas without undertaking hand hygiene on two occasions and the continued use of gloves without appropriate hand hygiene between tasks. Leaders took Immediate IPC spot checks to strengthen assurance processes.  During the inspection leaders gave us assurance that this practice had been carried out by housekeeping staff who were not performing direct patient care and the staff had followed correct IPC guidance for their role.

Staff told us systems were in place to prevent and monitor infection, including surgical site infection (SSI) surveillance and infection control policies aligned with national guidance. Data for June 2025 to June 2026 showed there had been no cases of MRSA or E. coli and one case of community-associated C. difficile. Mandatory surveillance data showed no SSIs following hip and knee arthroplasty, although the service reported a small number of superficial, deep and organ-space infections following other surgical procedures.

The theatre environment was designed to support infection prevention, with clear separation of clean and contaminated areas, compliant handwash facilities, appropriate airflow systems and off-site sterilisation of surgical instruments under a service level agreement. Staff followed infection prevention principles, including the use of personal protective equipment (PPE), hand hygiene and checks of sterile equipment before use.

Leaders demonstrated a strong focus on IPC through daily multidisciplinary safety briefings attended by representatives from clinical and support services. Staff had also improved water safety arrangements and managed identified legionella risks. There had been no infection outbreaks since 2023.

Staff used systems and processes to safely prescribe, administer, record and store medicines.

Staff followed systems and processes to prescribe and administer medicines safely. In theatres, medicines were not prepared ahead of operating lists.

Doctors reviewed each patient’s medicines on admission and provided advice to patients and carers about any changes. A pharmacist was involved in patient medicines reviews.

Staff had access to clear guidance about the safe use of antibiotics and opiates (Controlled drugs).

There were facilities for patients who wished to manage their own medicines. Patients who were able and wished to manage their own medicines were encouraged to do so.

Staff completed medicines records accurately and kept them up to date. There were accurate records of medicines administered in the operating theatre and recovery.

Medicines, including intravenous fluids, were stored in line with local and provider policy, reducing the risk of misuse and errors. Controlled drugs were appropriately managed, with keys to the controlled drug cupboard held by the nurse in charge on the ward and there were secure arrangements in theatres.

Staff completed a range of audits during 2025/26, including controlled drugs register audits, medicines storage and security audits, prescribing audits, and antimicrobial use audits. Audit results demonstrated high levels of compliance, including 100% compliance for medicines storage and security. Controlled drugs register and prescribing audits also showed consistently high compliance, typically in the high 90% range, indicating good oversight of medicines management.

Systems and processes were in place to support the safe management of medicines. Staff demonstrated effective governance arrangements in identifying and addressing risks. Staff followed national practice to check patients had the correct medicines when they were admitted, discharged or they moved between services.

Staff learned from safety alerts and incidents to improve practice. There was a review of medicines errors and steps to prevent reoccurrence.

Essential medicines were readily available for emergency situations and at short notice, including during the night and weekends. Adequate equipment, including intravenous pumps, subcutaneous pumps and self-administration pumps, was available to support safe and effective management of patients’ medicines.

Oxygen was prescribed when required, and air outlets were appropriately capped to prevent the accidental administration of air in place of oxygen.