Spire Harpenden Hospital

On this page

• 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

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 patient 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.

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 vision for what they wanted to achieve and a strategy to turn it into action. This vision reflected the overarching provider aims and objectives. Staff we spoke with were able to articulate how their work contributed to achieving targets.

Staff were focused on the needs of patients receiving care. Equality, diversity and inclusion were actively promoted across the service, and staff were supported through opportunities for professional development and career progression. The service had an open culture where patients, their families and carers as well as staff could raise concerns without fear of negative consequences.

Staff told us they felt respected, supported and valued by leaders and colleagues. They reported that the leadership culture was inclusive and how they felt valued and respected. Relationships between staff of all grades were positive, with strong teamwork and collaboration.

Staff felt motivated about the future and were enthusiastic about the planned changes for the service.

Individual and team achievements were recognised and celebrated, and staff felt appreciated for their commitment to their work.

There was a clear leadership structure, led by the Hospital Director and supported by the Director of Clinical Services, Operations Director and a range of experienced departmental managers overseeing clinical and non-clinical areas, including theatres. Leaders had the skills, knowledge and experience required to run the service and demonstrated a good understanding of the priorities, risks and challenges facing the hospital.

Staff told us leaders were visible, approachable and supportive. They had access to senior leaders through regular team meetings, departmental briefings, hospital-wide communications and direct contact with managers. Staff felt able to raise concerns and seek advice when needed. Leaders promoted staff development and encouraged opportunities for career progression, with staff reporting they were supported to develop their skills and take on more senior responsibilities.

Staff and patient survey results were acted upon. For example, patient feedback identified difficulties in accessing evening physiotherapy appointments, and in response the service increased evening clinic availability by adjusting clinic times. Feedback from a patient who experienced adverse effects from a fragrance system in a waiting area led to the system being removed to improve patient comfort.

Feedback was routinely collected through structured surveys, including the Friends and Family Test, which showed consistently high satisfaction levels. Survey themes, such as communication, feeling informed and overall experience, were reviewed through governance processes, enabling the service to identify areas for improvement and respond accordingly.

Staff and leaders demonstrated a culture of openness, honesty and transparency. Staff were encouraged to raise concerns and offer ideas; the culture enabled staff to be confident their voices were heard.

Staff told us they felt able to raise concerns without fear of adverse consequences and believed they would be supported in doing so. When concerns were raised, leaders responded appropriately, carrying out investigations in a sensitive and confidential manner. Serious concerns raised through whistleblowing processes were escalated to both local senior leaders and provider level leadership. Risk registers and management reports included analysis of concerns over time and associated action plans to address identified issues.

Patients, their families and carers were provided with information to explain how they could raise a concern and how this would be investigated. Senior staff on ward areas were encouraged to respond to immediate concerns or complaints with a view to resolution. There were policies in place to support the management and investigation of complaints.

Leaders acted to identify and address any disparities in the experience of staff with protected characteristics. They took steps to remove potential bias from workplace practices and processes, promoting equality of opportunity and ensuring staff could access development opportunities throughout their employment. Staff told us they had opportunities to apply for project work, new roles and external training opportunities through an open application process.

The service had measures in place to prevent and address bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act and those from excluded and marginalised groups. Staff told us they felt that everyone was treated fairly and that they felt able to report inappropriate behaviours or attitudes, knowing these would be taken seriously.

Staff with disabilities were supported through appropriate reasonable adjustments to enable them to perform their roles effectively. For example, a visually impaired physiotherapist was supported to maintain a full clinical caseload through the provision of adapted IT systems for record-keeping, alongside practical workplace adjustments to accommodate both the individual and their guide dog. This demonstrated a proactive and inclusive approach to supporting staff with additional needs and fostering an accessible working environment.

Leaders maintained effective governance arrangements through a structured committee framework and a range of on-site activities. Staff told us about regular daily safety briefings, weekly rapid response meetings, and quarterly safety, quality and risk committees where incidents, complaints, audit activity, staffing and patient safety risks were reviewed. These forums supported the timely monitoring of performance, identification and mitigation of risks, and the sharing of learning across services and departments.

Staff collected, monitored and communicated key performance and quality information through established governance processes. This included data relating to clinical incidents, complaints, audit compliance, workforce metrics and patient feedback. This information was shared across departments and escalated through local governance structures to group-level committees, providing oversight and assurance at provider level.

Leaders analysed and compared performance data within the wider organisation, and where improvements were required at location level, action plans were developed and monitored. For example, audit findings, incident trends and complaint’s themes were reviewed regularly, with actions tracked through governance meetings to ensure completion and improvement.

There was a Medical Advisory Committee (MAC) led by a chair and supported by the service’s leadership team, which provided oversight of clinical quality and performance. The committee met regularly and had good engagement from consultants. Its role included the review of practising privileges, monitoring of clinical performance, and oversight of governance data.

Leaders ensured processes for granting and renewing practising privileges were robust and effectively managed. Consultant activity, performance and clinical outcomes were subject to regular review to provide assurance regarding the quality and safety of patient care. Where concerns were identified, these were managed through established governance processes, including escalation to senior leaders and action taken in line with medical governance frameworks.

The MAC worked alongside the organisation’s wider governance structures to ensure effective oversight of consultants and support the delivery of safe and effective clinical practice across the service.

Staff at all levels were clear about their roles and accountabilities. Staff had job descriptions, and these set out expectations and responsibilities. Where senior staff had designated tasks related to audit and monitoring the quality of services, they understood what was required of them.

Staff had access to the information and data they needed, presented in accessible formats, to monitor performance, support decision making and drive service improvements. Information systems were integrated, secure and supported the effective management of data. Required data and o statutory notifications were submitted to external organisations in a timely and consistent manner.

Leaders made sure that accurate information was discussed and shared with staff through a range of structured communication channels. For example, information was shared through daily safety briefings, where all departments provided updates on staffing, patient activity, incidents, risks and operational issues. This ensured staff had a clear and consistent understanding of current priorities and safety concerns.

Leaders ensured information was communicated through weekly rapid response meetings and clinical governance meetings. Data relating to incidents, complaints, audit performance and patient feedback was reviewed and shared across teams, supporting transparency and informed decision-making.

Leaders ensured risks were clearly identified, monitored and managed through a formal risk log, which provided oversight of mitigating actions and progress towards resolution. Staff contributed towards decision-making to help improve sustainability and improve quality of care.

Leaders followed audit processes and the outcomes were used to ensure quality of services was maximised. Where improvements were required, leaders ensured action plans and the monitoring of these led to positive changes.

Leaders had plans to cope with unexpected events and had a business continuity plan, which included major incident plans.

Leaders had not reported any data breaches and systems were secure. Patient identifiable information was handled correctly.

We reviewed several service level and provider policies and found these were up to date and readily available to staff. Leaders maintained oversight of policy governance and ensured documents remained accurate, relevant and reflective of current practice.

Staff and leaders worked collaboratively with relevant external stakeholders and agencies to improve care and treatment for patients using the service. For example, the service worked closely with local NHS trusts and community services, enabling safe transfer of deteriorating patients and access to additional care when required. Staff also liaised with GPs and district nursing teams to support patients following discharge and ensure continuity of care.

Leaders worked in partnership with the wider organisation, including hub working with a neighbouring hospital, which enabled sharing of staff expertise and development of new services, such as the introduction of a robotic surgery programme. Leaders also described regular engagement with clinical teams across sites to share best practice and support safe delivery of care.

Some senior leaders were part of regional networks enabling them to understand the needs of the local community, contribute to wider healthcare discussions and align the service development with organisational ambitions.

Leaders and staff actively engaged with patients, staff, equality groups, the public and local organisations to inform planning and management services.

Leaders were committed to continually learning and improving services. There were processes for learning when things went wrong and from good practice, both locally and across the wider organisation. Staff described how incidents, complaints and audit findings were reviewed through governance processes, including daily safety briefings and rapid response meetings, where learning was shared and actions agreed. For example, incidents such as missed medications or clinical concerns were investigated, risk assessed and used to inform improvements in practice, and learning was disseminated across teams.

Leaders demonstrated an understanding of quality improvement and contributed to service developments. Improvement projects had focused on areas such as antimicrobial processes, microbiology result management, and pre-operative assessment pathways, with actions implemented following audit findings and incident reviews. Staff were supported to develop their skills and take part in improvement work through training opportunities and leadership development programmes.

Staff were supported to take time to develop their skills and pursue areas of interest, and leaders encouraged innovation and service development. For example, the introduction of a robotic surgery programme demonstrated how leaders worked collaboratively across sites to improve patient outcomes and expand the range of services available.

Staff and leaders were committed to excellence that centred on the patient experience. Where issues were identified, they worked together to find solutions. For example, patient feedback about access to physiotherapy appointments led to an increase in evening clinic availability, and concerns about environmental factors affecting patient comfort resulted in changes to improve the patient experience. Feedback was routinely reviewed and used to inform improvements, demonstrating a proactive and patient-focused approach to service development.