Spire Harrogate Clinic

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 rated Safe as Good. The environment was clean, and equipment was well maintained and was safe for use. Staff were trained to use equipment. 

Medicines and medical gases were managed and stored correctly. 

Staff had received safeguarding training and staff we spoke to knew how to raise concerns and who the freedom to speak up guardian was. 

Staff described a culture where they could raise concerns, and they learnt lessons from incidents. 

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 evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. We scored the service   

The service had a proactive learning culture. Incidents were tracked through the governance meetings and shared through the heads of department meeting and then discussed with staff at team meetings. The organisation had reports to share learning from incidents and safety concerns across the Spire group. The daily clinic huddles provided a forum to cascade information to all staff and a follow on meeting was held each morning for leads of departments. The morning huddle enabled the team to raise any concerns and actions needed to mitigate them. 

We were informed of one incident, which we saw went through a robust investigation process and ultimately found no care issues at the clinic. The service leads discussed the case with staff and although there were no issues identified, they still discussed whether their processes were rigorous enough to prevent this type of incident. It was decided that they would increase signage to remind staff of the steps. 

The service was keen to involve and develop staff at any opportunity. The Quality Governance Manager had recently implemented a change to how incidents were reviewed and investigated. It empowered all staff who specialised in specific areas such as health and safety, administration or housekeeping to take the lead in managing and investigating incidents relevant to their role. Full training and support was provided and all staff were encouraged to enhance their learning in this task.  

We heard from staff that there was a positive reporting culture and a keen culture to learn from incidents. As a small clinic there were few incidents recorded, (57 in the last 12 months, all categorised as no harm) however they were thoroughly reviewed and investigated and actions implemented where required. Staff were also encouraged to share their ideas to come to the best method of resolution and further monitoring. Service leads told us of one incident regarding a lost pathology sample. This led to enhanced monitoring including contacting the laboratory the following morning to get confirmation of receipt.  

The service received safety flashes which included incidents and never events within the wider Spire group. We heard an example of an incident from elsewhere, which was sent in a safety flash, it was shared with the clinic staff and then checked to ensure that actions that had been put in place at that location were also in place at Harrogate Clinic. The incidents were shared with staff immediately through the colleague boards, email and through huddles. Staff were always made aware of incidents in the local healthcare system and within the Spire group to take every learning opportunity.  

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. 

The clinic had a policy in place which outlined the acceptance criteria, all bookings were elective and approved by the Clinical Services Manager. The clinic did not have an emergency service and therefore did not accept unplanned admissions. Staff discussed patients with changing health needs at weekly multidisciplinary meetings to determine if they were suitable for treatment.  

The clinic had good referral to treatment times (RTT) at the time of our visit while their activity was still increasing since their registration in November 2024. We requested data for outpatients, however the provider told us there was no separate national RTT measure for outpatients. RTT was measured across the entire consultant-led pathway from referral to the start of treatment, with first outpatient attendance forming one stage of that pathway. 

They prioritised any patients who had waited longest, and patients had choices about the date and time of their appointments. However, at the time of our assessment there had been no incidents of long waits.  

The service engaged with local NHS and independent providers, primary care and the Integrated Care Board (ICB) to optimise the service they could provide for patients in the local area. 

Staff worked together to ensure that patients had everything in place for their appointments to avoid delays or cancellations. The service had medical and nursing staff working in the outpatients department as well as healthcare assistants. They all worked well together to create a positive experience for patients and to ensure clinics ran safely.   

Consultant clinics typically did not over run, however we heard of some occasions where this happened and we were told that all staff involved in the clinic remain until finished. The service were keen to say this was uncommon, and when this had happened, the senior leadership team had met with the consultant to ascertain why and to discuss how they could prevent this from happening again.  

All patients were given ‘Blooming Well’ cards on discharge, which provided useful numbers to contact and on call numbers. A registered nurse took the phone home for ‘on call’ so that there was access to someone at any point of day and night. However, it was very rare they would be called out of hours.  

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. 

Staff kept people safe. The service had safeguarding policies in place. Staff we spoke with were able to outline the safeguarding process. Safeguarding leads and flowcharts were displayed across the clinic for both staff and the public to see.  

All outpatient and service leads had completed the appropriate levels of safeguarding training – as determined by national guidance for their role. The Clinical Services manager was the safeguarding lead and was trained to level 4 in both safeguarding of children and adults. 

We saw information displayed on televisions, posters and in the staff hub to keep raising awareness and keep safeguarding in mind as well as the processes to follow. Staff said they felt confident and competent to raise a safeguarding issue and who to contact for advice.  

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. 

The service had clear risk assessments for patients, which they followed to ensure that they cared for patients whose risks they could manage. The risk assessments looked at both physical and psychological needs of the patient prior to their appointments or admission for minor surgery.  

A patient passport was in place which enabled staff to provide appropriate care for people with autism and learning disabilities. Staff had undertaken mandatory training about autism and learning disabilities. 

The service had consulted with various organisations, patients and the public in order to adapt and improve their services to suit the needs of the community. They continued to do this regularly to keep services relevant and to help prevent injuries.   

Patients gave positive feedback on the information they received prior to and after their care and treatment.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. 

The outpatient department was visibly clean and tidy and equipment was tagged to indicate it was clean. Equipment was serviced by an external provider annually, which staff said worked well. Staff told us that all items of equipment were readily available and any faulty equipment was repaired or replaced in a timely manner, however this had been very rare as all of the equipment in the clinic was new.  

We spoke with staff who were able to explain the processes relating to equipment monitoring, servicing and repairing. The service provided evidence of staff training in the use of clinical equipment and non-clinical equipment. 

All the equipment we saw (such as patient couches and blood pressure monitoring machines) were clean, well maintained and had service stickers displayed showing they were within the service, calibration and electrical safety test due dates. 

Staff told us they had the equipment they needed within the department to deliver care. Staff said they were grateful that the building and the equipment were all new and therefore had not had any issues with anything so far. The department displayed the cleanliness audit report in the public area which showed consistent compliance. 

Emergency equipment was checked in line with the policy and documented. There was one resuscitation trolley for the ground floor which was accessible in an emergency but not within a public area. 

The service had a management plan in place for the prevention and management of emergency situations. We saw that there was good supply of oxygen which was appropriately stored and utilised. 

There were arrangements in place for the handling, storage, and disposal of clinical waste, including sharps. The service complied fully with the Control of Substances Hazardous to Health (COSHH) practices.  

Housekeepers had accreditation for their work standards which we saw displayed.  

All waste was separated appropriately and contained in a dedicated room throughout the day and taken to large, outdoor, secure bins at the end of each day for collection.  

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. 

The service ensured there were enough qualified, skilled, and experienced staff to meet the needs of patients visiting the department. We checked a sample of staff files and required recruitment checks were complete. The outpatient’s department was fully staffed on the day of our assessment, however they had 2 vacancies for a bank registered nurse and a registered nurse (4.5 hours). Staffing levels were visible for patients to see. On the morning of our visit, we saw there were more actual staff than had been planned. This was a regular occurrence as we saw from the data that we received from the provider. The daily huddle checked there were enough staff, and they flexed staff to support other areas where required. 

Consultants and GPs worked at the clinic under the terms of their practicing privileges policy and were overseen by the quarterly Practicing Privileges Advisory Group (PPAG). The service had processes in place to check consultants met the terms of this policy and had completed relevant training. Consultants were available on-site during clinic hours.  

Staff told us how they had exceptional opportunities for development, and we heard how staff had been supported to complete further training to deliver better care. There were staff who had worked from a reception role and were now service leads and we were told of their encouragement and support to train and develop in areas they were interested in.  

Training records showed staff completed mandatory training and clinical competencies. Managers monitored compliance and there was a schedule of training in place. We reviewed training compliance, however the data was not kept by department, but for the whole clinic. It was overwhelmingly positive with almost all subjects achieving 100% completion, including training for autism and learning disabilities, PREVENT and NEWS2.  

The service leads always encouraged staff to express any wishes to undertake additional training and staff said that whenever there was an opportunity to get together and learn, they did this on an ad hoc basis in addition to any planned training. Consultants and staff with specific knowledge and expertise were happy to present short sessions when time allowed. 

All nurses were trained in paediatric and adult Immediate Life Support (ILS) and there was always one available on site. The service carried out scenario training on a quarterly basis, which staff said they found really useful.  

Sickness rates for the previous 12 months were at 1.6%, which was significantly lower than the Spire average.  

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. 

The service managed the risks of infection, there was a comprehensive infection control audit programme and strategy. The outpatient’s manager and housekeeping lead undertook monthly departmental audits and quarterly results were on display in the department, showing 100% across the board. Results were cascaded and the findings and any actions were discussed at team meetings. 

The environment was visibly clean and tidy and staff were seen to be bare below the elbow. We observed staff washing and sanitising their hands, there were handwashing facilities in the clinic rooms and equipment was clean, items were tagged as clean and dated. There was enough personal protective equipment (PPE) for all staff and clinical waste was disposed of appropriately according to the policy. 

All staff in outpatients had completed infection control training. Staff had access to advice from an infection prevention and control (IPC) lead at all times. 

The Clinical Services Manager attended Integrated Care Board meetings to learn from wider services and bring back to the clinic. They also attended quarterly antimicrobial stewardship (AMS) meetings with Spire Leeds for Yorkshire hub learning. Microbiology surveillance was managed through surgical site infection (SSI) swab tracking. Trends and themes were discussed at AMS meetings and any escalated concerns were raised with medical governance through practicing privileges advisory (PPAG) meetings. 

IPC audits were kept on the electronic system for viewing locally, which was new and positive for learning.  

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen. 

The emergency resuscitation trolley was checked daily, in date and sealed. Oxygen was in date and safely stored and there were anaphylaxis boxes available for children and adults. There were specific resuscitation equipment for children, however, the service leads told us that all interventional treatment was limited to patients 16 and over. Therefore, only basic life support equipment was available in line with Spire policy, based on Resuscitation Council UK guidance. This had been risk assessed by the central resuscitation lead nationally via Spire governance. 

All medication cupboards were locked and the key located with the registered nurse in charge. There were typically no medications to take home in outpatients, with the exception of the eye clinic.  

The medications register was located in the phlebotomy room, which contained minimal medication such as botox and local anaesthetic, which were both for surgical use. The service  did not carry out any sedation and there were no medications under patient group directions (PGD) for outpatients. (Patient group directions allow healthcare professionals to supply and administer specified medicines to pre-defined groups of patients, without a prescription). 

We reviewed medicines audits, which showed 98% compliance and was above the target, therefore no actions required.  

Temperatures were checked and recorded daily in areas where medicines were stored. Medication checks were carried out by pharmacy from another Spire site, for which we saw a service level agreement in place.  

Prescription stationery was securely managed by the outpatient’s manager and records kept for monitoring. They provided only private prescriptions.