HF Trust Bedfordshire

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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant the service was consistently managed.

Communication systems needed to strengthened to ensure people felt listened to and their voices heard. Processes for dealing with concerns and complaints required improvement so that people, their family and friends could feel confident that if they complained, they would be taken seriously and treated compassionately. There were governance arrangements in place to monitor the quality of care. The management and staff teams worked in partnership with key organisations to ensure people received the right care. There were processes in place to ensure that learning happened when things went wrong.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although the provider had a shared vision, strategy and culture this was not always embedded into staff practice. For example, leaders did not always demonstrate a positive, compassionate, listening culture. Feedback from relatives made it clear that concerns raised were not always taken seriously, and relatives did not feel listened to. One relative commented, “When I raise concerns, they treat me like I’m crazy.” Another relative told us, “Communication is very hit and miss.” This meant that trust and understanding between people and relatives was not focused on learning and improvement.

We did raise relatives concerns with the registered manager who swiftly completed an investigation and produced an action plan for improvement. They also addressed relatives’ individual concerns so they could be resolved satisfactorily.

The provider had a set of policies and procedures that helped to create a consistent approach to care. These included policies covering equality and diversity. There were regular updates for staff through staff meetings, 1-1 meetings, emails and newsletters. Staff completed mandatory training sessions to understand the vision, values, and strategic goals, and how their roles contributed to achieving them.

Managers did not always lead with integrity, openness and honesty. Relatives told us there was poor communication with managers. One relative told us they didn’t always raise concerns and felt reluctant to make a complaint because they didn’t feel listened to and felt their concerns were not taken seriously. Another relative commented, “Communication has broken down and now I just email the manager rather than talk to them, as they always talk over me.” Relatives told us family members had been taken to hospital, and they were not swiftly notified. One relative commented, “[Family member] has been taken to hospital and sometimes I’m not told until the next day.”

A relative told us that since their family member had gone into the service they had put on a large amount of weight, and they were concerned for their welfare. They said they had been waiting 3 months for a meeting with the management team, but this had not taken place. They commented, “I don’t think they are serious, and I don’t think this meeting will take place.”

Another relative said there had been an incident regarding their [family members] mobility car. They raised it with the manager and the relative was informed that the manager would look into the concerns. At the time of our call to the relative they had not received any feedback in relation to their concerns within the timescales given to them.

We spoke with the registered manager about the issues raised by relatives in relation to poor communication. They took the concerns seriously and straight away completed an investigation and produced an action plan to ensure improvements were made. Actions included the introduction of family forum meetings to commence from August 2025 and steps to improve communication would be raised at staff meetings. In addition, all concerns raised by relatives were addressed individually.

People and relatives did not always feel they could speak up and that their voice would be heard. Relatives told us they were often reluctant to raise concerns because they were not listened to and because actions were not always taken to address issues raised.

People using the service had regular monthly opportunities to meet with a key worker (principal staff member) to raise anything that was of concern to them.

All of the staff we spoke with said they felt they could speak up when needed and there were several different forums that allowed them to do this. Comments included, “I would report my concerns to my managers immediately, If I wanted to remain anonymous, I would use the safeguarding phone line.” And “I can raise concerns with my managers face to face in supervisions, or via email or an in-phase report which is our new incident recording system.”

Staff received safeguarding training that highlighted the importance of speaking up. The provider had the relevant policies and procedures in relation to speaking up and whistle blowing. Relatives stated in the past there was a forum where the provider held meetings for people and relatives to be heard. At the time of the inspection these has stopped. However, after we had shared feedback from relatives with the management team, they planned to introduce family forum meetings to commence from August 2025.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff members from diverse backgrounds felt valued and respected because the provider had implemented strategies that promoted cultural diversity and understanding.For example, staff were supported to observe religious holidays and embrace various cultural perspectives and traditions.

Staff were provided with training and further development, so they had the skills and knowledge to undertake their role. We were told there was an open-door policy that meant that staff were able to approach any manager if they felt they were not being treated fairly. There were policies and procedures in place to support non-discriminatory and equitable staff recruitment. Processes were in place to support staff to carry out their roles. Staff had completed equality, diversity and inclusion training.

The provider had clear responsibilities and a governance system in place. They used these to manage and deliver care, treatment and support. Staff described supervision (1-1 meetings with a line manager) and appraisal as regular and supportive. One staff member told us, “I have regular meetings with my manager where I can raise anything at all. My manager is very supportive.”

The deputy manager attended the different sites on a weekly basis to complete finance spot checks and have open honest communication within the staff team. Staff had several forums in which to share communications with managers. This could be done through email, phone calls, teams’ messages or face to face contact. The registered manager commented, “We have worked incredibly hard in trying to improve this area of managing the service and only yesterday the deputy completed a supervision with a member of staff who stated that they had consistently asked previous management for specific actions to be completed and it's only since we have been in post that these have been addressed.”

We saw that the service worked collaboratively with key organisations to support care provision. Contact with health professionals was made promptly to ensure people’s support was effective and fully met their needs. For example, where a person was living with particular conditions, such as epilepsy, specialist nurses were involved in the person’s care.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. The registered manager told us that multi-disciplinary meetings were organised if there were any concerns about a person’s care or well-being.

Staff told us they were kept up to date about changes to people’s care. One staff member said, “We have good communication between staff, and we are made aware of any changes quickly, this includes advice from professionals such as the dietician.

A health and social care professional told us, “They are transparent in raising safeguarding referrals. Their relationship with us is positive; whenever contacted, they are prompt with their responses.”

We saw that the service worked collaboratively with key organisations to support care provision. Contact with health professionals was made promptly to ensure people’s support was effective and fully met their needs. For example, where a person was living with particular conditions, such as epilepsy, specialist nurses were involved in the person’s care.

The provider focused on continuous learning across the organisation and local system. Following feedback from relatives about poor communication the registered manager immediately completed an investigation and produced a plan of action for improvement.

We saw learning from incidents was shared amongst the staff team to ensure care quality could be improved. For example, if a person had needed support when they became distressed, we saw the management team looked at the causes and any learning required. Where improvements were needed to practice, or changes to a person’s care planning, these were completed promptly to reduce the risk of reoccurrence.

Systems were in place to promote and support learning and improvement and the provider demonstrated a willingness to work collaboratively with others in order to identify new, innovative ways of working. Managers cascaded important information to staff. Staff could undertake further learning specific to people’s health needs.