During a routine inspection

• We rated safe as requires improvement and effective, caring, responsive and well-led as good. In rating the trust, we took into account the previous ratings of the seven services not inspected this time. We rated the trust overall for well-led as good. At this inspection, we rated two core services as outstanding, one core service as good and one as requires improvement. In rating the trust, we took into account the previous ratings of the seven services not inspected this time. Therefore, two of the trust’s 11 services are rated as outstanding, eight as good and one as requires improvement.
• Staff showed caring, compassionate attitudes, were proud to work for the trust, and were dedicated to their roles. We were impressed by the way all staff in the trust embraced and modelled the values. The values were embedded in the services we visited and staff showed the values in their day-to-day work.
• Staff managed medicines safely in most services. The trust had made improvements in medicines management since the last inspection. Documentation was clear, staff completed competency assessments, and managers implemented systems to manage medication and completed regular audits.
• The trust provided mandatory training, supervision and appraisal. Staff compliance with this in most services was above 75%. Managers discussed the values with staff in supervision, and based team objectives on trust values. Senior staff saw leadership as fundamental to their role and managers were visible and approachable. The trust recognised staff success through individual and team awards and staff were encouraged and supported to develop in their roles.
• Staff completed comprehensive and robust risk assessments and documentation showed clear patient involvement and inclusion. Care of patients focused on their strengths and areas of independence. Staff responded quickly and effectively to the changing needs of patients. Bed management processes were effective and embedded into some services.
• Staff included patients in service improvement, using their feedback to change practice. We saw many examples of innovation and projects that had been trialled and then implemented in the trust.
• Safeguarding and incident reporting were transparent locally and thorough; review and evaluation of this was proactive. Teams shared lessons learnt effectively and in some services shared this learning with patients. There was good evidence of multidisciplinary team working within the services and with external agencies.
• Local leadership across the majority of services was strong, visible and effective. Senior leaders were known to staff and visited services. The board encouraged feedback from all levels of the organisation. The responsiveness of the teams and at board level to issues raised during the inspection was immediate.
• The trust had a robust governance framework and structure. Service managers attended local monthly clinical governance meetings, which fed into the trust wider governance meetings. Local governance meetings discussed ward issues, such as incidents, safeguarding, staffing concerns, and identified and shared learning from incidents.
• Information technology systems and use of technology applications enabled staff to deliver care more safely and efficiently. Quality improvement initiatives had begun to make a difference. The system for agreeing projects to be supported showed commitment to the principles the trust upheld. Staff involved service users in project decision that needed to be made.
• A system called SPIKE gave staff access to monitor performance and leaders saw this as a way to assist data collection and analysis and reduced time on administration tasks. The trust was developing a second version of SPIKE to further improve data management and staff saw this as positive.
• We were provided with a good description of the way in which the trust implemented Duty of Candour, highlighting that it is in the terms of reference for the investigation of each serious incident that the duty of candour is complied with; patients are contacted before, as part of, and at the conclusion of each investigation.

However:

• Low staffing in the child and adolescent mental health ward may have impacted on the frequency of one to one keyworker sessions. In one ward for people with a learning disability or autism, shifts were not always covered with sufficient staff.
• Although staff on the mental health wards had assessed the risks posed by potential ligature anchor points, they had not identified all such risks. Also they had not taken action to fully mitigate the risks posed by some of the potential ligature anchor points that they had identified. The trust took immediate action at the time of inspection to address this and a plan of works was completed by the end of January 2018.
• We identified the use of restrictive practices on the child and adolescent mental health ward. Patients access to mobile phones was restricted and some patients were not allowed full access to the ward garden.
• Seclusion occurred outside of designated seclusion rooms in several services and staff did not always clearly document the reasons for this. Two seclusion rooms had environmental issues identified and were not compliant with the Mental Health Act code of practice. The trust took immediate action to address this.
• Some physical healthcare records lacked detail in care plans and monitoring for long-term health conditions did not take place.
• Supervision compliance was low in two services. Most services had local system to record compliance in the absence of a trust wide system.
• In one service, staff did not feel supported by senior managers and there was a poor working relationship with the education team. The leadership in Albany Lodge was new, the staff team was new and staff felt there was a lack of direction.
• The trust did not follow the NHS framework for reporting serious incidents.

During a routine inspection

We found that Hertfordshire Partnership University NHS Foundation Trust was performing at a level that leads to an overall judgement of good.

We found a great deal that the trust can be proud of.

We noted that people’s needs, including physical health needs, were assessed and care and treatment was planned to meet individual need. Staff had good opportunities for learning and development and showed a good practical understanding of the Mental Health Act and the Mental Capacity Act including Deprivation of Liberty Safeguards.

Caring was consistently of a good standard and we found staff to be dedicated, kind and patient focused. The CAMHS substance misuse team deserved recognition in terms of the care and treatment offered but also the responsiveness of the services provided to patients. The services at Logandene and Elizabeth Court had improved greatly since previous inspections. We also observed some good caring practice in the community services for people with a learning disability or autism.

Despite staffing pressures in some areas, staff were generally responsive to the needs of the patient group. The trust’s facilities and premises were generally appropriate for the services that were being delivered. The modern and purpose built facilities at Colne House, Seward Lodge and Kingfisher Court demonstrated an organisation that is proactive with regards to the rationalisation of its estate.

We found the trust to be well-led at board level. The trust’s vision and values were visible in most of the services provided and the work that the leadership team were undertaking to instil these throughout the organisation in order to promote a caring, transparent and open culture was notable. The executive team impressed us both individually and collectively. They demonstrated cohesion and a determination to improve and enhance the quality of care provided to those who use services within the Trust. The inspection team also noted the important role that non-executive directors and the board of governors performed in implementing quality and value throughout the trust.

The executive team met weekly and discussed ongoing issues and board challenge. This enabled the trust board to address any identified issues in a timely manner. The executive and non-executive directors regularly visited services as a way of staying in touch with staff, families and people who used services. Front line staff told us that these visits were much appreciated.

However:

We found areas of concern. In the CAMHS Section 136 suite at Kingsley Green. The privacy and dignity of young people was compromised as a result of the location of the suite. However, the trust acted immediately to remedy this and relocated the suite to a more appropriate environment.

Recruitment of staff was an area that required improvement by the trust in order to reduce reliance on bank and agency staff that were less familiar with the patient group. Staff morale was low in some areas following a trust wide transformation of services. However, we found evidence that the trust was taking action to address these issues.

We will be working with the Trust to agree an action plan in order to improve and address the areas of concern.