Hertfordshire Partnership University NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider maximised the effectiveness of care and treatment through comprehensive, multidisciplinary assessment and regular reviews of young people’s health, care, wellbeing and communication needs.

Young people were involved in the assessment of their needs during ward rounds, with support provided where required to maximise participation. Assessments were holistic and considered mental health, physical health, risk, nutrition, education and social context. Young people’s needs were routinely reviewed through ward rounds and multidisciplinary team meetings.

The service used a wide range of validated clinical assessment tools. Young people and parents/carers were actively encouraged to participate in routine outcome measurement.

Outcome data was used to inform service improvement. Quarterly outcome measure reports were reviewed through governance forums and learning from these reports directly influenced practice. For example, analysis identifying reduced parental confidence during inpatient admissions led to the piloting of a parental non-violent resistance (NVR) group which had plans for wider rollout as part of the pathway development.

The provider planned and delivered care and treatment in partnership with young people and their families, in line with current legislation, evidence-based good practice and recognised standards.

Young people received care that was underpinned by evidence-based clinical models appropriate to their needs. The unit had adopted a dialectical behaviour therapy (DBT) model, supported by regular skills groups and staff training. During our visit, we saw posters on the wall with DBT skills visible to young people and visitors to the ward.

The service demonstrated a strong commitment to continuous learning and evidence-based innovation. This included the implementation of the HOPE(s) model to support young people in, or at risk of, long-term segregation. Staff had received specialist HOPE(s) training, and the model had contributed to measurable improvements. For example, quantitative outcomes demonstrated an increased level of engagement in ward activities, a reduction in incidents of violence and self-harm and a reduced reliance on restrictive practices.

Care planning and clinical decision-making were informed by routine outcome measures (ROMs), guidance and best practice. The provider was in the process of transitioning from ‘Respect’ to crisis prevention institute (CPI) training which reflected national best practice in de-escalation, human rights and the reduction of restrictive practices.

People’s nutrition and hydration needs were met in line with current guidance. All young people received a nutritional screening on admission, with enhanced monitoring where required. The service conducted regular auditing of food and fluid chart documentation and acted promptly on any omissions identified. For example, between 9 and 15 June 2025, auditing identified intermittent gaps in recording, primarily affecting evening meals and snacks. Documentation was incomplete on several days for both young people reviewed. The provider responded appropriately by escalating issues promptly and maintaining close oversight and arranging targeted staff training. We saw evidence that this improved monitoring of food and fluid intake.

The provider ensured that care was well coordinated across staff teams and services, supporting continuity, safety and effective outcomes for young people and their families.

Staff had access to the information they needed to assess, plan and deliver care, supported by structured handovers, MDT documentation, risk assessments, care plans and regular clinical review. Handover processes were clearly defined, and information relating to risk, mental state and physical health and care priorities were routinely shared across shifts.

Care and treatment were delivered through strong multidisciplinary working, with nursing, medical, psychology, occupational therapy, social work, education and dietetic staff working collaboratively.

Plans for transition, referral and discharge were developed early and reviewed regularly. Structured discharge planning included liaison with community CAMHS, social care, education and placement providers. For young people subject to care, education and treatment reviews (CETRs), the service contributed to multi-agency review processes to support care planning.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Young people were actively involved in monitoring and reviewing their health and wellbeing. Physical health assessments, nutritional screening and food and fluid monitoring where indicated contributed towards early identification and intervention. Young people told us they were able to access medical staff when needed in a timely manner.

Activities timetables were varied and inclusive, supporting both emotional wellbeing and physical health. Cooking groups supported skill building and developing positive relationships with food.

Access to wider healthcare services was facilitated where required. This included liaison with specialist services such as dietetics.

The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The service had a well-established system in place for monitoring clinical outcomes which used a range of validated outcome measures collected from young people, parents/carers and clinical staff. Outcome data was reviewed through governance forums and influenced service development.

The service also monitored quality and safety outcomes, including incident trends, restrictive practice data and safeguarding activity. The data showed a reduction in incidents over time, with 99% of reported incidents resulting in low or no harm. Learning from incidents was embedded through PSIRF processes, SWARMs and MDT reviews.

There was a commitment to external quality improvement, including participation in national outcome frameworks (CORC), engagement with accreditation schemes such as the quality network for inpatient CAMHS, and work towards national autistic society (NAS) accreditation.

Outcomes of these initiatives also contributed towards increased engagement on the ward and a reduced reliance on restrictive practice.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Young people we spoke with said they had been given information about their rights under the Mental Health Act. Young people told us they were involved in discussions about their treatment during ward rounds and felt able to ask questions about their care, including medication. Carers told us that they were kept informed about their child’s care and treatment, particularly in relation to leave arrangements and discharge planning.

Where young people were subject to the Mental Health Act, staff worked with appropriate legal frameworks and recognised the importance of taking account of capacity, consent and best-interest decision making. We reviewed care records and saw that T2 and T3 documentation was in place, up to date and readily accessible to staff when administering medication for young people detained under the Mental Health Act.

The provider also monitored compliance with legal rights as part of the fundamentals of care (FOC) auditing, contributing towards enhanced oversight.