Hertfordshire Partnership University NHS Foundation Trust

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 requires improvement. At this assessment the rating has changed to outstanding. This meant service leadership was exceptional and distinctive. Leaders and the culture they created, drove and improved high-quality, person-centred care.

This service scored 96 (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 had a clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of young people and their communities.

The provider’s visions and values were embedded in day-to-day practice, rather than standalone statements. The service’s vision - “we are a compassionate, professional team who collaborate with the young person, families, carers and communities, holding hope, and keeping the young person at the centre of our care”- was evident in the way staff spoke about their work and in their commitment to supporting young people and families. Staff reported that they felt proud to work at Forest House and they found the work to be rewarding, especially when being able to see young people recover and achieve positive outcomes.

Leaders had taken steps to promote a positive and supportive culture, with structures in place to encourage openness and learning. These included staff meetings, listening events and practice governance forums, which provided opportunities for staff to raise concerns and contribute to service development.

Equality, diversity and human rights were embedded within the unit’s culture. Staff demonstrated awareness of the needs of young people with protected characteristics and those at risk of poorer experiences and took steps to address barriers to inclusion. The provider demonstrated clinical leadership in key priority areas, including a dedicated reducing restrictive practice lead nurse, the development of clinical pathways such as nasogastric feeding and improvements to the sensory environment. These initiatives were aligned with national guidance and the providers’ priorities.

The provider had exceptionally inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

Leaders were knowledgeable about the service context and priorities, including patient safety, restrictive practice and workforce pressures, and were able to think creatively and dynamically to overcome barriers. We reviewed practice governance meeting minutes, which demonstrated that leaders held meaningful discussions on decisions relating to restrictive practice such as the restrictions on access to caffeinated drinks. This demonstrated a thoughtful consideration of human rights, balanced with safety and autonomy.

Leaders were visible and approachable, and staff consistently told us they felt able to raise concerns. Leadership behaviours reflected openness, with a focus on listening and responding to issues raised through forums such as nursing meetings, governance structures and incident review processes, which were well attended.

There were systems in place to support leadership development, including access to training and development opportunities such as a charge nurse development day and upskilling charge nurses to undertake senior duties such as clinical audits.

The provider was exceptional at fostering a positive culture where people knew they could speak up and their voice would be heard.

The provider had a strong, open and transparent culture where staff felt confident to speak up and raise concerns, with clear evidence that voices were heard and acted upon. Staff described an environment where concerns about quality, safety and wellbeing could be raised and leaders demonstrated a commitment to listening and responding.

Themes from the freedom to speak up (FTSU) reports covered patient safety and quality issues, including unsafe staffing levels and the absence of structured debriefs following incidents. Leaders responded by introducing structured ‘Friday reflective sessions’ and debriefs supported by psychology.

Concerns relating to bullying, harassment and hierarchical behaviours in staff groups were also raised. The provider undertook fact-finding processes and provided feedback to staff, demonstrating a willingness to address behaviours promptly. Responses included listening events, nurse advocate sessions and wellbeing initiatives such as “star worker of the month”.

FTSU arrangements were well established, with 2 guardians in post, multiple routes for reporting concerns, and 44 trained FTSU champions across the organisation. Staff confidence in raising concerns was captured in the 2024 national staff survey, where the provider scored above national average on questions relating to speaking up and confidence that concerns would be addressed.

The provider valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who worked for them.

The provider celebrated diversity within the workforce. This included recognition of Black History Month in October and the celebration of Eid, with inclusive approaches such as sharing food from cultures represented within the staff team. These actions supported a sense of belonging and inclusion and were valued by staff.

FTSU data showed that a small number of concerns had been raised by staff relating to equality, bullying and harassment. Issues raised were investigated through fact-finding processes. Leaders responded to concerns about fairness, flexible working and reasonable adjustments through listening events, advocacy sessions and management review of rostering practices.

“You said, we did” initiatives demonstrated commitment at a senior level to ensuring equitable treatment of staff, such as the launch of a mobile app for flexible working, continual improvement of the reasonable adjustment processes, a men’s staff network and career ambassadors.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. They always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There was a robust framework for quality assurance and clinical governance, including regular practice governance meetings, learning from patient safety events, SWARMs and ‘Fundamentals of Care’ audits. These systems enabled leaders to identify risks, themes and areas for improvement, and to track actions to completion.

The service used a range of data and performance information to monitor quality, risk and outcomes. This included staffing data, training compliance, incident and safeguarding data, audit findings and routine outcome measures. Where gaps were identified, such as staffing pressures, leaders demonstrated awareness and implemented plans to mitigate impact.

Staff used electronic systems to record care, risk assessments, medication administration and outcome data. We saw evidence that these records were accessible and up-to-date.

Workforce planning and sustainability was supported using the Mental Health Optimal Staffing Tool (MHOST), which informed establishment levels and was ratified at senior level. Staffing was reviewed dynamically in response to acuity or other service pressures.

Governance meeting minutes demonstrated the provider had awareness of potential operational risks, such as infection prevention control risks, with clear processes in place to address these.

The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for young people. They always shared information and learning with partners and collaborated for improvement.

The provider demonstrated a strong commitment to partnership working to support joined-up, safe and effective care for young people and their families. Staff and leaders worked collaboratively with a wide range of external partners, including children’s social care, education services, community CAMHS and commissioning teams. Safeguarding arrangements were well embedded, with regular information sharing, attendance at Child in Need (CIN) and Child Protection (CP) meetings, and social care involvement in ward rounds.

The provider worked closely with education services through Forest House Education Centre (FHEC), supporting young people to maintain links with education throughout admission.

The provider engaged with partners to share learning and improve practice. This included the use of expert by experience input to inform service development.

In addition, the provider had been asked to support with the reopening and redevelopment of another tier 4 CAMHS unit, demonstrating a commitment to sharing learning with partners beyond the county.

The provider had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for young people. They actively contributed to safe, effective practice and research.

Staff and leaders showed a good understanding of incident learning and how it was used to inform service development. Learning from incidents was embedded through PSIRF processes, including SWARMs, reflective forums and governance meetings, with evidence that learning was translated into practical changes.

The service demonstrated innovation in response to identified need. This included the introduction of structured reflective sessions following incidents, implementation of HOPE(s) model to reduce long-term segregation, and work to improve sensory and neurodivergent-friendly environments. The bespoke sensory room was under development and was clear evidence of innovative practice in response to feedback regarding the environment. Leaders advocated for staff to develop leadership capability, included training staff as SWARM facilitators and enabling charge nurses to contribute to audits and governance initiatives.

The provider maintained strong external relationships that supported learning and innovation, including collaboration with the quality network for inpatient CAMHS (QNIC). The provider had also been requested to assist with the redesign of a tier 4 CAMHS unit in a different county.