Hertfordshire Partnership University NHS Foundation Trust

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question as outstanding. At this assessment the rating has remained outstanding. This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

This service scored 90 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 4. The evidence showed an exceptional standard. The provider was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations with kindness and respect.

During the inspection, we observed kind, cheerful staff interacting positively with patients and providing them with practical help, encouragement and emotional support. Staff supported patients to understand and manage their care and treatment by using different methods of communication considering their individual needs, including their personal, cultural, social and religious needs. Staff spoke passionately about their work and how they cared for patients and would fiercely advocate for their needs

Staff supported patients to have a meaningful life by accessing services and activities important to them. This included activities such as going to the zoo, restaurants, pop concerts, spa days and football matches as well as visiting local shops and participating in occupational and educational activities on the ward. Staff developed therapeutic relationships with patients based on trust, compassion, and understanding. They demonstrated a strong awareness of individual needs, preferences, and personal histories and always treated patients with dignity and respect.

We saw many examples where staff had gone the extra mile to support and care for patients. For example, staff had all clubbed together to buy an annual zoo pass for a patient in long-term segregation as they knew how much she loved animals. Staff then collaborated using a positive risk-taking approach to take her for a day trip to the zoo. Another member of staff bought in Jollof rice every week to share with a patient who shared the same Nigerian background.

All patients and family members were overwhelmingly positive when talking about the staff and the care they had received from staff and the service. We saw many examples of positive feedback received by staff.

Staff helped patients to keep in touch with their families and facilitated visits and trips to see their friends and loved ones.

We scored the service as 4. The evidence showed an exceptional standard. The provider treated people as individuals and was exceptional in how they made sure people’s care, support and treatment met people’s needs and preferences. The provider took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff within the service had an excellent understanding of each patient’s individual needs, their risk history and their social circumstances outside hospital. Staff, including occupational therapists, supported patients to participate in activities they enjoyed, and patients all had an individualised activity timetable, an individual positive behaviour support (PBS) plan and a sensory ladder.

Staff ensured that patients and their families could obtain information on treatments, local services, people’s’ rights and how to complain, in a way the individuals could understand. Families and carers were given information when their loved one was admitted to the hospital including other local services that provided support to people with learning disabilities and their families

The service demonstrated a strong commitment to meeting the diverse needs of all patients, particularly those with protected characteristics under the Equality Act 2010. Staff provided dedicated support for communication, advocacy, and cultural and spiritual needs, ensuring an inclusive environment for everyone. For example, a patient was of mixed-race heritage and had specific hair care needs. Staff recognised that hair care was an important aspect of the patient’s identity, dignity, and cultural heritage and a person-centred hair care plan was developed in partnership with the patient, their mother, and the ward team to ensure cultural needs and personal preferences were respected.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for preferences, allergies and sensory needs. We saw an example for a patient who followed the Sikh religion. When the patient was admitted to the ward, staff took appropriate steps to ensure their cultural and religious dietary needs were recognised, respected and met. Staff supported the patient to make informed choices from the meal planner, ensuring that all food offered was appropriate to their religious and cultural requirements and documented this within their care plan.

Staff ensured that patients had access to appropriate spiritual support, this included access to religious leaders such as imams or chaplains and support to attend places of worship. Spirituality was incorporated into the assessment process. On admission and during reviews, staff used the HOPE Model for Spiritual Assessment to inform care planning. This is a structured approach which ensured spiritual considerations were actively included within care plans. There were multi-faith rooms available to patients on all the wards.

The service was suitable for patients with mobility difficulties. All buildings were ground floor only and accessible for patients who used mobility aids, including wheelchairs. We saw an example where staff provided exceptional support to a bariatric patient (a patient with severe obesity who faces significant health, mobility, and care limitations due to their weight). The trust expedited the ordering of specialist equipment, to ensure the patient had a comfortable and appropriate bed and safe equipment for transferring to and from her wheelchair. All staff were trained in the safe use of the equipment and a speed-bump was removed from the on-site roadway so the patient could use their powered wheelchair to access the whole site and beyond. On discharge the patient provided very positive feedback about their care – ‘the staff are so nice and friendly. Even at my lowest times they have cared for me and made me laugh after working 13 hours on the wards. They have been so lovely.’

Staff ensured patients could gain information on treatments, local services, patients’ rights and how to complain. The information provided was in a form accessible to the patient group, in easy-read format.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at promoting people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Staff empowered and supported patients to have as much choice and control over their care and treatment as possible. They involved patients in decisions always considering their capacity and legal status. Psychology, speech and language and occupational therapy staff supported staff and patients to ensure information was in an accessible format and patients understood their care and treatment and their rights.

Patients we spoke with, and their carers/family felt very well informed about their care and treatment. Patients described that they had received information about their medication and that they were involved in reviews about their care and treatment. We saw evidence that, where appropriate, their family, carers or loved ones were involved in meetings about their care.

At Astley Court, a patient identified the need for a space to talk about medications more openly so patients could understand the effects and side effects of medication. This led to the development of a monthly patient-led discussion group called ‘Pill-O-fect’ with sessions on a wide range of topics chosen by patients, for example understanding why medication is prescribed and exploring the treatment of anxiety, depression and bi-polar disorder. The sessions aimed to empower service users with the knowledge they wanted and needed to enable truly well-informed consent to taking medication.

Care plans set out current needs, promoted strategies and short-term goals to enhance independence, and demonstrated evidence of planning and consideration of longer-term goals of each person. Consent to treatment was very well-documented and undertaken within 24 hours of admission in all the care records we looked at.

We scored the service as 3. The evidence showed a good standard. The provider listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff responded promptly and effectively to changes in patients need, concern, or distress. Staff knew patients very well so could identify changes in patient presentation or environmental dynamics and acted quickly to mitigate risk and safeguard wellbeing.

Patients felt confident approaching staff with issues or concerns, knowing they would be listened to and supported. Staff knew patients well enough to utilise de-escalation techniques specific to each patient when patients’ behaviours became heightened.

Patients on the ward had access to call bells when they needed immediate assistance.

Staff used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened. Staff received de-escalation training as part of their safety intervention training and staff we spoke with told us that they would always attempt to verbally de-escalate an incident before resorting to physical restraint.

Staff were aware of and dealt with any specific risk issues, such as risk of seizures or falls and care planned for these accordingly

We scored the service as 3. The evidence showed a good standard. The provider cared about and promoted the wellbeing of their staff and enabled them to deliver person centred care.

All the staff we spoke with told us the service line leads, matrons and other managers were approachable, supportive and fully engaged with staff on the wards. Staff and managers said they found senior managers to be extremely supportive.

Staff had access to the trust’s employee assistance program which provided a variety of support options for a range of issues. The trust also offered a wide range of services to support wellbeing, staff development, reflective practice, access to supervision, and leadership support. For example, structured staff development days, wellbeing champions and peer support, informal wellbeing initiatives, psychological safety and reflective practice and newsletters. Staff had access to the Professional Nurse Advocate service, which provided Restorative Clinical Supervision (RCS) for nurses and wider health and social care staff.

The trust recognised staff success within the service. The trust Inspire Awards recognised and rewarded staff who consistently demonstrated the trust values every day and went above and beyond what is normally expected of them.Winners were invited to attend an informal presentation with the Chief Executive and members of the Executive Team where they were presented with a certificate, commemorative badge and £50 voucher.We saw examples where staff from the learning disability wards had been nominated for, or won, Inspire awards.

Staff regularly took part in celebrations to celebrate special days and cultural events, for example Chinese New Year, Diwali and Black History month. Staff and patients took part in fundraising events, for example a pumpkin hunt to raise awareness and provide donations for the local foodbank.

Staff felt extremely positive and proud about working for the provider and their team. Staff had good morale and all the staff we spoke with, without exception, told us how much they enjoyed working for the trust and how they valued the exceptional support from colleagues and managers.