Hertfordshire Partnership University NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question as good. At this assessment the rating has changed to outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (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 making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patients, and their families, were encouraged to be involved in their care and treatment plan and knew who they could approach to request information from if needed. Staff had a very good understanding of patient’s individual needs, and these were respected. The family and carers we spoke with said they had specific support for their own needs, and they were fully involved in the care planning process through regular communication and updates, multi-disciplinary meetings and visits to the wards. One family member told us ‘I am treated and respected like a fellow professional at the meetings…not just a family member….everyone listens so carefully to me and values my views and opinions’.

We observed staff engaging with patients in a person-centred way and adjusting their approach according to the patient’s needs. For example, we saw how staff supported a patient who was anxious about joining in with a ward activity. The patient was gently encouraged to come into the room to observe, with no pressure to join in, which then gave him the confidence to participate when he was ready. We saw another example where staff had talked to a patient about the effects of menopause on her wellbeing and discussed different options for hormone replacement treatment considering her views and wishes.

Information was displayed around the ward informing patients of different treatment, care, and therapeutic options along with how to give feedback on care. All care and treatment plans we reviewed demonstrated that staff used a variety of methods to encourage patient involvement and listened carefully to patients and families’ suggestions and ideas.

There were a wide range of activities and education taking place on the ward. We found these to be both meaningful and that they touched on the strengths and interests of the patients taking part. There were options for both group and 1-1 activities dependent on patient preference and need. Staff on Elm Ward contracted an external service where specialist personal trainers provided physical exercise to people with learning disabilities, working with staff to offer patients a tailored programme unique to their needs. We observed patients and staff clearly enjoying a session taking place during our visit.

Staff described using clear communication methods and accessible materials, such as easy-read formats, to ensure patients understood their care and treatment options.

Systems were in place to ensure joint decision-making between staff and patients, with care plans reflecting patients physical, mental health, and social needs. Staff we spoke with told us they regularly involved patients and their families, using person-centred approaches consistently. We observed attentive staff always responding promptly and respectfully to patients’ needs.

We scored the service as 4. The evidence showed an exceptional standard. The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff carefully planned patients’ discharge and worked with care managers and coordinators to make sure this went well.

The trust had responded to the Transforming Care agenda and had successfully reduced their inpatient bed numbers. For example, Astley Court reduced their bed numbers from 12 to 6 beds and Elm Ward had reduced their beds from 14 to 8. The trust used additional funding to further invest in community teams based and run from the ward.The focus of these teams was to provide intensive support to patients in the community, prevent admissions to hospital wherever possible, and facilitate early discharge home.

We saw an example where staff took a highly collaborative approach to support a patient to transition back to school following his discharge from the ward. The patient’s schoolteacher attended every clinical meeting throughout his admission,and the teacher consistently received updates regarding his presentation, progress, and support needs. In turn, they helped the ward team build a better understanding of the patient by providing his PBS plan and additional documents relevant to his education and behavioural support.

Staff undertook capacity assessments and best interest meetings and used easy read materials and communication aids, such as social stories, to support patients with conversations about discharge and where they would be living after they left the hospital. Staff thought carefully about timing and how to communicate with patients about their transition to mitigate patients’ anxiety about their transition from the hospital.

Staff supported patients to maintain contact with their families and carers. Family and carer contact was facilitated flexibly and effectively, including using video calls. Family members told us they were fully involved in their loved one’s care and always welcome to contact or visit the wards.

Staff supported patients to access the community and take part in activities outside the hospital Patients were supported to access local day centres, Recovery College education, and community‑based leisure activities ensuring skills, confidence, and social connections were maintained. Individualised activities, such as continuing previously attended football sessions, supported inclusion, physical health, and emotional wellbeing. Patients participated in a wide range of other community and recreational activities, including shopping trips, personal care appointments, family visits, seasonal activities, and day trips. We saw an example at Astley Court where patients’ artwork was entered into a national award scheme, and patients received certificates and prizes as well as feedback from a professional artist. The completed artworks were displayed in the ward. Engagement in structured activity was reviewed through MDT discussions and incorporated into care planning and transition arrangements to support successful reintegration into the community.

Staff ensured all community engagement activities aligned with community care plans,considering any communication or sensory needs with activities adapted accordingly. Patients had communication and sensory passports which provided at-a-glance information to support the individual accessing the activities. The passports were designed so they could be taken with an individual to their activity and the format of the passports enabled easy access to important information for families,carers or external care organisations.

We scored the service as 3. The evidence showed a good standard. The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service provided appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff had access to the equipment and information technology needed to do their work.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. This information was presented and discussed in Quality and Risk meetings and clinical governance meetings.

Staff made notifications to external bodies as needed. The service submitted notifications to the Care Quality Commission in accordance with the requirements of their registration. The service submitted safeguarding referrals to the local authority.

Information governance systems included confidentiality of patient records. Records were maintained in line with the providers policies and procedures, ensuring personal information was securely safeguarded.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights and how to complain. Staff provided information in accessible formats to meet patients’ communication needs. Individual communication requirements were clearly recorded in patients’ care plans and regularly reviewed to ensure they remained appropriate.

We scored the service as 3. The evidence showed a good standard. The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Patients, relatives and carers knew how to complain or raise concerns. We saw that information about how to make a complaint and how to raise concerns with the Care Quality Commission was available in an easy read format on noticeboards throughout the wards. Advocates were welcomed and visited the ward regularly to support patients with raising concerns or giving feedback. One advocate told us when concerns are raised, they were addressed and dealt with in a timely manner.All the family members we spoke with told us they knew how to make a complaint if they needed to.

Staff knew how to acknowledge complaints and tried to swiftly resolve complaints or concerns informally with patients or families. Between January and December 2025, the trust received 1 formal complaint for Lexden Hospital which was thoroughly investigated within appropriate timescales and not upheld.

Staff facilitated community meetings to enable patients to discuss complaints and concerns. Members of the multi-disciplinary team and advocates attended community meetings as well as patients and ward staff. Staff documented what actions had been taken as the result of previous meetings. We saw ‘You Said, We Did’ posters on the wards.

The Trust facilitated ‘Making Services Better’ group meetings for the learning disabilities division. The 'Making Services Better' group was chaired by the Health Access Champions (individuals with learning disabilities who work for the Trust) and attended by staff such as senior nurses, therapists, psychologists and managers, all working in partnership to improve the experience of care and outcomes for those who used the learning disability services.

We viewed the compliments log for the hospital and saw a high number of compliments recorded from patients, family members and external stakeholders praising staff and the care and treatment at the hospital. We saw strong, consistent praise for the compassionate,personalised and consistent care delivered by the ward teams. Families and patients highlighted the progress made in physical health, behaviours,safety and anxiety management and highlighted the friendliness of staff and their commitment to ‘going the extra mile’.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

The service ensured patients could access care, treatment, and support tailored to their individual needs. Through effective assessment processes, staff identified and removed barriers to care, particularly for individuals with complex needs or protected characteristics under the Equality Act 2010.

Staff made reasonable adjustments for patients and completed assessments and recommended adaptations required, which the service implemented. For example, managers swiftly ordered equipment and provided training so staff could support a bariatric patient safely and effectively and provided motion sensor lights for a patient who was at risk of falls.

There was adequate medical cover day and night, a doctor could attend the service quickly in an emergency and the hospital was within a reasonable travelling distance to the local acute hospital.

Staff ensured the needs of people with mobility issues were met. The service had arrangements for people requiring disabled access.

We scored the service as 4. The evidence showed an exceptional standard. Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Staff facilitated community meetings and 'Making Services Better' meetings, which provided opportunities for patients to share feedback, raise concerns and contribute to ongoing improvements in the service.

Staff used the care planning processes to reflect the individual needs and circumstances of each person. This included consideration of relationship status, sexual orientation and any related risks or barriers that may affect how care was experienced.

Staff promoted cultural awareness and inclusion through a programme of themed monthly activities across the wards. These included events linked to Black History Month, Pride Month, Learning Disability Week, cultural food days and educational sessions. These activities supported engagement, cultural recognition and social inclusion for people from a wide range of backgrounds. Staff also supported race equity work through access to organisational training resources and structured virtual learning sessions. These initiatives helped staff to strengthen their understanding of equity, cultural identity and inclusion, contributing to the delivery of respectful, person-centred inpatient care.

Staff ensured supportive environments and made reasonable adjustments for patients with autism and/or sensory needs, including access to a sensory room, quiet/calm spaces, and use of an intensive support room where a low‑arousal setting was required to reduce sensory overload and support regulation.​ Elm Ward used Silent Alarm System (SAS)alarms to minimise sensory impact and reduce distress associated with loud or sudden noises, while maintaining safety for service users and staff.

Staff provided exceptional support to transgender patients. We saw an example where staff demonstrated a compassionate, respectful, and person-centred approach when a patient disclosed their decision to transition from female to male during their admission. Care delivery was responsive to the service user’s changing needs. Care plans and daily support arrangements were reviewed and adapted to reflect the service user’s gender identity and preferences and the patient was supported to share their preferred name and pronouns whilst staff supported the patient to access clothing that aligned with their gender identity.

Patient’s communication needs were always met. The service had accessible information available in different prints, symbols, photos and images. People were provided with communication information cards if required. We observed pictorial signs throughout the wards. There was a board with staff’s pictures, so patients knew who the staff were.

Managers made sure staff and people could get help from interpreters or signers when needed.

The service had clear policies aligned with equality, diversity, and inclusion principles to prevent disadvantage and promote fairness for all, including those with protected characteristics. The trust had signed up to the Patient and Carer Race Equality Framework (PCREF). PCREF is a national framework, launched by NHS England, designed to tackle racial disparities in mental health care and improve outcomes for diverse communities.

We scored the service as 4. The evidence showed an exceptional standard. People were given exceptional support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.

Staff began discharge planning at the point of admission with the goal for patients to stay in hospital for as short a time as possible. The multidisciplinary team planned for each patient’s discharge and move back to the family home, a community setting or supported accommodation. Staff ensured that appropriate arrangements were in place to sustain the patient’s mental health. This included liaising with health and social care professionals in the patient’s local area to ensure they had appropriate accommodation to be discharged to. Ward staff collaborated closely with the community IST teams who kept in touch with patients throughout their admission, to ensure a seamless transition back to the community.

Prior to discharge, staff had weekly planning meetings with the patient, family, carers, education providers and staff from any proposed new care provider. During these meetings, a comprehensive transition plan was created which detailed support during the transition process. If patients were being discharged to a new service, ward staff offered a full day of MDT training to the new staff team and, after training, there were opportunities for further reflection from both teams. Discharge was overseen by the community IST teams.

We saw evidence of exceptional discharge planning in all the care records we looked at. Staff worked together with patients, families and community teams to ensure patients left hospital in a considered, safe and planned way. Discharge plans included a comprehensive PBS plan, talking mats to determine wants and wishes, self-regulation exercises, coping strategies, sensory grab sheets, medication reminder plans and social stories for the day of the move. When a patient was preparing for discharge, staff identified activities local to the area where they would reside and commenced community engagement in preparation alongside families,carers and any other relevant support organisations such as colleges or sports clubs.

Feedback from families and external stakeholders praised the ward teams for clear communication, accessible explanations, and the team’s skill in engaging patients who struggled with communication or change. Staff willingness to try different approaches and tailor support was seen as a key strength.

The trust undertook an admission and discharge audit in September 2025 which looked at how long patients remained in hospital once they were clinically fit for discharge and the potential reasons for the delayed discharge. As of September 2025, the average time from admission to being fit for discharge was 120 days across all the wards with 49% of patients having a delayed transfer of care. The reasons for delayed discharge were largely due to patients awaiting a suitable placement with 78% of patients being in that category. Other reasons were lack of social care support and awaiting housing adaptation at 8% and 6% respectively.

The service was actively working to reduce delayed discharges and regularly liaised with commissioners and senior management regarding this. During MDT meetings and ward rounds, staff reviewed individual patients needs to identify any further support needed to aid discharge. The service audits provided feedback on the reasons for delayed discharge and reviews identified that placement breakdown was a common reason for delays, therefore the service was working with commissions and providers to source appropriate placements.