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 as outstanding. At this assessment the rating has remained 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 93 (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 had a very 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 people and their communities.

Staff knew and understood the trust’s vision and values and how they were applied in the work of their team. Staff told us the trust’s core values were ‘Welcoming, Kind, Positive, Respectful, and Professional.’ All staff, without exception, were enthusiastic and passionate about supporting patients and demonstrated the trust values in all their work.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing, through regular team meetings, staff development days and ‘Making Services Better’ meetings. Senior leaders visited the services regularly and staff described them as supportive, approachable, and responsive. Senior leaders interacted and spoke with patients whilst visiting the wards. For example, joining a patient once a week to share the lunch she had cooked. Staff development was encouraged through regular training, supervision and appraisal and staff had exceptional opportunities for personal and professional development.

All the staff we spoke to, without exception, told us they felt respected, supported and valued. They said the service promoted equality and diversity in daily work and provided opportunities for development and career progression. Staff told us they could raise any concerns without fear and would have no hesitation to do so.

We scored the service as 4. The evidence showed an exceptional standard. 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.

The trust leadership teams were well-established and worked effectively together.

Leaders had the skills, knowledge and experience to perform their roles, they had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

Leaders were visible in the service and approachable for patients and staff. All the staff we spoke with said that managers, service line leads, matrons and other senior leaders were hands on with patients, supportive, approachable and led by example. We found evidence of an extremely positive culture across the whole service. Leaders were exemplary in the way they led their teams, and we saw positive collaboration, non-hierarchical working and great teamwork across all the wards.

Staff development was supported through access to further training and courses. Staff we spoke with reported that the provider offered excellent opportunities for ongoing learning and professional development

We scored the service as 3. The evidence showed a good standard. The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

The trust had a Freedom to Speak Up policy, which emphasised thatall employees should feel comfortable raising concerns and sharing suggestions for improvement.The service had Freedom to Speak Up ambassadors and had assigned a senior member of staff to the role of Freedom to Speak Up Guardian (FSUG). Information on how to contact the FSUG was displayed in the wards. The FSUG fed themes into governance and cultural improvement, facilitated reflective sessions and wellbeing initiatives, contributed to induction and trainingand collaborated with leadership to embed learning into practice.

Staff could also raise concerns through alternative routes such as a 24-hour confidential whistleblowing hotline or via an anonymous submission to the electronic incident recording system. All the staff we spoke with told us they felt fully confident in speaking up and in raising concerns or making suggestions for improvements.

The trust recently held an Anti-Bullying Week which was marked by a piece on the intranet where the trust shared some practical advice on what to do if staff experienced or witnessed bullying,harassmentor discrimination, and how to speak up and get support.

Patients and staff could meet with members of the trust’s senior leadership team to give feedback. Feedback was welcomed from staff, patients and family members through community meetings, surveys, feedback forms and at ‘Making Services Better meetings.

We scored the service as 3. The evidence showed a good standard. 3. The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The trust had a ‘Belonging and Inclusion’ strategy which sought to understand, encourage and celebrate diversity in all its forms across the organisation. We saw an example where staff had celebrated Diwali – patients and staff shared traditional food and decorated the ward with colourful displays and information about why Diwali is celebrated and what it means to different people.

The trust provided 6 staff networks which reflected the diversity of the organisation: Black and Minority Ethnic staff, mental health, women, disability, Lesbian, Gay, Bisexual and Transgender (LGBT) staff and carers. The networks offered opportunities for staff to connect with other people, share information and ideas and receive support.

The trust employed a diverse team of staff from international backgrounds. Employment practices promoted equality of opportunity. Managers said the service did not discriminate against staff from minority groups. Staff did not raise any concerns about discrimination. Managers had implemented an anti-racism programme to reduce occurrences of racism and ensure staff felt supported and received appropriate post-incident support.

Staff were able to apply to work flexibly e.g. flexible working agreements to account for personal circumstances such as caring responsibilities and health issues.

Managers put reasonable adjustments in place for staff members to help them carry out their role. For example, pregnancy risk assessments, flexible working agreements and occupational health referrals.

Managers had access to appropriate human resource support for recruitment, performance management and occupational health support. Relevant policies and procedures were in place to support this.

We scored the service as 4. The evidence showed an exceptional standard. 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.

Our findings from the other key questions demonstrated that governance processes operated extremely effectively at team level and that performance and risk were managed very well. Governance arrangements were proactively reviewed and reflected best practice. The exceptional leadership, culture and robust governance were used to drive and improve the delivery of high-quality, person-centred care. The service systematically monitored standards of care to continually improve outcomes for patients.

Managers carried out an extensive programme of audits to monitor areas such as care and treatment records, physical health checks medicines management and staff supervision and appraisals. Managers also conducted monthly walkaround audits of the wards to check the quality and safety of the ward environments. We saw how high-quality governance processes and audits were embedded within the service to ensure that high quality care could be sustained into the future.

Staff held a range of scheduled governance meetings using structured agendas, which included, patient safety and incident learning, ward operational and patient care updates, workforce and training matters, quality improvement activityand environmental and estates issues. We looked at the minutes for the previous 3 months of meetings and could see the agendas were comprehensive, areas of concern were identified, and actions were RAG rated toindicateany requirement for action to improve service user and carer experience, clinicaleffectivenessand/or patient safety.

Staff had implemented recommendations from reviews of incidents, complaints and safeguarding alerts. For example, staff had reviewed fire related processes following an unannounced fire safety assessment including the introduction of a new tracker and a requirement for regular reporting and increased training.

Staff maintained and had access to local risk registers. These were up to date and included delayed transfers of care, the risks to patients from falls and the risk of violence and aggression. The risk registers included a rating for the severity of each risk and control measures to mitigate against harm as well as a named member of staff as the risk manager.Risk registers were reviewed at Weekly Quality Monitoring Meetings and Local Quality and Risk Meetings.

The trust had business continuity plans for emergencies – for example lack of water, gas leakages, outbreaks of infectious diseases or adverse weather.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system worked and well and helped to improve the quality of care.

Managers had access to information to support them with their management role. This included dashboards which gave information on the performance of the service, staffing and patient care.

We scored the service as 4. The evidence showed an exceptional standard. The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

Staff worked closely with the local council’s social care teams and community learning disability nurses, as well as providing services directly to the population and a clinical leadership and support role to care providers, individuals and their family carers.

Trust services were a key element of the NHS Transforming Care Programme and worked closely with local authority Transforming Care Teams and the Integrated Health and Commissioning Teams and were closely engaged in the Care and Treatment Reviews and Dynamic Support Register functions. The trust were also members of the All-Age Big Plan (learning disabilities strategy) for Hertfordshire. Commissioners told us the services of the trust ‘worked collaboratively and seamlessly across organisational boundaries with both the Council teams and wider care provider sector’.

The trust’s role in the Dynamic Support Register (DSR) provided further shared ownership and a system‑wide gatekeeping function. The integration of the Intensive Support Teams with inpatient provision provided key links and a model that supported timely admission decisions and escalations. Joint working with the Integrated Health and Care Commissioning Team and the trust’s specialist learning disability services strengthened continuity of care and enabled commissioners to maintain a clear line of sight across the person’s journey through services.

The recent development of Elm Ward demonstrated the collaborative approach to inpatient learning disability and mental health care, underpinned by effective governance, partnership working, and oversight arrangements. Commissioners maintained clear visibility of quality, safety and patient experience through regular ward visits, structured oversight meetings, and people’s journey through services, through the Care and Treatment Reviews and six‑week follow‑up processes. This ensured that people’s care pathways were properly scrutinised and that patients and their care partners worked together towards the least-restrictive approach. One commissioner told us ‘This service model supports system resilience and partners working together for positive outcomes for people. Partnership working with the ward has been consistently acknowledged as good practice in both Care and Treatment Reviews and Independent Panel Reviews. Ward staff played a central role in promoting this constructive interface, reinforcing a culture of openness, responsiveness, and shared responsibility between commissioners and HPFT.’

Staff maintained community partnerships and worked with local organisations to support patient care and learning opportunities. For example, Sport for Confidence, the Koestler art awards and the Recovery College.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. We saw evidence that staff felt comfortable providing feedback and expressing their opinions.

We scored the service as 4. The evidence showed an exceptional standard. 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 people. They actively contributed to safe, effective practice and research.

Wards participated in accreditation schemes relevant to the service and learned from them. The trust participated in the Quality Network for Inpatient Learning Disability Services (QNLD) accreditation programme. The QNLD, led by the Royal College of Psychiatrists, aims to improve learning disability services. At the time of inspection, Lexden Hospital had completed the full QNLDAIMSaccreditation cycle, including peer review and Accreditation Committee decision.Elm Wardwas pursuing QNLDAIMS accreditation.Their evidence portfoliowas submittedin February 2026and peer review dates were scheduledfor 25March 2026. AstleyCourt QNLDAIMS accreditation expired inOctober 2025 and theunitwascurrently goingthroughre-accreditation(there had been a delay due to QNLD capacity).All 3 wards were accredited by the Royal College of Psychiatrists’ Centre for Quality Improvement.

Ward teams were all actively involved in quality improvement and innovation projects to constantly improve the services offered to people with learning disabilities. For example, ‘Enhancing Sensory Therapeutic Engagement’ – an Elm Ward CQI Project; the Embedding Safety Framework; Dysphagia in people with learning disabilities: a multidisciplinary QI project and service evaluation; the Pill-O-Fect Programme; trauma informed walkthroughsand trainingand the anti-racism programmes.

The trust hosted theRADiANTnetwork which was founded with participation from 12-13 NHS Trusts. The network focused on 5 neurodevelopmental conditions- learning disability, autism, ADHD,epilepsyand brain injury and aims to promote research, stafftrainingand public education in these areas.As part of its core function,RADiANToffered afree 2 hour Continuing professional development programme every month and all staff were invited to attend either live orwatch arecording later.

Staff had undertaken and published a range of research in national publications. These included, the national Frith prescribing guidelines for learning disability; My Diabetes Me: A randomised controlled trial to test the clinical and cost-effectiveness of a diabetes self-management education programme for adults with intellectual disabilities and ‘Making Positive Moves’ – a National Institute for Health and Care Research (NIHR) funded research project which involved talking to people with learning disabilities about their experiences of moving from hospital to community. Other published papers included, ‘Injectable Contraceptive Use in Women with Intellectual Disability – A Narrative Review and Local Case Series’ and ‘Psychiatry and Neurodevelopmental disorders: experts by experience, clinical care and research’ published in the British Journal of Psychiatry and ‘Anticholinergic Burden in People with Intellectual Disability in Psychiatric Inpatient Units’ published in the Journal of Mental Health Research in Intellectual Disabilities.

Staff from the trust had won several national awards, for example, in 2025, the Mid-West Essex psychiatry team were named best psychiatric team of the year: Intellectual Disabilities at the Royal College of Psychiatrists awards.