Hertfordshire Partnership University NHS Foundation Trust

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

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding. Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition. Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. Staff informed and involved families and carers appropriately. 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 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.
Staff attitudes and behaviours when interacting with patients showed that they were discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it. We saw positive interactions between staff and patients. We observed staff responding to patients in a sensitive manner. Staff were observed to be kind and friendly towards patients and each other.

Staff demonstrated compassion and empathy during trauma-informed team formulations. Evidence suggested there was a caring culture throughout the whole multi-disciplinary team.
Staff supported patients to understand and manage their care, treatment or condition. Patients told us they spoke to the doctor if they had any queries about their medication. Patients were encouraged to attend ward rounds and express their views.
Patients said staff treated them well, were kind and went out of their way to help them. They said staff listened to their concerns and were supportive. One carer told us “[Staff] treated [the patient] like one of their own children” and “those people have saved [the patient]”.
Staff maintained the confidentiality of information about patients. Information held on electronic systems was protected. Staff entered a personal username and password to access this information.

We scored the service as 4. The evidence showed an exceptional standard. The service 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 service took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.
Patients were empowered to purchase their own food and could ensure their own dietary requirements were met. One patient had expressed that one of their interests was cooking. Staff supported the patient to purchase the ingredients they needed, and the patient cooked a meal for all the other patients on the unit.
Staff supported patients to access additional activities that met their interests. For example, staff had previously organised a trip to the seaside that was attended by patients across the service utilising public transport. Patients also participated in creating artwork that would be on display at an art exhibition at the trust headquarters. Staff planned to take patients to see the exhibition later in the year.
Staff in the service had started a new process of rating patients red, amber or green on a daily basis. Service users attended a morning meeting and shared what they wanted to achieve that day. A patient’s rating was changed to green when they had achieved what they wanted to. The purpose of this was to support patients to do things that added meaning to their day.
Staff ensured that patients had access to appropriate spiritual support. There were multifaith boxes, which included different religious texts to suit different religious needs. We saw a chaplain visiting the units at the time of the inspection. Different cultural events were celebrated throughout the year by patients and staff at the service.
Staff treated patients as individuals. One carer told us that staff took the time to get to know their loved one and involved the patient and carer in discussions about their preferences and what helped them, in order to develop a personalised plan. The plan was communicated to all staff who were working with the patient (including non-regular staff) and it had a positive impact on the patient.
The service provided pets as therapy (PAT) dogs who regularly visited the units. We saw a visit from a PAT dog during the inspection and patients had developed a close relationship with the dog. We saw pictures where patients had taken the dog out for a walk in the local woodland. Feedback we saw from one patient expressed what a positive difference visits from a PAT dog had made to their experience of being an inpatient, especially as they were missing their own dog.
The service made adjustments for disabled patients. Gainsford House and Hampden House were situated on one level. The Beacon could be utilised by disabled patients as there were 2 bedrooms situated on the ground floor. All units had disabled toilets with pull cords to alert staff if needed.
Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on. There was information available for patients and carers on all the units. Information was available in different languages if required. Staff told us they had experience in accessing interpreters for previous patients for whom English was not their first language.
 

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 people to understand and have involvement in their own care and treatment. Patients told us that they were involved in creating their care plans with staff and that they were reviewed regularly. Patients were supported to set their own short and long term goals.All patients had a rehabilitation skills and intervention framework in place.
Staff within the service had a good understanding of patient’s mental health, their risk history and their social circumstances outside hospital. Occupational therapy staff supported patients to pursue their interests and hobbies.Staff went the extra mile to support patients. For example, staff supported a patient to clear clutter from their home that was in disrepair and supported the patient to make improvements so that they could sell the property.
Staff supported patients to maintain contact with their friends and family. Patients had access to visits and there was a quiet space available for them to meet their friends and family. Some patients preferred to have their visits out in the community while using Section 17 leave. Patients were able to contact their friends and family when they wanted to.Staff went over and above their role to support and facilitate a visit for a patient that required careful planning and risk assessment. It meant that the patient was able to maintain a meaningful relationship that was important to them.

We scored the service as 3. The evidence showed a good standard. The service 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 identified and responded to changing risks to, or posed by, patients. Staff engaged with patients and were able to notice and respond to any change in presentation. Patients told us they could approach staff with any concerns they had, and that staff would support them.
Staff used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened. Patient records included evidence of de-escalation methods being used. Data held by the trust showed that the use of physical interventions was consistently low throughout the service.
Staff ensured that patients’ needs were responded to. Patients had access to call bells when they needed immediate assistance. We reviewed observation records and found that observations were completed in line with policy.
 

We scored the service as 4. The evidence showed an exceptional standard. The service always cared about and promoted the wellbeing of their staff, and was exceptional at supporting and enabling staff to always deliver person-centred care.
Staff felt respected, supported and valued. Staff felt positive and proud about working for the service and their team. Staff told us the teams were motivated and they felt they could speak freely and share ideas in meetings.
Staff had access to support for their own physical and emotional health needs through an occupational health service. Staff also had access to a free and confidential employee assistance program. Staff received reflective practice sessions and were debriefed in the event of any incidents.
The trust recognised staff success within the service. For example, the service held staff awards where staff members were nominated for positive work they had done. Managers provided staff with positive feedback when they did something well, and positive feedback from patients and carers was also shared with staff.
Leaders supported staff development. Staff appraisals included conversations about career development and how it could be supported. Managers discussed development goals with staff, identified individual skills and supported them to take on specific lead roles within the service or signposted them to additional training. Staff could access leadership courses to support their development.
Leaders promoted the wellbeing of staff. There was a staff wellbeing champion within the service who organised staff wellbeing activities. The trust had a staff health and wellbeing team who ran events and activities to support staff wellbeing.