Hertfordshire Partnership University NHS Foundation Trust

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• 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

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 good. At this assessment the rating has changed to outstanding. Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected analysed data about outcomes and performance. They used this to identify improvements. This meant service leadership was exceptional and distinctive. Leaders and the service 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.

We scored the service as 4. The evidence showed an exceptional standard. The service 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.
The provider’s senior leadership team had successfully communicated the trust’s vision and values to staff and leaders in the service. Leaders knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff could describe the trust’s values and behaviours and how they applied them to their work supporting patients.
Leaders ensured staff were connected with the values of the service. Values were built into staff recruitment, development and support. Values focused questions were embedded in the interview process so that appointments were made not only based on skills and experience, but also on alignment with the desired way of working and supporting each other. Leaders discussed values and behaviours with staff in their annual appraisals.
Staff had the opportunity to contribute to discussions about the strategy for their service. Leaders implemented development days for individual teams and service-wide development days. Staff reflected on practice, shared learning and identified service improvement priorities during these sessions.
Patients had the opportunity to be involved in discussions about the service. A patient representative was able to attend quarterly leadership meetings and delivered a presentation based on patient experience and feedback about the service. Each unit had a ‘tree of hope’ display that was made in collaboration with patients.
Staff described a positive working culture within the service and spoke highly of their colleagues. They told us they had confidence in their team and trusted their colleagues.
 

We scored the service as 3. The evidence showed a good standard. The service had 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 did so with integrity, openness and honesty.
Leaders had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they managed. They were aware of service performance and aware of challenges faced by the service. They collaborated with one another and other staff to develop solutions or mitigations and were supported by management at provider level.

Staff survey results from 2024 scored the highest of all clinical services in the trust for indicators such as feeling respected, supported and valued and having confidence that concerns would be addressed. Leaders gained feedback and used it to improve.
Staff felt supported by managers and told us that they were approachable and engaged well with them. Leaders were visible within the service and had the experience, capacity, capability, and integrity to ensure that the organisational vision could be delivered, and service risks were well managed.
There was a positive culture across the service. Staff told us they could speak freely and they felt their suggestions were listened to. Reflective practice was available to all members of staff to promote a supportive culture of development.
The trust supported staff development. Leadership training was available for staff who wanted to work in a leadership role. There was also training available for staff who already worked in leadership roles. Multiple staff undertook leadership apprenticeships and coaching. Regular service development days and charge nurse development days provided a structured programme for leaders at all levels.Some parts of the service leadership team had staff acting up in interim roles.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at fostering a positive culture where people knew they could speak up and their voice would be heard.
The service had a freedom to speak up process if staff wished to raise concerns confidentially. Staff told us they felt they could raise concerns with their managers and that they would be dealt with appropriately. The trust had two freedom to speak up guardians and there were freedom to speak up champions within the service. Staff could find details about the freedom to speak up process in the trust policy.The freedom to speak up guardians fed into governance and cultural improvement, and collaborated with leaders to embed learning.
There were 3 freedom to speak up cases raised within the service during the last 12 months. The cases were managed through a process of acknowledgement, signposting, escalating to relevant parties, feeding back and gaining consent from the person raising the concern before closing the case.
Leaders collected staff feedback. We reviewed the 2024 and 2025 staff survey results. The service scored significantly above trust and national averages on all speaking up indicators. Staff felt secure raising concerns about unsafe practice, they felt encouraged to report errors and were confident errors would not repeat. Staff were confident the organisation would address concerns. Service leaders created an action plan to address concerns raised by staff. For example, some staff raised that they felt they were not offered challenging work. The service level action plan included how development conversations would be reviewed and job enrichment opportunities would be offered to staff. Staff shared feedback at a local level by attending team meetings.
Patients had the opportunity to provide feedback about the service. They knew how to raise concerns and received a response. Staff facilitated regular community meetings on the units, which were dynamic and gave patients the opportunity to give feedback and receive updates about progress or changes following their feedback.The service user and carer reference group provided a further avenue for raising concerns, with evidence of these being acted on. Attendance was significantly improved by combining the group with social activities and peer support. Leaders and staff apologised and responded quickly with humility and candour when things went wrong.

We scored the service as 4. The evidence showed an exceptional standard. The service strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who work for them.
The trust had a ‘Belonging and Inclusion’ strategy which had 3 priorities: ‘to celebrate and develop our inclusive culture, to grow our diverse workforce, and to eliminate discrimination in all its forms’. The trust had inclusion ambassadors who participated in work to remove bias from recruitment practices and policies.
The 2025 staff survey revealed that 7.1% of staff reported experiencing discrimination from service users and/or carers, and 10% reported experiencing some form of discrimination from colleagues. Leaders organised training in unconscious bias to be delivered across the service in response to the results. Leaders organised the training to demonstrate commitment to recognising and respecting diversity among both colleagues and service users and promoting an equitable and inclusive organisational culture.
The provider had a range of equality, diversity and inclusion networks that staff could access. These included networks for LGBTQ+, black, Asian and minority ethnic (BAME) staff, disabilities and women. These groups provided supportive and informative networks for staff.
The trust employed a diverse team of staff from international backgrounds. Employment practices promoted equality of opportunity.
Managers put reasonable adjustments in place for staff members to help them carry out their role. For example, staff were able to request flexible working arrangements and occupational health referrals were made as required.
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 service 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.
The service operated within a governance framework that provided oversight of safety, quality, experience and risk.This framework ensured that the fundamentals of care were delivered to a high standard. Governance meetings took place at ward, division and trust level with a structured route for reviewing themes, agreeing actions and escalating issues when required. Meetings at all levels followed a clear structure to ensure that essential information was shared and discussed. We reviewed minutes from the last 3 meetings and saw that areas discussed included patient safety, quality, risks and patient experience.
Staff maintained and had access to local risk registers. The risk registers for the units were up to date and included restrictive practice, medication errors and ligature risks. 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 quality monitoring meetings and local quality and risk meetings.
Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. For example, staff completed audits of infection prevention and control (IPC), restrictive practice and safeguarding. Leaders carried out walk around audits to review the quality and safety of the environments.
Managers had access to information to support them with their management role. This included information on performance, staffing and patient care. The electronic system used by the service allowed managers to have access to information such as whether care plans, physical health checks and legal status were up to date. They also had access to information on staff training compliance. Service performance was discussed in governance meetings.

Staff carried out monthly fundamentals of care audits across the service. This included an in-depth review of individual patient records which included risk formulation, physical health, care plans and restrictive practices. This meant leaders had oversight of compliance with core care actions for every patient.
The service had plans for emergencies – for example, adverse weather or an outbreak of illness. The service had business continuity plans in place for all units.
Staff had access to the equipment and information technology (IT) needed to do their work. The IT infrastructure worked well. However, on one occasion the electronic records system did not display up to date information. In one section of a patient’s risk assessment, it stated that the patient was absent without leave (AWOL), however staff confirmed that this was not the case. This entry was reviewed and corrected by the service.

We scored the service as 4. The evidence showed an exceptional standard. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.
Service leaders engaged with external stakeholders such as commissioners and the local authority. Staff developed and maintained effective working relationships to support patient care and maintain their safety.Feedback from stakeholders described strong, longstanding and effective partnership working. Stakeholders consistently described collaborative, transparent and responsive relationships. They highlighted the integrated model of care used within the service as contributing to better outcomes for patients.
The service operated an innovative model of integrated partnership working. Staff worked in partnership with other service providers to ensure patients’ needs were met.The multi-disciplinary teams (MDT) included embedded social workers, a drug and alcohol worker and peer support worker within the teams. The service integrated health, social care, substance misuse and lived experience within one delivery model, which supported patient care. The substance misuse worker delivered various substance misuse training sessions to staff, including harm minimisation, MDMA awareness and opiate substitute treatment (OST).

Consultants within the service were representatives of The Faculty of Rehabilitation and Social Psychiatry Executive Committee within the Royal College of Psychiatrists (RCPsych). The committee consists of elected members who lead on policy, standards, and training regarding the rehabilitation of patients with severe mental illness. The service was a member of the RCPsych Quality Network and the multi-disciplinary team delivered presentations to the national annual conference. Staff and leaders shared best practice with other providers, a number of which have visited the service to learn from their operational model.
The service ran an event for patients called ‘rehab’s got talent’. The event was popular with patients who wanted to demonstrate their skills and talents. Staff described it as a positive and empowering event with patients building their confidence and social connections.
Patients and staff could meet with members of the trust’s senior leadership team and commissioners to give feedback. Patient feedback was included in local governance meetings. A patient representative from within the service delivered a presentation to leaders based on patient experience and feedback about the service.

We scored the service as 4. The evidence showed an exceptional standard. The service 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.
Staff and leaders from all 3 units worked to achieve accreditation by the Royal College of Psychiatrists Quality Network. Accreditation for Inpatient Mental Health Services (AIMS) rehabilitation accreditation was awarded to the units in 2023. Accreditation is a comprehensive process that aims to improve the quality of service provision and patient care.
Staff were actively involved in quality improvement and innovation projects to constantly improve the service. Service provision was based on national guidance and evidence-based practice. Service leaders reviewed the patient journey through the rehabilitation pathway across the inpatient community units and transition to community rehabilitation pathways. The project aimed to create a recovery focused rehabilitation pathway that supported independence, skills development and improved quality of life through evidence based interventions. Four workstreams were set up with stakeholders and experts by experience to develop improvements across interventions, documentation, the environment and workforce development. Achievements included introducing rehabilitation aligned outcome measures, implementing the rehabilitation skills framework, updating patient information and referral guidance, improving sensory friendly areas, strengthening trauma informed practice, enhancing activity reporting and relapse prevention work, and establishing a structured training framework.
Leaders were in the process of establishing a family intervention pathway across the trust. The rehabilitation service had 11 staff trained with a further 2 undergoing training at the time of inspection. Trained staff could provide support to families based on a cognitive behavioural model. They did this by addressing areas of day-to-day difficulty in the family in relation to the patient’s contact with mental health services. This work helped prevent relapse in the community. 
Service leaders led a structured, multi year improvement programme focused on bowel health monitoring. This included documentation, risk management and patient education. Staff developed an audit tool, introduced weekly audits, integration into physical health frameworks, and recognition of bowel health as a key clinical indicator. There were numerous changes to bowel health monitoring within the service following this project, including standardised bowel‑chart documentation and monitoring, stronger escalation pathways and reinforced training to embed bowel monitoring into daily care. These service improvements had led to early detection of concerns, improved clinical oversight and staff confidence. The initiative was highlighted by colleagues as a key area of innovation within the service.
Leaders introduced trauma informed approaches across the service. This was facilitated by a project group, additional training and small working groups on each unit. Staff were supported to consider how to recognise the impact of trauma, use supportive language, build safe and trusting relationships and reduce the risk of re traumatisation. The project group monitored ongoing progress across the service.