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

At our last assessment we rated this key question as good. At this assessment, the rating has remained as good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 service scored 82 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The trust had a clear vision and values that were embedded across services. Staff described delivering care in line with the trust's values of being welcoming, kind, positive, respectful and professional. This supported a person-centred approach and collaborative working with people using services, carers and partner organisations. The trust’s vision and values were displayed in team locations and were available on the trust’s website.

The trust's Great Together strategy (2023–2028) set out a clear vision for delivering high-quality, person-centred care through co-production, partnership working and continuous improvement. The strategy focused on improving outcomes, reducing inequalities, developing the workforce and ensuring people using services and carers remained at the centre of service design and delivery.

Staff described positive, supportive cultures within teams and the wider service that were focused on delivering high quality care for people who used services, as well as staff wellbeing. However, staff working in the crisis teams described ongoing staffing pressures and told us they regularly worked additional hours to maintain safe service delivery. Some staff said they had raised these concerns with senior leaders but did not always feel sufficient action had been taken to address them. The Trust had a governance process for monitoring additional hours, supported by a Time Owed Policy. Recruitment initiatives strengthened workforce capacity. Following the inspection, the Crisis Function Team (CFT) successfully recruited a Band 6 Bank Nurse and appointed a new Support Worker, leaving no substantive vacancies. Safe staffing levels were maintained, with management providing additional cover during short-term sickness absence through time owed or bank shifts, in line with Trust policy.

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 demonstrated the skills, knowledge and experience to manage services effectively and had a good understanding of the challenges within their teams. Staff spoke positively about local leaders, describing them as approachable, supportive and trusting, and told us they felt able to raise concerns or seek advice when needed.

Leaders promoted staff wellbeing through local initiatives and recognition schemes, and staff had access to a range of professional and leadership development opportunities, including specialist qualifications and leadership programmes.

Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

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

Freedom to Speak Up (FTSU) at the trust was supported by 2 Guardians who provided a confidential service for staff to raise concerns through multiple accessible routes. The service was supported by a network of Speak Up Champions and promoted through inductions, staff engagement activities and regular communications. The Guardians also worked with senior leaders to identify themes and support learning and improvement across the organisation. Overall, the focus was on improving staff voice, psychological safety and openness within the workforce.

Between 1st May 2025 and 30th April 2026, 3 FTSU concerns were raised across Mental Health Older People services relating to bullying, workplace culture and staff wellbeing. All cases were acknowledged, escalated appropriately and supported through the FTSU process with input from the Guardian and HR. All cases were closed, with mixed feedback from staff, including some positive outcomes alongside ongoing concerns in a minority of cases. No patient safety issues were identified. Themes were shared through governance processes and used to inform ongoing work to improve staff wellbeing and psychological safety.

The service introduced QR codes on staff identification badges, linking directly to the Friends and Family Test survey to make it easier for people using the service and carers to provide feedback during routine contact. This initiative was developed by staff to improve the accessibility of feedback opportunities.

Feedback from surveys, complaints, patient advice services and improvement projects were routinely reviewed to identify themes and monitor performance. Actions arising from feedback were tracked, shared with staff and the public through "You said, we did" communications, and used to inform ongoing service improvement.

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

The trust's Belonging and Inclusion Strategy promoted inclusive leadership, equality and anti-racist practice. Staff were supported through mandatory training, induction, wellbeing initiatives and Freedom to Speak Up processes. The trust also monitored equality through the Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES).

Staff networks supported a culture of inclusion, belonging and staff support by providing opportunities for connection, peer support and shared learning. They aimed to contribute to improved staff wellbeing, morale and job satisfaction, and helped promote understanding of diversity and challenge discrimination. The networks also supported staff development through networking and skill-building opportunities.

Staff Networks included:

Black, Asian and Minority Ethnic (BAME) Network

Disability Network

LGBTQ+ Network

Women’s Network

Men’s Network

Carers’ Network

Faith and Belief Network

Neurodiversity Network

Armed Forces Network

Reasonable adjustments were made for staff with disabilities, supported through workplace assessments and Health and Safety input. Flexible working arrangements, including home working, condensed hours and part-time working, were used to support staff with caring responsibilities, health needs and work–life balance.

In February 2026 the Trust celebrated Race Equality Week. The Trust used the week to talk with staff and service users about differences and the daily barriers they experienced. Each day there were staff blogs where staff spoke about their own personal experiences including, the Trusts Freedom to Speak Up Guardian.

Staff were supported to engage in inclusion activities, including Black, Asian and Minority Ethnic (BAME) network meetings and Black History Month events. Black history months events were held Trust wide by multiple teams. These events fostered inclusivity, enhanced cultural understanding, promoted diversity and team building. Older People teams in the north and north west participated.

Following the inspection, to celebrate the National Day for Staff Networks, the Trust hosted a day of meet and greet sessions with each of the staff networks, hosted by a network chair and their executive sponsor. Open to all staff, these sessions represented an opportunity for staff to find out more about the networks, including how they supported staff and helped build a culture of belonging and inclusion in the Trust. The Trust was also planning a Pride celebration in June.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had established governance arrangements with clear lines of accountability and defined roles and responsibilities to support the delivery of safe care. Leaders used available information on risk, performance and outcomes to monitor service delivery and ensure issues were escalated and shared appropriately at team and directorate level.

A structured governance framework was in place, with regular meetings that provided assurance that key areas such as incident learning, complaints and safeguarding were reviewed consistently. Staff discussed learning from incidents, including those reviewed through PSIRF processes and local debriefs, within governance forums and at team level to support ongoing improvement.

Leaders had access to real-time performance data through an electronic dashboard integrated with clinical systems, supporting oversight of quality, risk and service performance. Staff had access to the necessary IT systems and equipment to undertake their roles effectively.

Risk management systems were in place at both service and team level. The risk register reflected operational and clinical concerns identified by staff and leaders and identified 3 moderate risks across Mental Health Older People’s Community Services. These included staffing level pressures within the South West community service, shortages of social work and psychology cover within the North West service, and risks relating to violence and aggression within the East older people’s mental health community service. All risks were managed within local teams, held on service risk registers, and subject to regular review through governance processes.

Business continuity arrangements were in place, including plans for staff shortages, loss of utilities, and IT or telecommunications failure. These plans were reviewed annually and provided clear guidance to staff in the event of disruption.

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 share information and learning with partners and collaborate for improvement.

The Trust staff used the Hertfordshire West Essex Shared Care Record (My Care Record) which provided access to information from multiple health and care organisations, supporting continuity of care, informed decision-making and safer, more co-ordinated services, demonstrating integrated care.

The service partnered with Hertfordshire County Council to address delays in transferring people with dementia from hospital to community care. Together, they developed 'Sunflower', an enhanced MDT model within a care home providing wraparound support during transition and recovery. The initiative successfully enabled safe, timely transitions, improved outcomes and reduced prolonged hospital stays, with no compromise to patient safety. Its strong evidence base demonstrated the effectiveness of the model and led to lasting improvements in care processes and pathways for people with changing care needs.

The service worked with local communities to break down barriers, in January 2026 staff from the service including the clinical director joined the Watford African Caribbean Association (WACA) for their Dementia Awareness Day. The aim of the event was to bring the community together to explore ways of breaking down stigma and building understanding around dementia. The service’s attendance was a meaningful step forward in reducing stigma, reaching underserved communities, and supporting early access to mental health and dementia services.

Commissioners described effective joint governance arrangements with the provider to oversee the quality, safety and performance of specialist mental health services for older people. Regular contract, quality and partnership meetings were used to monitor performance, safeguarding, incidents, staffing, complaints, patient safety and service improvement, supported by quality visits and routine performance reporting. Feedback from people using services, complaints and learning from incidents informed quality assurance and improvement activity.

Commissioners provided evidence that previous concerns regarding dementia assessment waiting times had been closely monitored through enhanced oversight and targeted recovery plans, resulting in improvements to service delivery. A wider review of older people's mental health services identified opportunities to improve pathways, access and outcomes, with further development work planned.

Commissioners also demonstrated oversight of discharge planning and patient flow through regular review meetings, with services working alongside health, social care, care providers and carers to support safe transitions and avoid unnecessary admissions where possible. Partnership working and co-production with people who used services informed service development, including work to improve dementia care and strengthen joint working across organisations.

The service demonstrated effective engagement in clinical networks and partnership forums to support service development, shared learning and integrated working across older people’s mental health and dementia pathways. Minutes from the Dementia Strategy Steering Group evidenced active participation in a multi-agency forum across Hertfordshire, demonstrating collaborative system leadership, joint oversight of pathway development, and coordinated work to improve support for people living with dementia and their carers.

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 contribute to safe, effective practice and research.

The Trust demonstrated a strong programme of quality improvement across Older People’s Community Services. Key projects included the redesign of the memory assessment service (EMDASS), which reduced waiting lists, increased capacity, improved pathway consistency, and strengthened performance against access targets. The 28-day access improvement programme for community mental health teams significantly improved the timeliness of assessments, with compliance exceeding 90% across services.

Quality improvement work within crisis services focused on medication management, risk assessment, suicide prevention, and enhancing responses to older adults in crisis, contributing to safer and more responsive care. Frailty and falls initiatives strengthened multidisciplinary working, physical health oversight, and staff capability through the introduction of a community frailty pathway, regular MDT support, and targeted training. The Integrated Community Team remodelling project improved role clarity, governance, and pathway coordination, helping to reduce duplication and support more seamless care.

The trust demonstrated a strong culture of research, innovation, and continuous improvement across Older People’s Mental Health Services. This included participation in national dementia and frailty research, the development of innovative digital approaches to dementia care, and collaboration with universities and external partners. The service had also received local and national recognition for its work in dementia care, integrated working, health inequalities, sustainability, and workforce development.

Older People’s Psychology Service presented at this year’s Faculty of the Psychology of Older People (FPOP) Conference in June 2026, having previously presented in 2025. Their interactive workshop explored practical approaches to supporting older adults experiencing rumination and regret in later life. Drawing on neuropsychological and cognitive perspectives, the session gave delegates the opportunity to consider practical therapeutic approaches to these challenges. The Trust was also being represented by an Assistant Psychologist, who presented her work on the development and audit of the Managing Thinking and Memory Group (MTaMG) for people living with mild cognitive problems.

The trust demonstrated a clear commitment to developing its lived experience workforce and had strengthened this by recognising lived experience roles as an established professional group. Dedicated leadership supported the recruitment, development and supervision of staff in these roles. Lived experience leads worked within services to promote co-production and ensure people's experiences informed service design and improvement. This approach reflected national guidance and evidence supporting the role of lived experience in improving engagement, recovery and people's experience of care. Staff were supported through a structured programme of training, supervision and competency development.