Hertfordshire Partnership University NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question as good. At this inspection the rating has improved to outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 92 (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 always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

When people were referred to the service, staff undertook a comprehensive assessment of their needs within 28 days (or 24 hours if they were referred in crisis to one of the intensive support teams).

We reviewed 22 care records during the inspection. There was a consistent and high-quality approach to assessing, and reviewing peoples’ health, care, wellbeing and communication needs. Following the initial assessment, people were assigned a named professional from the team who worked with the person and their family or carers to create a care plan, including in an accessible format, to meet that person’s communication needs, outlining the support and treatment they needed. If someone’s needs could not be met by the team, they were given supported guidance to access other services which could help them.

Care plans were personalised, comprehensive, updated in a timely manner and showed good evidence of engagement with families or carers. Staff took account of individuals’ communication preferences and needs, ensuring that people could understand and engage with their care planning including providing easy read care plans and finding ways to communicate and present information in a way it could be understood.

Staff assessed needs and developed care plans of care in a highly personalised way. For example, the speech and language therapy team worked collaboratively with a person to develop personalised communication cards for meetings with professionals and medical appointments. The cards were laminated and attached to a portable sheet for community use. The intervention enabled the person to attend a local acute hospital appointment they had previously declined, as they felt better equipped to advocate for themself. We saw another example where staff supported a person with a special interest in music to engage with personal hygiene through a bespoke social story incorporating their own vocabulary, idiosyncratic language and musical interests. We also saw an example where a person was supported to develop and deliver their own communication training video for staff. They co-produced the content, recorded the video and co-delivered the training, using their own personal experiences and insights to help staff better understand their communication needs and how these could be supported in everyday interactions.

Staff ensured people had an up-to-date hospital passport (a personal document that gives healthcare staff quick, essential information about an individual's medical history, communication preferences, and specific care needs).
 

We scored the service as 4. The evidence showed an exceptional standard. The provider always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). These included medication, psychological therapies, physiotherapy and occupational therapy.

The teams included or had access to the full range of specialists required to meet the needs of people referred to the service. As well as doctors and nurses, people could access support from occupational therapists, psychologists, psychotherapists, relationship counsellors, arts and music therapists, speech and language therapists, dieticians, and physiotherapists.

Speech and language and physiotherapy staff had collaborated and undertaken published research into dysphagia (difficulty or discomfort with swallowing). People with learning disabilities are at a significantly higher risk of dysphagia which causes severe health risks, including choking, aspiration pneumonia, malnutrition, and premature death. The resultant Dysphagia and Respiratory Pathway (DARP) integrated dysphagia and respiratory care into a single, coordinated pathway for people. Staff ensured people were screened for swallowing and respiratory risks, including factors associated with community acquired pneumonia. We saw evidence of this in peoples’ records. Staff provided practical support tools, developed with staff and carer feedback, for fellow professionals, families and carers to reduce the risks associated with dysphagia.

Staff developed their practice and kept up to date with new treatments and innovations. For example, staff introduced Video Interaction Guidance (VIG) - an evidence-based, video feedback intervention recommended by NICE to support positive relationships, communication, and attachment. Psychology staff contributed to the development of the evidence base and set up an international Special Interest Group which met a few times per year bringing together practitioners who were using VIG with children and adults with learning disabilities.

All staff were encouraged to get involved in quality improvement (QI) by undertaking QI projects, both large and small, and sharing the learning from these across the trust. For example, we saw a project undertaken in Essex to identify the barriers to increasing the number of face-to-face physiotherapy sessions offered, which had successfully led to an increase in provision.

The trust provided placements for student nurses and allied health profession apprentices within the community teams. We heard and saw many examples of extremely positive feedback from learners who had undertaken placements highlighting the welcome they had received and how much they had learnt. Many students had chosen to return to undertake their final placements or to pursue careers within the trust.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. All the staff we spoke with told us they had excellent opportunities for personal and professional development. Staff attended development days focused on training, team building and innovation.

The training was appropriate for the people using the service. The trust offered staff a wide range of additional and specialist training, for example, autism and sensory practice, Makaton, Talking Mats, physical health and health inequalities, dysphagia, respiratory health and epilepsy. PBS training was a particular strength within the trust with over 95% of staff having completed training in PBS with advanced and post-graduate training available.

The trust hosted the RADiANT network which was founded with participation from 12-13 NHS Trusts. The network focused on 5 neurodevelopmental conditions- learning disability, autism, ADHD, epilepsy and brain injury and aimed to promote research, staff training and public education. As a part of its core function, RADIANT offered a free 2 hour continuing professional development programme every month which trust staff, UK or international based clinicians could attend live or watch a recording later.

Hertfordshire and Buckinghamshire and Essex teams provided regular Lunch and Learn sessions. These sessions were open to all staff and recordings were available for those unable to attend on the day. These forums enabled staff to explore emerging priorities, share learning across disciplines, reflect on practice and strengthen their response to local service needs. Some of the recent topics included, complaints training, psychodynamic approaches, learning disabilities and dementia and working with staff teams supporting people with learning disabilities.

Mental Health Act Compliance

Staff received and kept up-to-date with training on the Mental Health Act (MHA) and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. At the time of inspection, compliance with MHA training was 96.8%.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were and when to ask them for support.

Staff followed clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice.

People had easy access to information about independent mental health advocacy.

Staff explained to each person their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the person’s notes each time.

For people subject to a Community Treatment Order, staff completed all statutory records correctly.

Care plans clearly identified people subject to the Mental Health Act and identified the Section 117 aftercare services they needed.

Managers and staff made sure the service applied the Mental Health Act correctly by completing audits and discussing the findings.

We scored the service as 4. The evidence showed an exceptional standard. The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff held regular multidisciplinary meetings to discuss and improve the care of people using the service. These meetings were attended by a range of staff from different disciplines and were effective in discussing a range of issues including changes to peoples’ presentation, risks, incidents and medication. This included details of the views of the person, their family and other professionals that were involved, including social care.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. We saw seamless working and excellent collaboration between community teams and staff working on the inpatient wards.

The service had effective working relationships with teams outside the organisation, for example, commissioners, the local authority, GPs and secondary health services. In Hertfordshire, the community learning disability nurses were employed by Hertfordshire County Council due to historical commissioning arrangements. However, they attended MDTs and worked closely with HPFT teams. Managers in Hertfordshire attended a bi-monthly meeting with the county council leads, chaired by health commissioners, to discuss service strategy, risk, learning and quality improvements.

In Hertfordshire and Buckinghamshire, staff attended an Improving Health Outcomes Group (IHOG) which was attended by commissioners, safeguarding and local health and council staff, focusing on GP engagement, health liaison and reducing health inequalities.

We saw an example where a community nurse in Norfolk coordinated care for a pregnant woman with learning disabilities, epilepsy, a congenital cardiac condition, anxiety and depression — working across maternity, obstetric, cardiac, psychiatric, speech and language therapy, occupational therapy, safeguarding and social care services. This work led to an invitation to deliver teaching to third-year student midwives on supporting pregnant women with learning disabilities, reasonable adjustments and reducing discriminatory practice.

We scored the service as 4. The evidence showed an exceptional standard. The provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff identified peoples’ physical health needs and recorded them in their care plans. Staff monitored physical health including a focus on early recognition of deterioration and completion of core physical-health checks including dysphagia, bowel health and nutrition screening.

Staff provided enhanced physical health clinics for people with co-morbid severe mental illness (SMI) as an addition to the standard learning disability annual health checks conducted by a GP. These included a review of medication side-effects, blood tests, blood pressure monitoring, assessment of bowel health and an electrocardiogram (ECG). This model originated from a pilot project demonstrating improved physical health outcomes through comprehensive screening combined with health facilitation and social prescribing. In June 2026, the standard operating procedure was updated to reflect new research including LeDeR findings, Royal College of Psychiatrists metabolic monitoring guidance and the Health and Care Act 2022. The clinics demonstrated extremely positive outcomes and led to a series of published research papers. Following health checks, people were given easy read health action plans, agreed by themselves and their carers and shared with their GP in a structured outcome letter.

Staff actively promoted uptake of cancer screening (cervical, breast, bowel), abdominal aortic aneurysm (AAA) checks, dental appointments, audiology, optical checks and vaccination. Staff identified reasonable adjustments, for example, longer appointments, Easy Read materials, desensitisation, adapted equipment and carer involvement and documented and reviewed these at each contact. For example, we observed a physical health clinic where staff explained how to perform self-checks for testicular cancer in a way that the person could understand.

The trust provided a Female Hormone Clinic for women with learning disabilities and/or Autism. Staff provided assessment and management of female hormonal conditions such as menopause, perimenopause and Polycystic Ovary Syndrome. Staff also reviewed the impact of oral and injectable contraception use on mental health and behavioural challenges in people.

In Essex, staff developed an initiative, ‘Do You See Me’ that aimed to increase awareness of the barriers that people with a learning disability can experience when accessing health services and to support GP practices in making reasonable adjustments that improved access, experience, and outcomes. The nursing team distributed a comprehensive resource package to all GP practices across North East Essex designed to enhance staff knowledge and strengthen the delivery of accessible healthcare for people with a learning disability. The packs included resources such as guidance relating to annual health checks, cancer screening information to support uptake and informed decision making and a choking awareness pack aimed at improving recognition, prevention, and management of choking risks.

The trust employed people with lived experience of learning disabilities as Health Access Champions (HACs). HACs helped identify barriers to healthcare, promoted accessible communication, contributed to service improvement initiatives and ensured the voices of people with learning disabilities were represented in decision-making. They played a key role in co-production, working alongside staff, people and carers to influence service design, accessibility, recruitment and quality improvement activities. For example. they worked with the community learning disability nurses to promote annual health checks and flu jabs and supported people with learning disabilities to get good NHS healthcare. At the time of inspection there were 8 HACs employed by the trust.
 

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People’s outcomes were monitored using recognised rating scales. Staff used a standardised set of outcome measures to ensure equitable assessment, improved oversight and to demonstrate evidence of people’s progress. Staff used Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS LD) as the primary outcome measure as well as a range of clinician-reported, patient-reported and co-produced outcome measures such as, LifeStar, Therapy Goals and Outcomes (TGO), and Clinical Global Impression (CGI).

The trust had a target of 75% completion of the standardised outcome measures for all people using the service to ensure these were embedded into clinical practice. At the time of inspection, East and North Hert’s and Northeast Essex teams were meeting the trust target whilst Buckinghamshire and West Hert’s had shown significant improvement and were now approaching the target at 66% and 68% respectively. Managers acknowledged that the Norfolk teams who transferred to the trust in June 2025 needed further support to ensure the consistent use and completion of clinical outcome measures. However, they had demonstrated improvement since the previous audit, increasing from 3% to 15%.

We saw many examples of positive outcomes for people. For example, the Intensive Support Team supported a non-verbal autistic person with a severe learning disability, who had not left their house for many years, to move from the family home into residential care after their parent was no longer able to care for them. The team used physical prompts, reassurance, familiar routines and parent presence to support them into the car and stayed at the care home to help them settle. The approach demonstrated person-centred risk assessment, trauma-informed planning, family involvement, MDT coordination and positive risk-taking in a situation where there was realistically one opportunity to get it right.
 

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff informed people of their rights relating to consent and respected these when delivering person-centred care and treatment. We reviewed 22 care records and found that staff assessed peoples’ mental capacity where appropriate, recorded informed consent to treatment, and involved people and families in decisions about their care and treatment options.

The trust had a Mental Capacity Act policy in place, and 98.6 % of staff were up to date with Mental Capacity Act and Deprivation of Liberty Safeguards training. Staff audited the application of the Mental Capacity Act and took action on any learning that resulted from it.

The trust provided access to an independent advocacy service. Information about the service was displayed in reception and waiting areas, and staff supported people to access advocacy, including helping to arrange appointments where required.

When people lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture, and history.

A small number of people were subject to community treatment orders (CTO). The service undertook audits to monitor compliance with requirements under Section 132 of the Mental Health Act, ensuring that people subject to CTOs had their rights explained to them.