Hertfordshire Partnership University NHS Foundation Trust

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last inspection we rated this key question as good. At this inspection the rating has improved to outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (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 was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People were encouraged to be involved in their care, and staff had a very good understanding of peoples’ individual needs, and these were respected. Systems were in place to ensure joint decision-making between staff and people using the service, with care plans reflecting people’s physical, mental health, and social needs. Staff told us they involved people and their families, using person-centred approaches and clear communication methods consistently. We observed attentive staff responding promptly and respectfully to peoples’ needs.

The trust offered exceptional support to family members. Staff had developed a ‘Carer Pathway’ to ensure a consistent model of support for family carers across HPFT services and to allow performance to be more accurately measured. The pathway was based on five key stages of carer support – ‘identify, welcome, support, involve and transition’. This included provision of a welcome letter to all carers, assigning a named professional as a point of contact, offering a carers assessment and informing of any involvement opportunities to help services improve. The family members we spoke with said they had specific support for their own needs, and they were fully involved in the care planning process through regular communication and updates.

Psychologists had implemented a division-wide Trauma-Informed Walkthrough project to enable staff to understand the effects of trauma and how a trauma informed approach can be supportive​. (Trauma-informed approaches (TIA) are frameworks that recognise the widespread impact of trauma and aim to create safe, supportive environments that prevent re-traumatisation and empower individuals). The aims of the project were to identify how existing practices aligned with TIA, support local teams to develop service improvement projects and to increase awareness and change the culture and ethos of the service to be more trauma informed​. This had led to tangible service improvements, including clearer information before appointments, better recording of historical trauma, the use of more sensitive language and improved access to service information.

We scored the service as 4. The evidence showed an exceptional standard. The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The trust offered a number of specialist pathways providing a range of interventions from all professions within the multi-disciplinary teams. At the time of inspection there were 5 approved trust wide pathways, for example, epilepsy, dementia, complex behaviours and physical health, and a trajectory in place for a further 6, including pregnancy, end of life care and safe relationships. Staff were involved with discussions regarding these pathways and ensuring they were consistent across all the teams and locations.

The trust had responded to the Transforming Care agenda and had significantly reduced their learning disability inpatient bed numbers since the last inspection. The trust had used the available funding to provide intensive support to people in the community, their families and professional carers to prevent unnecessary admissions to hospital. This strategy was proving successful, for example there had been no new admissions to the inpatient unit in Hertfordshire for 8 months at the time of inspection. We received feedback from a commissioner who told us ‘The service is a key and active part of our prevention work and uses admission avoidance processes proactively as evidenced by a sustained reduction in admissions’.

Staff undertook research to better understand the needs of people with learning disabilities and their local communities. For example, psychologists conducted an audit to investigate how individuals with a learning disability who had allegedly engaged in online sexual offending presented to services following contact with online vigilante groups. The aim of the audit was to contribute to the understanding of this area and subsequently aid the development of further support for these individuals.

The service used a caseload management model so that people who used the service had a named professional allocated to them and had continuity of care.

We scored the service as 3. The evidence showed a good standard. The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service provided information that was accurate, up to date and tailored to individual needs. It complied with the Accessible Information Standard, ensuring that people with disabilities or sensory impairments received information in formats they could understand and access. Health Access Champions, Experts by Experience and participants in the Client Opinion Groups, were able to review information that was given out to people and feedback their opinions and suggestions for any changes.

Staff had access to the equipment and information technology needed to do their work.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and peoples’ care. This information was presented and discussed in Quality and Risk meetings, business meetings and clinical governance meetings.

Information governance systems included confidentiality of patient records. Records were maintained in line with the providers policies and procedures, ensuring personal information was securely safeguarded.

Staff ensured that people could obtain information on treatments, local services, their rights and how to complain. Staff provided information in accessible formats to meet peoples’ communication needs. Individual communication requirements were clearly recorded in care plans and regularly reviewed to ensure they remained appropriate.

We scored the service as 4. The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result.

People knew how to complain or raise concerns. We saw information about how to make a complaint and how to raise concerns with the Care Quality Commission was given to people and was available on noticeboards in reception areas, including links to a QR code to provide feedback to the trust.

Staff knew how to acknowledge complaints and tried to swiftly resolve complaints or concerns informally. In the 6 months prior to the inspection, the trust received 3 PALS enquiries and 7 formal complaints across all the learning disability community teams, of which 3 were upheld. There were no Ombudsman complaints upheld. The main themes of complaints and concerns were access to services, transitions between organisations, care coordination and communication around clinical decisions. Staff made changes and shared learning following complaints.

The trust facilitated ‘Making Services Better’ and ‘Client Opinion Group (COG)’ meetings. The Making Services Better groups were chaired by the Health Access Champions and attended by staff such as senior nurses, therapists, psychologists and managers, who worked in partnership to improve the experience of care and outcomes for those who use our learning disability services.

People with Learning Disabilities attended the COGs to talk about their experiences of health services and ways these could improve. We saw an example where people attending a COG looked at and discussed the trust leaflet on dementia. The participants all agreed the booklet, colours, size of the font and information was good and easy to read, and they had no changes they wanted to make.The trust carers strategy included an action for all family members to be told about opportunities to contribute to service improvements.

We viewed the compliments log for the service and saw 244 compliments recorded from people, family members and external stakeholders praising staff and the care and treatment provided by the service. Feedback consistently highlighted compassionate, person-centred care, strong communication, collaborative working with families and providers, and meaningful improvements in people's wellbeing, independence and quality of life.

We scored the service as 3. The evidence showed a good standard. The service ensured people could access care, treatment, and support tailored to their individual needs. Through effective assessment processes, staff identified and removed barriers to care, particularly for individuals with complex needs or protected characteristics under the Equality Act 2010.

Staff assessed people, including those with complex needs, effectively. Within Buckinghamshire and Hertfordshire, all teams within the service were 100% compliant with the trust target of 28 days maximum waiting time for first assessment. Within Essex, teams were 94% compliant at the time of inspection.

The trust target was for 95% of people to commence treatment within 18 weeks from referral. Teams within Buckinghamshire, Hertfordshire and Essex all met this target with compliance rates ranging from 95% to 99%.

Prior to June 2025, community learning disability services in Norfolk were managed by a different healthcare trust and staff had been managing a significant waiting list and historic backlog of appointments which impacted on their ability to meet the trust targets. At the time of inspection, they were under target at 69% for compliance for waiting for treatment. However, performance was improving, managers and staff felt well supported and were confident they were on track to meet the trust targets once they moved to a planned new operating model in October 2026.

The trust had a standard operating procedure which described how staff would monitor and support people while they waited for a specific intervention or therapy using a person-centred approach. The process included ensuring a care plan and risk assessment, including a crisis management plan, was completed following acceptance of a referral and maintaining open and regular communication and keeping people informed about the progress of treatment availability and any changes in the plan or timeline.

Occupational therapy and psychology staff undertook autism spectrum disorder (ASD) assessments for people who needed them. This meant that people and their families had a greater understanding of the impact of ASD on their daily functioning. This helped inform future recommendations around routine, sensory regulation, community support, and psychological intervention.

We scored the service as 4. The evidence showed an exceptional standard. Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Staff promoted a culture in which the people using the service felt empowered to give their views. Staff facilitated Client Opinion Groups and Making Services Better meetings, which provided opportunities for people to share feedback, raise concerns and contribute to ongoing improvements in the service.

Staff used the care planning processes to reflect the individual needs and circumstances of each person. This included consideration of protected characteristics and any related risks or barriers that may affect how care was experienced. We saw an example where staff had supported a person who had gender dysphoria (distress or discomfort a person feels because their internal gender identity does not match the sex they were assigned at birth). Staff assessed capacity and provided support to the person, their family and professional carers whilst they were undergoing treatment at a gender clinic and managed their ongoing safety and risks in the community.

Staff within offending behaviour intervention teams (OBIS) provided exceptional support to people with learning disabilities who were in the criminal justice system. Staff offered specialist forensic risk assessment and management of risk in the community, delivery of offence-specific therapeutic interventions (e.g. to prevent sexual/violent offences) and complex case management. In addition, staff offered support, training and consultancy to other teams, organisations and care providers and in-reach support to achieve effective discharge from secure inpatient settings to the community. Psychology staff in Hertfordshire offered systemic consultation and family therapy for people open to OBIS alongside offence specific CBT based interventions.

Managers supported race equity work through access to organisational training resources and structured virtual learning sessions. These initiatives helped staff to strengthen their understanding of equity, cultural identity and inclusion, contributing to the delivery of respectful, person-centred community care.

Managers made sure staff and people could get help from interpreters or signers when needed.

The service had clear policies aligned with equality, diversity, and inclusion principles to prevent disadvantage and promote fairness for all, including those with protected characteristics. The trust had signed up to the Patient and Carer Race Equality Framework (PCREF). PCREF is a national framework, launched by NHS England, designed to tackle racial disparities in mental health care and improve outcomes for diverse communities. The trust had assessed itself against PCREF and had an action plan in place which was co-developed with people who used services, staff and stakeholders.

Staff were trained in equality, diversity, inclusion and human rights with 98.5% of staff having completed this training at the time of inspection.

The trust had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.
 

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We saw evidence within care records that staff supported people and their families to plan for future changes, including the progression of illness, advance care planning, lasting power of attorney and future care arrangements.

Staff held regular meetings with children's services to plan for the appropriate future adult services for rising 18 year olds. Staff discussed the needs of young people from the age of 17.5 years. This ensued that there was a smooth transition for young people and they did not experience gaps in care or get lost to services. In Essex there was a dedicated Transition Worker who worked jointly with Children's and Adolescent Mental Health Services (CAMHS) through a shared transition pathway and checklist, supporting safe transition into adult services and reducing crisis escalation.

Staff worked with relevant healthcare professionals and partner organisations to plan care for people with complex needs. Referrals were reviewed through multidisciplinary team meetings to agree the most appropriate care pathway and ensure people received support from the professional best placed to meet their needs.

When a person was moving to a new area or coming to the end of an episode of care, staff developed bespoke plans and undertook pre and post move handover or discharge meetings with local services to ensure continuity and quality of care.