Hertfordshire Partnership University NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question as good. At this inspection the rating has improved to outstanding. This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

This service scored 88 (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 had a strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

Staff reported serious incidents clearly and in line with trust policy. Staff recorded incidents on an electronic incident reporting system. All staff we spoke with knew what to report and how to report it.

The trust had a robust incident management and patient safety governance framework aligned to the Patient Safety Incident Response Framework (PSIRF). Managers reviewed and monitored incidents through service, divisional and trust-wide governance structures to ensure risks were identified, learning was captured and improvements were implemented. A monthly divisional safety report was presented by the head of nursing to the trust-wide safety group to support organisational assurance and shared learning. This ensured that local learning contributed to wider divisional and trust-wide patient safety improvement. 

The trust reported 705 incidents in the 6 months prior to inspection. Of these incidents 68% were classified as no harm and 21% were low harm.There were 57 reported deaths, commonly reported as natural causes/from known medical conditions.The highest reported incidents were personal accidents (in the community), violence and aggression and safeguarding.There was only 1 serious incident reported which was being investigated at the time of inspection.

Staff reported all deaths of people who were open to the team, or were open in the previous 6 months, to LeDeR (Learning from Lives and Deaths – people with a learning disability and autistic people - an NHS England service improvement programme to reduce health inequalities and prevent early deaths). National and local LeDeR reports were shared and discussed at monthly Quality and Risk meeting and findings from LeDeR continued to inform the development of local pathways and physical health rating tools.

Learning and quality improvement were embedded throughout the service. We saw an example where staff identified learning following the death of a person in the community from complications from constipation. (Constipation is a very common, serious, and potentially life-threatening condition for people with learning disabilities). Staff initiated a multi-disciplinary bowel health working group and strengthened interventions such as including bowel health in all initial and ongoing assessments, creating constipation care plans for people at risk, liaising with GPs and providing training for families and professional carers to educate them regarding bowel health and how they could support the people they cared for, including teaching abdominal massage.

Staff also shared concerns and identified learning where the practice of staff not employed by the trust, for example social care and residential support staff, had led to incidents or created risk. This had led to practical changes such as updated medication management processes, clearer dysphagia and mealtime support guidance and improved monitoring of people with high risks. Swarm reviews had also supported improved recognition of vulnerability and exploitation, clearer planning for missing episodes, safe endings, financial safeguards, and more robust management of complex behaviours and risks to others. (A Swarm review is a rapid, blame-free team debrief held immediately after a safety incident to identify systemic learning and prompt actions.)

Staff received feedback from investigation of incidents, both internal and external to the trust. Learning was shared through multi-disciplinary team (MDT) meetings, safety huddles, Quality and Risk meetings, divisional safety reporting and Learning Notes to support wider organisational learning and reduce recurrence.

Staff understood the duty of candour. They were open and transparent and gave people and families a full explanation if things went wrong. The trust had a duty of candour policy which gave additional information on the trust’s standards and expectations in relation to the duty of candour.

We scored the service as 4. The evidence showed an exceptional standard. The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

The service’s referral processes ensured that all essential information about the person was received to determine if their needs could safely be met. Referrals were accepted from families, professional carers, GPs and other health or social care staff as well as self-referrals. Staff triaged referrals and offered a comprehensive face to face assessment within 28 days. If a person was in urgent need of support, staff from the intensive support teams would respond immediately and offer a phone call or face to face visit within 24 hours.

Staff ensured peoples safety by assessing people’s needs thoroughly and being flexible regarding eligibility criteria – for example by not immediately dismissing a referral if someone did not have specific medical evidence of a learning disability. Where it was decided a person was not eligible or suitable for the service, staff offered guided support to help them identify alternative sources of help. One member of staff explained their aim was to ensure that everyone had a positive experience and was in a better position after any contact, regardless of whether they went on to have ongoing care and treatment from the service.

The trust introduced the community intensive support teams (ISTs) as a response to the national Transforming Care Agenda review - an NHS-led initiative designed to improve the lives of people with learning disabilities and/or autism and prevent unnecessary admission to hospital. Staff from both the community and inpatient wards worked closely together to ensure comprehensive information sharing and risk assessment. If a person was admitted, IST staff regularly visited, if appropriate, to provide reassurance and continuity of care. The consultant psychiatrists worked across the community and inpatient wards to facilitate safe transitions and access to all relevant information.

The trust worked with commissioners and social care in each area on local Dynamic Support Registers (DSR) - a tool designed to identify and support people with learning disabilities or autism who were at risk of unnecessary hospital admission. This ensured individuals received appropriate community-based care, prevented crisis situations, and aligned with national ‘homes, not hospitals’ policies.

Community teams had effective working relationships with external teams and organisations. Our review of records from meetings and care records indicated involvement of family members, key stakeholders, and social care teams in discussing people’s progress, future care planning, transitions and discharges. Community staff worked closely with staff on the inpatient wards when someone was about to be discharged to ensure positive transitions.

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.

We scored the service as 3. The evidence showed a good standard. The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The trust had a safeguarding policy which included clear processes and flowcharts to support staff in recognising abuse and making a safeguarding referral when appropriate and staff kept safeguarding logs.

Staff were trained in safeguarding, knew how to make a safeguarding referral, and did that when appropriate. Safeguarding training was mandatory for all staff and staff undertook safeguarding training at the appropriate level every 3 years. At the time of inspection, 99.1% of staff had completed Level 1 Safeguarding Adults and 98.6% of staff had completed Levels 2 and 3. Over 94% of staff had completed all levels of training in safeguarding children.

Local authorities within the 4 counties covered by the trust held the responsibility for investigating safeguarding incidents. In Hertfordshire, there was a 113 agreement in place with the local authority, with some staff trained to make decisions and investigate concerns under Section 42 of the Care Act for adults with functional mental disorders.

Staff worked in partnership with local authority colleagues by raising safeguarding referrals where appropriate. Between April and June 2026, staff made 105 referrals to the local authority safeguarding teams. These related to a variety of concerns, with the majority relating to the quality, consistency and safety of care provided by external support providers and carers including medication management, adherence to dysphagia guidance, physical health monitoring, supervision arrangements and the implementation of agreed care plans.

Staff could give examples of how to protect people from harassment and discrimination, including those with protected characteristics under the Equality Act.

Good practice in applying the Mental Capacity Act

Staff supported people to make decisions on their care for themselves. They understood the trust policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for people who might have impaired mental capacity.

Staff received and kept up-to-date with training on the Mental Capacity Act and had a good understanding of at least the five principles. At the time of inspection, across all teams, compliance with training in Mental Capacity Act and Deprivation of Liberty Safeguards was 98.6%.

Staff gave people all possible support to make specific decisions for themselves before deciding a person did not have the capacity to do so. We saw an example where staff conducted a capacity assessment for a person who had a history of eating out-of-date and inappropriately stored food. Following the assessment, structured plans and resources were provided to support them in making informed choices around dietary intake and food storage.

Staff assessed and recorded capacity to consent clearly each time a person needed to make an important decision.

When staff assessed people as not having capacity, they made decisions in the best interest of people and considered their wishes, feelings, culture and history. They consulted with people’s representatives as appropriate when making decisions on a person’s behalf.
 

We scored the service as 4. The evidence showed an exceptional standard. The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

Staff knew people well and were aware of any risks they posed to themselves, to other people or to the environment. Following referral, staff undertook a risk assessment of every person, and this was reviewed regularly. Staff assessed additional risks which are present for people with learning disabilities, such as bowel health, dysphagia (difficulty or discomfort with swallowing) and sexual safety.

Where appropriate, staff developed positive behaviour support plans (PBS) for people to equip families and paid carers with strategies to recognise and respond when a person was becoming distressed. (A PBS plan is a person-centred, proactive strategy to understand and manage distressed behaviours, focusing on improving the quality of life for individuals with learning disabilities or autism). At the time of inspection, 95% of staff had completed some form of internal PBS training, with further advanced training available. The programme had been recently refreshed to strengthen trauma-informed practice, multidisciplinary delivery and involvement from experts by experience to ensure quality, consistency and sustainability.

The trust had introduced Positive Partnership Teams (PPTs) across Hertfordshire, Buckinghamshire and Essex.The role of the PPTs was to upskill and support paid care staff, working within supported housing for example, to help people live well in the community and prevent inappropriate admission to inpatient services. Staff provided training in PBS, Person Centred Active Support and the SPELL Framework (the SPELL framework is a person-centred, evidence-based approach developed by the National Autistic Society to help understand and support autistic individuals). Staff offered regular hands-on training sessions, using learning disabled actors, where carers could learn practical skills, try immersive scenarios and improve their confidence and knowledge. We saw an example where a PPT had worked with carers supporting a person who had previously been banned from their local pub due to distressed behaviours. Following this piece of work, they were welcomed back to the pub to celebrate their birthday.

Staff recognised the potential impact of hormonal changes for women, particularly during menopause, and had incorporated menopause related considerations into peoples’ risk assessments to reflect hormonal fluctuations as a potential factor affecting an individual’s presentation, behaviours or risks.

Staff communicated with people so that they understood their care and treatment, finding effective ways to communicate with people using easy read materials, choice boards, pictorial aids and social stories. Following the initial assessment, people were given an easy read summary with information about what care or support they would receive and from whom.

We scored the service as 3. The evidence showed a good standard. The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff were based in a range of locations including central office hubs as well as smaller satellite sites. Staff undertook visits to people’s homes or residential settings, and at most locations there were bookable rooms available to meet people for appointments or for group sessions. Where these were not available, staff used community settings if they needed to.

Staff completed and regularly updated thorough environmental risk assessments, including ligature audits, and removed or reduced any risks they identified.All areas were clean, well maintained, well-furnished and fit for purpose.

Waiting rooms had sufficient chairs for people to sit and wait, with information boards displaying details of local resources, advocacy contact details, and information on how to give feedback including quick response (QR) codes. Each site had a water cooler for people to access drinking water if needed.

Staff had access to alarms in meeting rooms and lone worker safety devices for when they went on home visits.

The clinic rooms we observed were clean and well-maintained, containing medication storage facilities and physical health monitoring equipment, such as blood pressure monitors. Records showed that this equipment was regularly serviced.

We scored the service as 4. The evidence showed an exceptional standard. The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

At the time of inspection, the overall vacancy rate was 3% in Essex, 9% in Hertfordshire and Buckinghamshire and 9% in Norfolk. Many of the vacancies in Hertfordshire were due to the planned expansion of the intensive support service with the creation of new occupational therapy and psychology posts for this service. Within Norfolk there had been a temporary freeze in recruitment following the move to a new operating model with the expectation that all posts would be fully recruited by December 2026.

The trust had a successful ‘grow your own’ strategy to recruit to more difficult to fill posts and to give staff opportunities to progress their careers within HPFT. For example, by the introduction of Band 5 to Band 6 development posts for registered nurses and allied health professionals.

At the time of inspection, the overall sickness rate was level with the trust target rate of 4%. The overall unplanned turnover rate was 6%; this was lower than the trust target of 8%. The trust did not use agency staff and used bank or locum staff who knew people well to cover for vacancies, annual leave and sickness.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. The trust provided staff with mandatory training, an extensive programme of specialist training and professional development, team meetings, supervision and appraisal of their work performance. At the time of inspection, the compliance rate for clinical supervision was 94% and for appraisal was 99%. New staff, including bank staff and locums, were provided with appropriate induction.

Staff had received and were up to date with appropriate mandatory training. The overall training compliance was 96%. The mandatory training programme was comprehensive and met the needs of people and staff. Staff completed the Oliver McGowan Mandatory Training on Learning Disability and Autism with 99.3% of staff having completed this at the time of inspection.

Managers monitored mandatory training and alerted staff when they needed to update their training. Managers received a regular report showing compliance with mandatory training. This report included details of training that was soon to expire.

During the inspection, staff demonstrated how learning was translated into practice through comprehensive assessment and treatment, accessible communication, reasonable adjustments, proactive physical-health care, multidisciplinary formulation, trauma-informed and least restrictive approaches, early intervention and collaborative work with families, carers, providers and mainstream services.

We scored the service as 3. The evidence showed a good standard. The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service effectively assessed, managed, and controlled infection risks, taking prompt action to prevent the spread of infection and sharing concerns with relevant agencies when required.

Staff followed infection control policy (IPC), including handwashing. Masks and hand gel were available, and staff followed personal protective equipment guidelines.

Staff maintained equipment to a good standard, ensuring it was clean and appropriately labelled with in-date cleaning stickers.

Infection prevention and control principles, including hand hygiene, were consistently followed, supported by the trust’s infection prevention and control governance policy. Managers regularly undertook infection control audits and took action to follow up any concerns identified.

At the time of inspection, staff training compliance was 98.5% for Level 1 and 97.7% for Level 2 Infection Prevention and Control.

We scored the service as 3. The evidence showed a good standard. The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely.

Staff reviewed each person’s medicines regularly and provided advice to people, families and professional carers about their medicines.

Staff completed medicines records accurately and kept them up-to-date.

Staff stored and managed all medicines and prescribing documents safely.

The service ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines.The service worked towards achieving the aims of STOMP (stopping over-medication of people with a learning disability, autism or both).Staff undertook structured medication reviews aligned with STOMP principles, with side effects, ongoing clinical indication and opportunities for deprescribing reviewed, in collaboration with the MDT.

Staff reviewed the effects of each person’s medication on their physical health according to NICE guidance.Clozapine and depot (slow release medication) clinics were well developed and staff worked proactively to engage with people. Staff completed extra health checks for people with co-morbid severe mental illness (SMI) taking psychotropic medication.

Clinic rooms were clean, temperature controlled, with appropriate secure medicines storage facilities. There was access to emergency medicines. Medicines, including controlled stationery such as FP10 prescription pads (an FP10 prescription is the official NHS prescription form used in England by authorised prescribers to order medicines or appliances for supply to patients in primary care settings), were stored safely and securely. We saw evidence that staff had safe processes in place for transportation of medicines to people’s homes.

The Medicine Safety Oversight Group met regularly, reviewed audits, medication safety reports and safety data, including medicine incidents and national safety alerts, and ensured action plans were implemented.