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

Well-led – 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 inspection we rated this key question as good. At this inspection the rating has improved to outstanding. This meant service leadership was exceptional and distinctive. Leaders and the culture they created drove and improved high-quality, person-centred care.

This service scored 93 (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 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 trust had a clear, compelling and shared vision, strategy and supporting objectives that responded proactively to the changing needs of its population and communities. These were co-produced with staff, people and those close to them, and community partners. The vision, strategy and supporting objectives were well-understood, owned and embedded across the service.

The strategy delivered measurable improvements in population health, access to care, and people’s experience and outcomes, including demonstrable reductions in health inequalities. Equality, diversity and inclusion were embedded as core strategic priorities

Strategies and plans were fully aligned with those of the wider health and care system and actively shaped it. The service played a strong role within the system. Through effective collaborative working with system partners and local stakeholders, the service contributed to shared priorities and continually improving outcomes.

Staff knew and understood the trust’s vision and values and how they were applied in the work of their team. Staff told us the trust’s core values were ‘Welcoming, Kind, Positive, Respectful, and Professional.’ Staff were enthusiastic and passionate about advocating for people with learning disabilities and demonstrated the trust values in their work. Staff were proud of the service and consistently reported high levels of engagement, pride and trust in leadership. They told us the service was an inclusive, supportive and empowering place to work.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing, through regular team meetings, staff development days and ‘Making Services Better’ meetings. Senior leaders, including members of the executive team visited the services regularly and staff described them as supportive, approachable, and responsive.

All the staff we spoke with, without exception, told us they felt respected, supported and valued. They said the trust promoted quality improvement and provided excellent opportunities for learning, development and career progression. Staff told us they could raise any concerns without fear and would have no hesitation to do so.

We scored the service as 4. The evidence showed an exceptional standard. The provider had exceptionally 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 always did so with integrity, openness and honesty.

The trust leadership teams were well-established and worked effectively together.

Leaders had the skills, knowledge and experience to perform their roles, they had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

There were comprehensive and successful leadership strategies to ensure and sustain their delivery. Leaders used analyses of evidence from feedback from staff, performance data, and lived experience to develop them. There was strong collaborative team working and support across all functions. Staff were engaged, empowered and united by shared values, with a clear sense of belonging and a common focus on improving the quality of care and people’s experiences.

Leaders actively created and sustained a culture of psychological safety, where staff felt confident to speak up, challenge and innovate. Leadership behaviours demonstrably enabled continuous improvement and high levels of staff engagement and morale.

All the staff we spoke with told us leaders were approachable, supportive and fully engaged with staff. Managers said they found their senior managers to be extremely supportive. Staff highlighted effective communication from the trust senior leadership team including the visibility and presence of the chief executive officer (CEO) and other trust executives. One staff member told us the CEO visited and always remembered people’s names which made staff feel valued and that they mattered no matter what their role was within the trust

Staff development was supported through access to further training and courses. Staff we spoke with reported that the provider offered excellent opportunities for ongoing learning and professional development and progression into leadership roles.

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

The trust had a Freedom to Speak Up policy, which emphasised thatall employees should feel comfortable raising concerns and sharing suggestions for improvement.The service had 2 Freedom to Speak Up Guardians (FtSUGs) and had 49 Freedom to Speak Up Champions. The FtSUGs fed themes into governance and cultural improvement, facilitated reflective sessions and wellbeing initiatives, contributed to induction and trainingand collaborated with leadership to embed learning into practice.

In the 12 months prior to the inspection, there were 9 concerns raised with the FtSUGs - themes included bullying or harassment, staff safety or wellbeing and other inappropriate attitudes or behaviours. Of the 9 cases received in this period, 6 were closed and 3 were ongoing.

As part of ongoing work to increase visibility and raise awareness of the Speaking Up process throughout the trust, the FtSUGs had visited many of the community teams in the 12 months prior to inspection as well as attended team meetings virtually. Following the visits any issues raised by staff were escalated to the divisional director.

Staff could also raise concerns through alternative routes such as a 24-hour confidential whistleblowing hotline or through an anonymous submission to the electronic incident recording system. All the staff we spoke with told us they felt fully confident in speaking up and in raising concerns or making suggestions for improvements without detriment.

People using the service and staff could meet with members of the trust’s senior leadership team to give feedback.

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

The trust provided 6 staff networks which reflected the diversity of the organisation: Black and Minority Ethnic staff, Mental Health, Women, Disability, Lesbian, Gay, Bisexual and Transgender (LGBT) staff, and Carers. The networks offered opportunities for staff to connect with other people, share information and ideas, and receive support.

The trust employed a diverse team of staff from international backgrounds. Employment practices promoted equality of opportunity. Managers said the service did not discriminate against staff from minority groups. Staff did not raise any concerns about discrimination.

The Health Access Champions (HAC) demonstrated the trust's commitment to employing people with learning disabilities in meaningful paid roles. HACs brought valuable expertise, increased diversity within the workforce and promoted equality and inclusion. The trust developed comprehensive support structures including competency frameworks, supervision arrangements, wellbeing support, reasonable adjustments and workforce development plans to enable success in employment.

Staff were able to apply to work flexibly, for example, flexible working agreements to account for personal circumstances such as caring responsibilities and health issues.

Managers put reasonable adjustments in place for staff members to help them carry out their role. For example, pregnancy risk assessments, flexible working agreements and occupational health referrals.

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 provider 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.

Our findings from the other key questions demonstrated that governance processes operated extremely effectively at team level and that performance and risk were managed very well. Governance arrangements were proactively reviewed and reflected best practice. The exceptional leadership, culture and robust governance were used to drive and improve the delivery of high-quality, person-centred care. The service systematically monitored standards of care to continually improve outcomes for people.

Governance systems were inclusive and empowering, enabling staff at all levels to identify risks, raise concerns and contribute to improvement. The service demonstrated a learning-focused governance culture, where insight from staff, people who use services and partners informed action and improvement.

Leaders were assured of the service’s performance through excellent analysis of quantitative data, qualitative insight, audit, lived experience and external assurance. Focus was on patterns, trends and root causes rather than isolated metrics, and this intelligence was used to challenge, learn and improve.

Managers carried out an extensive programme of audits to monitor areas such as care and treatment records, physical health checks, medicines management and staff supervision and appraisal. We saw how high-quality governance processes and audits were embedded within the service to ensure that high quality care could be sustained into the future.

Staff held a range of scheduled governance meetings overseen by an integrated governance committee using structured agendas, which included, patient safety and incident learning, workforce and training matters and quality improvement activity. We looked at the minutes for the previous 3 months of meetings and could see the agendas were comprehensive, areas of concern were identified, and actions were RAG rated to indicate any requirement for action to improve service user and carer experience, clinical effectiveness and/or patient safety.

Staff had implemented recommendations from reviews of incidents, complaints and safeguarding alerts. For example, staff had thoroughly reviewed policies and procedures following a person having a weapon in the community and made changes as a result.

Staff maintained and had access to local risk registers which 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 local and divisional Quality and Risk Meetings. Examples of risks were, lack of appropriate social care placements for people with high support needs, an increase in referrals for people who did not have specialist healthcare needs related to learning disabilities and the risk of violence and aggression.

The trust had business continuity plans for emergencies – for example lack of water, gas leakages, outbreaks of infectious diseases or adverse weather.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system worked well and helped to improve the quality of care.

Managers had access to information to support them with their management role. Dashboards included information on the performance of the service, staffing and care.
 

We scored the service as 4. The evidence showed an exceptional standard. The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

Staff worked closely with system partners to coordinate care, reduce health inequalities and advocate for people with learning disabilities across organisational boundaries. This included direct clinical liaison with acute hospitals, primary care, mainstream mental health, maternity, pharmacy and specialist services. The trust had joint operational arrangements with local authority social care, commissioning and safeguarding teams; and strategic engagement through Integrated Commissioning Board forums, multi-agency networks and health improvement groups. Staff were involved in shared referral and allocation decisions, joint assessment, care and treatment reviews, transition planning, medication review with GPs, discharge coordination and multi-agency risk management.

Trust services were a key element of the NHS Transforming Care Programme, they worked closely with local authority and Integrated health and commissioning teams and were closely engaged in the Dynamic Support Register functions. The trust were also members of the All-Age Big Plan (learning disabilities strategy) for Hertfordshire. We sought feedback from external stakeholders - commissioners in Buckinghamshire, Hertfordshire and Essex highlighted collaborative working as a key strength, with responsive communication at both operational and management levels, strong multi-disciplinary partnerships, and a shared focus on achieving positive outcomes for adults. Essex commissioners also identified other key strengths, including a passionate workforce, a proactive approach to multi-disciplinary working, timely crisis interventions, openness to joint initiatives and responsive senior management when concerns were raised. However, a Norfolk external stakeholder told us, the shared multidisciplinary approach to positive risk-taking, communication and joint governance needed further development and strengthening within Norfolk, acknowledging the trust had only recently started providing community services and the service was still undergoing a redesign.

In Norfolk, staff escalated concerns following 3 serious emollient-related fire incidents, including one fatality (emollient creams and lotions can soak into clothing, bedding, and bandages, turning dried fabric into a dangerous fire hazard). Staff helped establish a multi-agency working group with the County Council, Integrated Care Board, LeDeR (Learning from lives and deaths – people with a learning disability and autistic people) and Norfolk Fire Rescue Service. Outcomes included amended nursing health assessments, GP and provider awareness-raising, an easy read fire safety resource, improved links with Fire Rescue and strengthened care planning. The group received Norfolk Fire Rescue's 'Partnership of the Year' award in October 2025.

A community nurse in Norfolk led the development of the first fully integrated antenatal pathway for women with learning disabilities in England, bringing together all statutory services involved during pregnancy under a single coordinated framework. The project originated from evidence that the needs of prospective parents with learning disabilities were being identified too late in pregnancy, leading to poorer outcomes. The nurse won a research fellowship to develop the pathway further and was a Nursing Times Awards finalist in 2025.

We scored the service as 4. The evidence showed an exceptional standard. The provider 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.

As the largest provider of learning disability services nationally, the trust played an active role in advancing and shaping best practice locally, nationally and internationally. For example, the trust hosted theRADiANTnetwork which was founded with participation from 12-13 NHS Trusts. The network focused on 5 neurodevelopmental conditions- learning disability, autism, ADHD,epilepsyand brain injury and aimed to promote research, stafftrainingand public education.As part of its core function,RADiANToffered afree 2 hour continuing professional development programme every month which staff could attend live orwatch arecording later.

The trust participated in accreditation schemes relevant to the service and learned from them. The trust participated in the Quality Network for Learning Disability Services (QNLD) accreditation programme. The QNLD, led by the Royal College of Psychiatrists, aims to improve learning disability services. At the time of inspection, the teams in Essex, Hertfordshire and Buckinghamshire had all successfully gained accreditation.

Staff across the trust were actively encouraged and supported to get involved in quality improvement (QI) and innovation projects to constantly improve the services offered to people with learning disabilities. We saw many examples, including a project led by Intensive Support Team nursing staff, focused on promoting bone health for people with learning disabilities who take anti-seizure medication and a physiotherapist-led project implementing a dedicated postural clinic to address an inequality in service, aligned with the Association of Chartered Physiotherapists for People with Learning Disabilities (ACPPLD) standards. These standards advise routine monitoring and review, to address the risk of secondary complications from poor posture through proactive monitoring rather than reactive referral.

In Essex, occupational and nursing staff co-produced a therapeutic programme called Fishing for Health (F4H) which used supported fishing and outdoor activity as a vehicle for assessment, intervention and community inclusion in non-clinical settings. The programme offered people access to green space, meaningful occupation and social connection that may otherwise have been unavailable to them. The model aligned with the Transforming Care agenda by supporting wellbeing, building coping strategies and reducing factors that contribute to mental health deterioration and avoidable admission. F4H was shortlisted for the Health Service Journal Mental Health Innovation of the Year Award in 2023.

Staff had undertaken and published a range of research in national publications. For example, in Essex, the enhanced physical health care clinic (EPHC) had been the recipient of several awards and staff had contributed to many academic publications. Staff had been able to research several specific health conditions, including cancer, hypothyroidism prevalence, and cardiovascular risks. This research indicated that the EPHC had increased uptake of several important screenings for a group vulnerable to health inequalities, including cancer screening, and picked up people vulnerable to cardiac events.

The trust supported the National Institute for Health and Care Research funded PETAL study: Personalised Treatment packages for Adults with Learning Disabilities who display distress presenting as aggression to others in community settings. This aimed to develop a personalised, multi-component approach and evaluate how adults with learning disabilities who experienced distress through aggression to others respond to PETAL therapy alongside usual care. The trust supported 20 people from community learning disability services to take part in the PETAL study.

We saw many other examples of published research including articles related to the clinical utility of a short ADHD assessment tool, the experience of carers from ethnic minority backgrounds, improving the participation of people with learning disabilities in elections, homelessness following prison release, the omission of people with learning disabilities from the NHS 10 year plan and a systematic review of easy read health information for people with learning disabilities.

Staff from the trust had won several national awards, for example, in 2025, the Mid-West Essex psychiatry team were named best psychiatric team of the year: Intellectual Disabilities at the Royal College of Psychiatrists awards.