Our strategy

Who we are and what we do

The population we serve

Since 2010 when Hertfordshire Community NHS Trust, or HCT as we are commonly called, was established, we have been rooted in Hertfordshire, serving communities across East and North Hertfordshire and South and West Hertfordshire. Across this area we deliver a wide range of community health services, working with partners to ensure that the 1.2 million residents have the care and support they need.

Over the last five years our reach has grown significantly, for example we now also deliver School Aged Immunisation Services and Child Health Information Services across the entire East of England (figure 1), with a population of 6.5 million, our services playing a vital role in preventing ill health and ensuring vulnerable children and young people do not slip through the net.

We are committed to reducing health inequalities and we know that geography, deprivation and other factors can create barriers to good health. Our presence across this wider region means we can reach more people who need us most, bringing high-quality community care closer to home.

Figure 1. NHS East of England region showing ICB boundaries (adapted from NHS Confederation).

 

Our population and its health

Whilst we provide services across the entire East of England area, most of our services are in Hertfordshire. Hertfordshire is often described as 'an affluent county with pockets of deprivation' – but this simple phrase masks a complex reality. Behind the statistics are diverse communities with very different experiences of health and healthcare.

We see this diversity every day. Our staff work in busy and thriving towns, remote rural villages, coastal areas, and in many of these areas families face significant challenges. They support people from different cultural backgrounds, with different languages, different health beliefs, and with varying levels of trust in health services.

Understanding this diversity is essential to our work; we cannot assume that a service designed for one community will work for another. Instead, we actively listen, adapt our approach, and work to reach those who might otherwise be left behind. This means tailoring how we communicate, where we deliver care, and how we make it easy for everyone to access the support they need.

The Hertfordshire population and its health

• 6% of the population have diabetes
• 14% of the population has a cardiovascular disease
• 6.25% of the population are living with frailty, most of who will have at least two long-term conditions
• 20% of year 6 students are obese, a trend that has consistently been rising over the last 15 years
• Consistent increase in pupils diagnosed with special educational needs (SEN), expected to reach 20% by 2030
• Higher percentage of 0-4 year olds attending A&E than regional and national averages
• Total population has grown by 8% since the 2011 census
• Our population is getting older. 16% are over the age of 65 now, expected to increase to 24% by 2040
• 14 of 690 areas in Hertfordshire are in the most deprived 20% of areas in the country. 279 areas are in the 20% least deprived
• Life expectancy is 83 years — higher than the national average
• Healthy life expectancy ranges from 56.9-75.5 years
• Hertfordshire is becoming more diverse. In 2021 28.2% of residents identified themselves as being from an ethnic minority, compared with 19% in 2011.

 

Our Trust in numbers

• 842,000 contacts with adults per year,
• 405,000 children and young people contacts per year
• Almost 9,000 patients cared for virtually through our Hospital at Home service each year
• Over 1.7 million vaccinations delivered per year
• Register over 80,000 births per year
• 2,900 staff across Adults, Children’s and Corporate Services
• Care provided from 50 sites (and thousands of patient’s homes)
• Consistently 94% of patients responding to the NHS Friends and Family Test say their experience of HCT services was good or very good
• Annual income of £180m
• 667 GP surgeries we support to record vaccinations

 

Our people and our culture

None of this would be possible without our staff. They are the heart of our organisation – bringing skill, compassion, and commitment to every interaction.

We are proud of the culture we have built together. Our results have improved each year for the last few years and our 2024 NHS Staff Survey results show that HCT is a place where people feel valued, supported, and able to speak up. Some highlights include:

 

• 75% of staff would recommend HCT as a place to work – significantly above the national average of 60%
• 85% agree that care of service users is our top priority – placing us in the top 20 organisations nationally
• We ranked second in England for staff retention and job satisfaction (staff saying they were not thinking about leaving the organisation)
• 76% feel safe to speak up about concerns – the sixth highest score among all 263 NHS Trusts
• In the top 2% nationally for access to learning and development opportunities.

 

These results reflect our unwavering commitment to supporting our people. When staff feel valued and empowered, they provide better care. When they can develop their skills and speak up without fear, our services improve. When they want to stay with us, our communities benefit from their expertise and continuity of care.

We know these figures tell only part of the story and behind each statistic are individual experiences – and not all of them are positive. Some colleagues face challenges we need to address or have experiences that fall short of our aspiration to make HCT a great place to work for everyone. We are committed to understanding these differences and creating a workplace where everyone can thrive. This strategy sets out some specific actions for how we will do that including continuing to support our Shadow Board and staff networks, rolling out our anti-racism leadership programme and events to actively celebrate the diversity within our organisation.

 

Our partners

We work collaboratively, continuously striving to strengthen our partnerships and develop new ones so that we can provide care, as a whole health and care system, in a way that best supports our population. Our partners come from a variety of sectors, including health and care, education and the third sector, as shown in figure 2.

Partners by type

NHS	Health and care	Education	Government	Voluntary, Community, Faith and Social Enterprise	Other
Integrated care boards (ICBs) Acute trusts Community and mental health trusts Ambulance trusts NHS England and East of England region	Health and care partnerships Primary care Healthwatch Patients and families Carers	Universities Schools Colleges	County and borough councils Central government	Charities Hospices Faith groups	Trade unions Regulatory bodies Corporate and comercial companies

Figure 2. Variety of parthers we work with.

 

We work with a wide range of organisations and, at a local level, a vast number of GP practices and schools to support the health, wellbeing and education of our population. This includes:

• 667 GP surgeries across the East of England
• Approximately 500 primary schools and 150 secondary schools in Hertfordshire
• 25 Special Educational Needs schools across Hertfordshire.

As with all aspects of what we do, we take a continuous improvement mindset to partnership working and have honest and self-reflective discussions at Trust Board and Board sub-committees. We seek to be a proactive, engaged and supportive partner, however we know that there is variation in partners' experience of us. Going forward, we want to ensure the voice of primary care has greater strength within our governance processes. This strategy puts partnership working as one of our core strategic aims.

Hertfordshire Community NHS Trust is a specialist community provider. We treat people where they live – in their own homes, care homes and community centres. Crucially, we see ourselves as part of those communities.

We believe that only by understanding what our communities need, their hesitations and concerns, and their lived experiences of care can we deliver services that truly meet their needs and actively reduce inequalities.

Our staff occupy a privileged position. They are invited into people's homes during life's most significant moments: welcoming a new baby, supporting families managing long-term conditions, or guiding people through challenging times following injury or illness, and as they approach the end of life. These connections give us unique insight and the opportunity to make a real difference.

Specialist community services have the power to unlock transformational change across the entire healthcare system, improving experiences and outcomes for everyone we serve. Over the past five years, we have responded with agility and creativity to recover from the COVID-19 pandemic, working hand-in-hand with system partners to address shared challenges. We are now integral to the urgent and emergency care sector, responding directly to 999 and 111 calls. Our Hospital at Home service has significantly expanded access to hospital-level care for people in their own homes.

As we look ahead, we will maintain this agile, responsive approach. We will use our skills and unique position as a specialist community provider, working in partnership to drive the improvements needed to meet current and future challenges – and to continuously enhance the care we provide to our population.

As the reorganisation of the NHS takes shape, we have recently moved into the new Central East Integrated Care System, where we intend to actively and enthusiastically support their strategic commissioning intention:

“We will focus on shifting our system toward prevention, early intervention and investment in programmes that reduce avoidable healthcare utilisation, spend and environmental degradation”

 

How we have developed our strategy

We have developed our strategy through conversations with our staff, our service users and our partners, focussed on considering the following questions:

• What does our population need from us now, and in the future?
• How can we, as a specialist community services provider, meet the needs of our patients?
• What do our partners need from us, and how can we support the broader health and care system so that together we can provide sustainable, high quality care?
• How can we make sure that HCT is a great place to work, and that our staff are happy, well trained and supported, to deliver outstanding care for the people we serve?

 

We have followed a structured strategy development process, to ensure our plans for the future are grounded in evidence, directly respond to the challenges we face, national and local priorities, and the opportunities that we can realise.

Insert development process

Understanding our stakeholders: how we codesigned our strategy

Our approach to developing this strategy was built on a fundamental belief: the best strategies emerge from genuine engagement and co-creation with the people who matter most – service users, our staff and partners. Their insights, lived experiences, and ideas have shaped every element of this strategy.

Staff engagement

• Two dedicated staff strategy development groups met regularly throughout the process – one for representatives from our staff networks and Shadow Board, and another open to all HCT staff members. These groups provided crucial space for in-depth discussion and helped us test and refine our values and strategic aims.
• 64 teams participated in our ‘meeting in a box’ initiative, representing adult, children’s and corporate services. Team leads facilitated discussions using ready-to-go packs, exploring how we could improve patient care and the working lives of for our staff. This generated over 300 responses, with some teams providing collective input.
• Staff forums provided the context for strategy conversations, with discussions embedded into All Staff Conversations, Leaders Forum and our Essential Leadership Day.

 

Service user engagement

• Patient representative groups helped us understand diverse needs. We attended forums and surveyed organisations including Healthwatch, Citizens Advice East Herts, the ADD-Vantage ADHD support service, Carers in Hertfordshire, Herts Vision Loss and One Vision to learn how we can better support the communities they represent.
• Direct conversations with service users and carers took place including the Young Carers Forum, where we heard firsthand from people whose lives are touched by our services
• We made it easy to share views using social media and QR code posters at our sites to invite individual service users to tell us what matters to them and how we can improve.

 

Partner engagement

• Every key partner was invited to shape our direction. We mapped our partnership landscape and sought views from all partners across healthcare, social care and education, about our priorities and opportunities to collaborate more effectively.
• Engagement was tailored to build meaningful dialogue, combining surveys with one-to-one conversations. Our Chair held dedicated meetings with primary care clinical directors to ensure local clinical leadership voices were heard.

 

The themes, priorities, and initiatives in this strategy and our new organisational values, are rooted in hundreds of conversations and reflect what our stakeholders told us matter most. Their voices have shaped what we will do, and how we do it over the coming years.

 

Building on our 2020-2025 strategy

The past five years have tested us in ways we could never have anticipated. The COVID-19 pandemic transformed how we worked, who needed our care, and what communities expected from us. Our staff rose to every challenge – adapting services overnight, supporting frightened families, and keeping our most vulnerable residents safe.

In our 2020-2025 strategy, we set ourselves eleven ambitious outcomes. We are proud to have made significant progress against every one – and in many areas exceeding what we thought possible. Our progress falls into three areas that will shape our future direction:

 

1. Delivering excellent care

We maintained focus on quality even during the most challenging times. Over 95% of patients rated their experience of our services as good or very good, and we consistently exceeded national targets for urgent community response services. We established rigorous outcome measurement across our services – over 90% now have both clinical and patient-reported outcome measures, providing clear evidence of the difference we make.

Moving forwards, we know we can do better. Too few people respond to our feedback requests, which means we are not hearing from everyone about their experiences. Our new strategy prioritises reaching those voices we are missing.

 

2. Innovating to meet changing needs

When the pandemic hit, we proved our ability to move quickly and think differently. We pioneered new pathways to deliver acute-level care at home – treating conditions like pneumonia in people's own homes when they would previously have spent days in hospital. We designed and launched the East and North Hertfordshire Hospital at Home service and established our Urgent Care Coordination Hub for Hertfordshire and West Essex with the East of England Ambulance Service.

We embraced digital technology – from robotic process automation for referrals to new dental scanner technology for people who cannot travel to clinics. These innovations not only made us more efficient, they also improved access for people who had previously struggled to get the care they needed.

We invested in protecting our climate and the health of future generations. We installed LED lighting and solar panels across our sites, trialled heat pumps, and reduced our carbon emissions by 19% during this strategy period. This commitment was not an add-on – it was backed by dedicated executive leadership and ring-fenced capital funding, demonstrating that sustainability is integral to how we deliver care.

 

3. Creating a workplace where people thrive

Our most recent staff survey placed us second out of 263 NHS organisations for staff who rarely think about leaving, and in the top 2% for access to learning and development. 75% of our staff would recommend HCT as a place to work – well above the 60% national average.

These results reflect deliberate choices. We became the first NHS Trust to establish a Shadow Board, ensuring diverse voices could scrutinise our decisions at the highest level. We invested heavily in speaking-up culture and staff development. We focused on reducing inequalities in how different groups experience working at HCT.

But good is not good enough. Some colleagues still face barriers and challenges. Some groups report poorer experiences than others. Our new strategy commits us to addressing these gaps.

Allied health professionals at the Queen Victoria Memorial Hospital

 

The foundation for our future

These achievements demonstrate what we can accomplish when we stay true to our values, listen to our communities, and empower our staff to innovate. They also reveal where we need to focus next: improving access, hearing from more service users, reducing waiting times, and ensuring every member of staff has an excellent experience at HCT.

Our 2025-2030 strategy builds directly on these lessons. It maintains what works, addresses what needs to improve, and positions us to meet the challenges ahead.

 

Why are we developing a new strategy now?

Whilst our last strategy had run its course, we could have chosen just to extend it. However, our Trust Board decided it was the right time to develop a new strategy as the context in which we operate and the opportunities we have in front of us have materially changed over the last few years.

The NHS 10-year plan does not just mention community care; it is largely built on it. The three ‘big shifts’, hospital to community, sickness to prevention, and analogue to digital, position community services as the solution to some of the system’s greatest challenges.

Through the lifespan of our last strategy, we have proved that we can deliver care that in previous years was only ever possible within a hospital. We can deliver this care efficiently and with excellent outcomes and experiences for patients.

In addition, technology has now enabled what was previously impossible. AI, predictive analysis and remote monitoring mean we can identify people at risk before they deteriorate, deliver sophisticated care at home, and manage complexity in community settings. We can deliver the proactive, preventative care model that communities need, and this strategy sets out how we can do it.

 

Strategic challenges and opportunities

We have examined our population's changing needs, the evolving health and care system, what our stakeholders tell us, and the financial realities we face. This honest assessment reveals significant challenges – but also exciting opportunities to transform care for our communities.

 

The challenges ahead

Growing demand and changing demographics and needs

Hertfordshire's population is growing rapidly – reaching by 2025 the growth we had anticipated for 2040. The nature of that population is changing too. By 2040, we will have 50% more people aged 65+ and 80% more people aged 85+. More people are living with long-term conditions, often multiple conditions at once. Currently, 62% of people living with frailty also manage at least two long-term conditions. This multi-morbidity means people often navigate multiple services and appointments – a fragmented experience when they need coordinated, holistic care.

For children and families, the picture is equally stark. The number of children with Special Educational Needs has risen sharply – from 28,000 in 2015 to 38,000 in 2023, with 46,000 expected by 2030. That is one in five school-aged children. Childhood obesity remains a persistent challenge, affecting 8.5% of 2-year-olds in Hertfordshire, rising to 18% in Reception and 31% by Year 6. These rates are consistently higher in areas of greater deprivation. Our teams, especially Public Health Nursing, have an essential role in supporting children and families to have a healthy weight, and live happy and healthy lives.

The simple truth is that demand for our services is high and rising. We can only maintain the quality of care our communities deserve if we work differently.

 

Health inequalities remain unacceptably wide

In Hertfordshire, there is a 13-year gap in life expectancy between different areas, with those in more deprived areas experiencing poorer health outcomes. The difference in healthy life expectancy is even starker: some areas average 8 years of self-identified poor health, while others endure 19 years.

Deprivation drives much of this inequality, but not all of it. Gypsy, Roma and Traveller communities, looked-after children, people with severe mental illness, and people from LGBTQ+ communities all experience poorer access and outcomes. We can narrow these gaps through working with local partner and community groups – but only if we truly understand what drives them. That means engaging directly with communities, listening to community leaders, and designing services around what people tell us they need, not what we assume they need.

The NHS Core20PLUS5 framework, which identifies priority areas for action on inequalities, was published in 2021 and many areas of inequality have widened further since then. Our strategy seeks to embed reducing inequalities across all our services and focusses specific high-impact initiatives for example, on oral health checks and children with asthma.

 

Workforce challenges threaten our ability to deliver

We are proud to be a great place to work, but national recruitment shortages affect key professions including children's therapists and audiologists. Our location on the edge of London creates additional pressures – professionals are often drawn to the capital's higher pay supplements, and we face challenges retaining staff once they are qualified and experienced.

We also do not yet fully reflect the diversity of the communities we serve. People from some ethnic minority backgrounds remain under-represented, particularly at senior levels. If we want to truly understand and meet our population's needs, our workforce must represent that population.

As we care for more complex patients within the community, we have the challenge of extending the skills of our staff and asking many of them to work in a different way to how they have worked in the past.

 

Financial pressures demand greater efficency

Like every NHS and public sector organisation, we operate in an extremely challenging financial context. We must increase productivity and healthcare utilisation year-on-year while maintaining quality and meeting growing demand. This is not optional – it is essential for our sustainability and our responsibility to deliver value for the public purse.

Evidence shows NHS productivity has decreased in recent years. Our data shows variation across services – some are highly efficient, whilst others have room to improve. Where we do have a real strength is in our extensive data that can show us exactly where we can improve. Through our business information systems, we can compare current and past performance across services and benchmark ourselves against similar providers.

This data-driven insight is our advantage. We know where the opportunities lie. Through continuous improvement, better use of digital technology, and smarter processes, we can increase productivity and deliver better value for money while simultaneously making things better and easier for staff and service users. Efficiency, quality and expanded community capacity are not competing goals; they are interdependent and essential to our future.

The NHS is committed to moving care closer to home – the ‘left shift’ from hospitals to community settings. However, currently there is no significant additional investment to fund this transformation. We must work with partners in our health and care partnerships to find ways to release funded capacity from hospitals to reinvest in providing more care closer to home. This means demonstrating that community-based care delivers excellent outcomes and value for money, making the case for reinvestment compelling and evidence-based.

 

Our opportunities

These challenges are real, but do not define us. Within each challenge lies an opportunity to do things differently – and better.

Leading the shift to community-based care

The NHS 10-year plan emphasises moving care out of hospitals and into communities. This is where we excel. We have the expertise, the relationships, and the reach to work with partners to lead this transformation in the areas we serve. Care delivered in people's homes and neighbourhoods is not only better for patients and families, it is more cost effective and better use of public funds. The plan also emphasises neighbourhood-level services, tailored to local needs. This is our opportunity to work with partners to design and deliver truly local care.

 

Delivering high quality patient care through effective partnerships

As core members of our health and care partnerships, we can break down the barriers that frustrate patients and families. Too often, people experience care that is organised around organisational boundaries rather than their needs. We can work together to design pathways that are easier to navigate, joining up services so that people experience care as a coherent whole rather than disconnected episodes.

 

Harnessing technology and data

Technology is advancing faster than ever, and we have already shown we can use it effectively – from robotic process automation to AI-driven solutions. We can do more, and faster, to harness technology for better patient outcomes, enhanced staff experience, and increased efficiency.

The NHS 10-year plan envisages an exponential increase in the use of wearables, remote monitoring and other technologies to expand healthcare into people’s homes. We see significant opportunity here, particularly in preventative care where we can use predictive data analysis and remote care capabilities to identify patients at risk of deteriorating and intervene early to prevent an urgent, emergency or crisis situation.

We also have a wealth of untapped data. Within HCT, we hold extensive information about our services, activity, demographics, inequalities, and workforce. Used well, this data can show us exactly where improvements are needed. Beyond our own data, we can work with partners and commissioners to use population health data more strategically – differentiating our service design to match the specific needs of each community we serve. This can be done at a very local level, with data now available for us to work with partners to understand, at a neighbourhood level, what communities need from us, who is using our services and how we can improve integration, outcomes, experiences and healthcare utilisation.

 

Prioritising prevention at every stage

Prevention must be at the heart of everything we do. It is the only sustainable way to meet rising demand while improving health outcomes.

We already deliver prevention across the life course – health visiting, school nursing, immunisations, frailty care, physiotherapy, rehabilitation. But we can do more. We can empower residents to care for themselves and their families through better advice, support, and public health messaging. We have a fundamental role across all three types of prevention:

 

1. Primary prevention – stopping problems before they start. As the provider of immunisation and child health services across the East of England, we support the health and life chances of millions by delivering vaccinations effectively and creatively, reaching every child regardless of background or circumstance, and overcoming damaging and increasing vaccine hesitancy.

2. Secondary prevention – catching issues early. We can do more to support people with long-term conditions who are beginning to deteriorate. Several of our services, such as our Hospital at Home service, Integrated Community Teams and Diabetes Service, already do this well; preventing avoidable hospital admissions and getting people the care they need before they reach crisis point. Expanding this work will keep more people safely in their own homes.

3. Tertiary prevention – managing conditions to prevent deterioration. Our rehabilitation services, including community inpatient units, enable earlier discharge from hospital and intensive rehabilitation programmes. This reduces the time frail and elderly people spend in hospital beds, where deconditioning often leads to permanent loss of independence.

 

Engaging communities as partners

Many of our services, such as our Children’s Asthma and Wheeze service working with the Traveller community to improve access to healthcare, have shown us what's possible when we work directly with communities. When we listen, adapt, and involve people in shaping services, we achieve better uptake, better outcomes, and better experiences. We want to embed this approach across all our services – actively seeking out seldom-heard groups, understanding their needs, and co-designing solutions. This will make our services more equitable, more effective, and more personal.

 

Leverging academic partnerships for innovation and improvement

Our strong relationships with the University of Hertfordshire, the University of East Anglia, and other academic institutions open doors to research opportunities, student placements, curriculum planning, and a steady pipeline of future staff. These partnerships can drive innovation and ensure we remain at the forefront of evidence-based practice.

 

Strengthening our role as an anchor institution

We are a major employer in Hertfordshire and a significant part of the local economy. As an anchor institution, we have both an opportunity and a responsibility to support our local community – through employment, procurement, environmental action, and social impact. We can do more to fulfill this role.

 

Embedding our quality management system to drive improvement of service quality and operational efficency 

As we embed our Quality Management System across HCT, we have a powerful tool for driving improvement. By using structured improvement methodology, we can enhance service quality, increase operational efficiency, and create more sustainable ways of working – all while delivering better care for our population.

Our vision — Outstanding care, healthier communities

Our vision reflects both continuity and evolution. We remain absolutely committed to the principles that have guided us over the last strategy – putting patients, their families, and carers at the centre of everything we do, but have sharpened our focus on what matters most: the quality of care we provide and the health of the communities we serve.

 

We exist for one reason: to care for the people who need us. Every decision we make, every improvement we pursue, every interaction we have must start and end with a simple question: "Is this right for the people we serve?" Asking this question is fundamental to our purpose, and it demands that we never lose sight of the privilege and responsibility of being invited into people's lives at their most vulnerable moments.

 

This is why we are here; to provide outstanding care that makes a genuine difference when people need us, at any stage of life. It means a health visitor who spots the signs that a new parent is struggling. A physiotherapist who doesn't just treat a knee but understands how that injury is stopping someone from working, caring for their family, or living independently. A nurse who takes the time to really listen when someone's words say one thing, but their body language says another.

 

We want every person who uses our services to feel seen, heard, and valued. Their feedback should change how we work. Their experiences should inform every decision we make. Their outcomes should be what we measure ourselves against. When we truly deliver outstanding care, we don't just treat illness, we transform lives, provide comfort, and build healthier communities.

This strategy commits to putting patients, families and carers at the heart of everything we do, to deliver outstanding care and support healthier communities.

Staff receiving their HSJ Award for the FOLLOW initiative.

 

Our strategic aims

To deliver this vision, we have developed five strategic aims for our organisation, developed through extensive engagement with service users, patient representative groups, our staff and our partners. These strategic aims respond directly to the opportunities created by the NHS 10-year plan and position HCT to lead the transformation of community healthcare in the areas we serve.

These aims describe what we feel are the most important areas for us to focus on over the next five years to respond to the opportunities and challenges that we have identified, to deliver outstanding care to those who use our services, and to work as an integral part of our local neighbourhood to improve and maintain the health and wellbeing of the population we serve.

For each of our aims we have identified what this means for our service users, what it means for our staff, and the difference we want to make.

We have tried to be both ambitious and realistic in this strategy. We have not included anything that we do not think is possible, or realistic. We have been deliberately ambitious, which means that some of what we have included will take more time and progress is unlikely to be easy or straightforward in every area. As we described previously in this strategy, we are part of a complex and interdependent health and care system, and much of what we have included within this strategy will involve working with commissioners and partners to ensure we collectively prioritise our resources.

Additionally, the prioritised actions we have included in this strategy will not cover everything that we do over the next five years. We have identified activities that we think will most strategically support us to achieve our aims, and these will start to shape our work immediately. However, our services are continually working to improve and evolve and this will not stop. Also, we know that things can change quickly and dramatically in the future and we will remain responsive with our plans.

 

1. High quality, equitable and sustainable care

We will deliver outstanding care that is safe, effective, and responsive to what people need – shaped by their voices and experiences. We will reduce waste, embrace innovation, and make the most of every resource, because sustainable and efficient services are the foundation of excellent care both now and for the future.

 

What this means in practice

For service users and families:

You will find our services easier to access and navigate, with reduced waits. You will not have to repeat your story multiple times or face unnecessary complexity when you need support from different teams. Your care will feel joined up, and your voice will genuinely shape how we work.

 

For us:

We will fundamentally shift how we organise care – coordinating around patient needs rather than our structures. Our staff will work in services that are well-organised, efficient and free from unnecessary waste and the voice of our patients will be embedded and central to everything we do.

 

For our partners:

We will work together to create seamless pathways between our organisations, release capacity to enhance prevention and shift more care into community settings. We will eliminate duplication and always ask “how does this feel for the person using our services?” Together, we will build a system where resources go further, outcomes improve, and no one falls through the gaps.

 

To deliver this objective we will prioritise the following actions:

Improving access and coordination and reducing waits

• Reduce waiting times for services currently exceeding national standards or commissioned targets.
• Remove barriers to access by reviewing and improving opening times, locations, outreach approaches and how people can contact and use our services.
• Redesign pathways for adults and children with complex needs or multiple long-term conditions, ensuring their care is coordinated rather than fragmented, with a single coherent plan that makes sense to them.
• Prioritise resources and waiting lists to actively reduce inequalities, ensuring those who face the greatest barriers get equitable access to high-quality care.
• Continuing to improve the support available for neurodivergent children and young people, so they have the support available to live their lives, to thrive and engage with school.

 

Maximising efficiency and value

• Improve productivity and efficiency across all services through redesigning care models and processes, digital innovation and data-driven decision-making, releasing more time for direct patient care.
• Improve utilisation of outpatient capacity, including flow though our neighbourhood care service, including Hospital at Home, and significantly reducing missed appointments (did not attend (DNA) /not brought in (NBI)).
• Maximise opportunities to deliver acute-level care to people in their own homes when this delivers better outcomes and experiences.
• Continue strengthening our pivotal role in urgent and emergency care pathways, relentlessly seeking new and improved ways to prevent avoidable ambulance conveyances and hospital admissions.
• Embracing research opportunities to identify ways we can improve care and pioneer new services.

 

2. Driving proactive and preventative care

We will embed prevention throughout all our services, supporting residents to stay healthier for longer, protecting their wellbeing, and reducing unnecessary hospital admissions and crisis situations.

What this means in practice

For service users and families:

You will receive earlier intervention, tailored advice, and care that helps prevent illness or injury before it happens. We will support you to stay healthy and independent for longer, avoiding unnecessary hospital visits.

For us:

Prevention will be a core part of what we do – embedded in every service we deliver. We will use data and evidence to target support where it makes the greatest difference and empower our staff to make every contact count.

For our partners:

We will work together to strengthen prevention across entire pathways, aligning public health and community care efforts. Together we can improve population health and manage the growing demands from an ageing population sustainably.

 

To deliver this objective we will prioritise the following actions:

Support our communities to improve and safeguard their health and wellbeing

 

• Empower residents to take control of their health, through improved self-care and public health messaging, helping families and parents prevent avoidable hospital attendances.
• Increase vaccine uptake by improving our messaging and delivery approaches, particularly addressing hesitancy in East of England areas with lower uptake.

 

Prioritise specific high impact prevention initiatives

• Scale up and target our Community Health Remote Care service, to reach more people who will benefit the most, delivering at a level that creates measurable population health impact.
• Develop and enhance services to care for patients who are experiencing a deterioration of their condition, to provide early intervention and prevent them needing urgent or emergency care.
• Strengthen existing and pioneer new services to make best use of remote monitoring, wearables and other innovations to identify and put support in place before people experience significant deterioration in their condition.
• Ensure every child and young person we support with asthma has a personalised management plan, co-designed with them to make it accessible, practical and effective.
• Expand oral health checks to tackle the growing problem of dental decay, with particular focus on protecting children’s dental health.
• Embed and strengthen our services to directly respond to 999 / 111 calls to put urgent community care in place to prevent deterioration and avoidable hospital admissions.
• Become sector leaders in inpatient plus-size rehabilitation, including working with partners to ensure safe and smooth transition from acute to community rehabilitation.

Embed prevention in every service

• Make prevention everyone’s business – every service will identify and deliver proactive and preventative elements as standard practice, not as an add-on.
• Strengthen our ‘making every contact count’ approach, ensuring our specialist services consider all conditions and risks affecting the patient, not just the one they are treating.

 

3. Working in partnership to meet population needs

We will work collaboratively with our partners across health, care, education and the voluntary sector to creative positive social impact and deliver seamless, integrated services that are designed around people and places, not organisational boundaries.

 

What this means in practice

For service users and families:

You will experience joined-up care that is designed around your community’s needs, with the right support available closer to home. You will not have to repeat your story multiple times, and you will receive consistent, high-quality care across areas, rather than a postcode lottery.

 

For us:

We will work as equal partners across the health and care system. Our staff will be embedded in neighbourhood health services, identifying with and contributing to their local communities. We will work with colleagues from partner organisations, breaking down silos to deliver better outcomes for the people we serve.

 

For our partners:

Across health, social care, education and VCFSE, partners will consistently experience HCT as an active, engaged and collaborative partner. We will share expertise, data and resources to create truly cohesive neighbourhood teams. Care will be coordinated around people, not organisational boundaries. We will actively incorporate VCFSE and other partners into pathways, recognising each organisation’s unique strengths.

 

To deliver this objective we will prioritise the following actions:

 

Strengthening strategic partnerships that transform care

• Actively contribute to our health and care partnerships, eliminating organisational silos and duplication that frustrate patients and waste resources.
• Transform public health nursing services, in collaboration with partners, aligning to local priorities to give every child the best possible start to life.
• Work with acute partners to shift care closer to home, redesigning pathways to reduce unnecessary hospital admissions and bringing more outpatient activity into the community.
• Amplify the community voice by working with ICB community partners to demonstrate the transformative impact of specialist community providers in delivering the NHS 10-Year Plan and improving outcomes for our populations.

 

Creating high-performing neighbourhood teams

• Be a lead partner in shaping neighbourhood health services in Hertfordshire, working in equal partnership to create a new model of community-based care.
• Proactively adapt our services to neighbourhood delivery, ensuring we provide responsive, tailored care that meets the specific needs of each local population.
• Work with partners to develop a joined-up approach and optimise the opportunities offered by neighbourhood health centres to integrate and deliver joined up care.
• Foster a culture of prevention, respect and collaboration within every neighbourhood team, building understanding of each other’s unique strengths and breaking down barriers that get in the way of excellent care.

 

Maximising our social impact and working with communities

• Embed VCFSE organisations as integral partners in our care pathways, with every service identifying and engaging relevant voluntary, community, faith and social enterprise partners.
• Use our role as an anchor institution to reduce health inequalities at neighbourhood level and pioneer work that enhances life chances for children, young people and care leavers.
• Deliver our Green Plan ambitions, including carbon reduction through LED lighting, smart building management systems, heat pumps, and innovative approaches that protect the health of future generations.

 

4. Make HCT a great place to work

We will attract and retain a highly skilled, inclusive and supported workforce, by creating an environment where people thrive and feel valued, to deliver the care our population needs.

 

What this means in practice

For service users and families:

You will receive compassionate, high-quality care from skilled and motivated staff who feel valued and supported in their roles. When our people are at their best, you receive the best care.

 

For us:

We will nurture an inclusive, supportive culture where staff are empowered to develop, contribute ideas and deliver their best work. Everyone will feel valued, have their wellbeing supported, feel safe to speak up about any concerns and feel connected to our purpose.

 

For our partners:

We will be a reliable, collaborative partner with a stable, skilled workforce. We will share good practice and learning to strengthen the wider health and care system.

 

To deliver this objective we will prioritise the following actions:

Enhancing staff wellbeing support and development

• Expand wellbeing support to reach everyone, building on our successful staff wellbeing clinics to provide consistent access for all staff, including those working away from main Hertfordshire bases.
• Make it easier and faster for staff to get the support they need – corporate teams will provide high quality services to staff, enabling staff to focus on delivering for patients and service users.
• Ensure our estate and working environments support staff wellbeing and provide a great place to work.
• Actively support staff career development, helping staff to thrive in their roles, gain new skills and experiences and to build a career in the NHS and fulfil their ambitions.

 

Building an inclusive culture and celebrating our diversity

• Continue our commitment to being an anti-racist organisation, by delivering our anti-racism action plan and bespoke leadership programme, embedding it across the organisation to tackle discrimination and develop inclusive leaders.
• Ensure that our workforce reflects the communities we serve, including in leadership positions, and celebrate our diverse culture, so that diverse perspectives shape our decisions and care delivery.
• Strengthen our Shadow Board and staff networks, ensuring key decision share tested with staff before implementation.
• Ensuring our managers are well trained to continue to create an environment where staff feel safe and empowered to speak up about concerns or potential improvements.

 

Empowering our people to innovate and improve

• Provide the support, guidance and autonomy for teams to generate ideas and make improvements in their areas. Streamline approvals process to reduce unnecessary barriers.
• Create equity across all our locations and teams – as we expand our services beyond Hertfordshire, every staff member will have equal access to development, wellbeing support and opportunities, and feel equally part of HCT.
• Help services to use workforce data effectively – to understand and plan services sustainably.

 

5. Improving, innovating and embracing technology

We will continuously improve the care we provide, pioneering innovative approaches and embracing technology, to deliver better outcomes and experiences for patients and staff.

 

What this means in practice

For service users and families:

You will benefit from more seamless, reliable and personalised care, supported by modern technology that makes services easier to access and improves your experiences and outcomes.

 

For us:

We will foster a culture where improvement and innovation are everyone’s business. Staff will be empowered to test new ideas, adopt digital tools confidently, and use data and insight to continuously enhance care delivery.

 

For our partners:

We will collaborate to test and scale innovation, share learning, and ensure that digital and improvement initiatives align across organisations to deliver integrated, efficient and high-quality community care.

 

To deliver this objective we will prioritise the following actions:

 

Build a culture of continuous improvement

• Continue to embed continuous improvement into the core of how we work – encouraging teams to try new approaches, pioneer new services, share learning and celebrate successes.
• Continue to embed the Quality Wheel as the standard improvement tool across teams.
• Lead and contribute to research that builds the evidence base for community-delivered care – particularly for frailty, multi-morbidity, and genomics projects, sharing our insights to shape best practice and policy.
• Partner with academic and system leaders to co-design and test new models of care.
• Launch an innovation and improvement fund to back staff-led ideas.

 

Harnessing technology and building digital skills and confidence

• Fully integrate HCT services with the NHS App for easy, universal access.
• Transition to a paperless-by-default organisation to cut waste, costs and carbon.
• Actively seeking out and adopting AI solutions for our organisational challenges.
• Ensure all digital solutions are inclusive and accessible, meeting diverse population needs, providing service users, carers and families with support to help with digital adoption.
• Equip all staff with the digital technology, equipment and data they need to deliver safe, efficient care.
• Provide training and digital support for staff to reduce worries about new ways of working, to feel confident with new tools and establish digital champions.
• Ensure all digital adoption and changes do not widen or negatively impact on health inequalities or digital exclusion.

 

Our next steps

We believe that this strategy sets out a compelling vision for our organisation over the next five years We now need to deliver it. It is essential that our organisational strategy flows through our organisation so that everyone is working together to deliver it. We are excited to begin its delivery, ensuring we are providing outstanding care, for healthier communities.