HoNOS secure in everyday practice: what it captures, and misses, in low secure LD and non-LD services

Purpose This study aims to evaluate the use of HoNOS Secure across three low secure forensic wards (non-LD and LD) as a measure of clinical progress and service effectiveness, and a validated, interpretable Clinician Reported Outcome Measure to support internal audit, quality assurance and commissioner reporting. Design/methodology/approach Routinely collected RiO data were de-identified and anonymised; HoNOS Secure scores were structured in Excel and analysed in Python. Given ordinal data and a modest sample, domain-wise Friedman tests were used, with Bonferroni-adjusted Wilcoxon post hocs where indicated. Findings The largest improvement was Domain E (need for escort; −0.71), indicating reduced procedural restriction. Domains D (staffing; −0.32) and G (environmental/interpersonal risk; −0.23) also declined. Smaller gains appeared in B (risk to self) and A (risk to others). Domains C (building security) and F (risk from others) rose slightly (+0.14 each), changes likely driven by context rather than deterioration. In the LD subgroup, G declined (−0.50) and B improved modestly, while D increased (+0.50) on limited data. No domain reached statistical significance; Domain E approached significance (p = 0.0797). Research limitations/implications The evaluation is on a small, single-Trust sample (n = 30) and 6 / 12-month windows constrain generalisability and may miss longer trajectories; sole reliance on HoNOS Secure may under-detect relational/functional change, especially in neurodivergent groups. Practical implications The evaluation suggests that monitoring anchored on procedural/dynamic domains and HoNOS Secure should be paired with brief qualitative and neuroaffirming indicators, particularly in LD services. Originality/value This study findings position HoNOS Secure as a shared MDT language that maps onto risk meetings, ward rounds and discharge planning, prompting formulation and evidencing progress.