St Andrews Healthcare Northampton

Updated 12 December 2025

We inspected St Andrews Healthcare Northampton between 11 July and 13 August 2025 (on site) and until end August 2025 (off site). This inspection was an unannounced focused inspection. This was carried out in response to a serious incident of concern which had occurred on a learning disability / autism ward within the secure division. We were aware there had been a number of allegations from patients alleging abuse by staff, on different wards across the hospital. At the time of this inspection, internal investigations were ongoing.

St Andrew’s Healthcare Northampton is part of St Andrew’s Healthcare, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs. During our inspection we visited wards across the medium and low secure wards, to include learning disability / autism wards (LDA); wards for older people with mental health problems and wards for people with acquired brain injury.

During our inspection, we visited the following wards as part of the assessment:

• Brook ward: a low secure ward for persons diagnosed with a major mental illness, Learning Disability and/ or Autism for men with 10 beds
• Oak ward: a recovery-orientated medium secure service for women aged over 18 with 10 beds
• Bracken ward: a blended forensic admissions Ward for women with 11 beds
• Fairbairn ward: a medium secure service for deaf men with 17 beds
• Tallis ward: an admission, assessment and rehabilitation ward for males with 11 beds
• Elgar ward: an admission, assessment and rehabilitation ward for females with 12 beds
• Walton ward: an admission, assessment and rehabilitation ward for males living with Huntington’s disease with 14 beds.
• Redwood ward: a specialist older peoples ward for males with complex dementia and / or progressive neurological conditions.

During this assessment we assessed the following service groups: Forensic inpatient or secure wards; wards for older people with mental health problems and services for people with acquired brain injury. We assessed 14 quality statements under 3 key questions: safe, caring and well led.

We rated the service as Inadequate. This service remains in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we user our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.

Updated 22 July 2025

Overall Summary

This assessment of forensic inpatient or secure wards at St Andrew’s Healthcare Northampton took place between 11 July and 13 August 2025. This was an unannounced focused inspection which was carried out in response to a serious incident of concern. The incident (which took place in June 2025), took place on a learning disability/autism ward (LD/A). The incident resulted in staff injury. The incident was identified by the provider. Managers completed a review of the incident, including viewing the incident on closed circuit television (CCTV) on 1 July 2025. Upon review of the incident via CCTV, the provider identified several serious concerns regarding the management of the incident, and inappropriate use of safe intervention techniques (SIT). The provider then took immediate steps to safeguard the patient and take the appropriate action regarding the staff members involved. The incident raised questions in relation to people’s safety, alleged inappropriate use of restraint, alleged staff assault on the person and a lack of privacy and dignity. The incident also raised concerns about a closed culture within the organisation.

St Andrew’s Healthcare Northampton is part of St Andrew’s Healthcare, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs. During our inspection we visited wards across the medium secure, low secure, child and adolescent (CAMHS) and learning disability/autism services (LD/A) wards.

An inspection has been undertaken of a specialist service that is used by autistic people or people with a learning disability. We have assessed the service against ‘right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

During our inspection, we visited the following wards as part of the assessment:

Brook ward: a low secure ward for persons diagnosed with a major mental illness, Learning Disability and/ or Autism for men with 10 beds

Oak ward: a recovery-orientated medium secure service for women aged over 18 with 10 beds

Bracken ward: a blended forensic admissions Ward for women with 11 beds

Fairbairn ward: a medium secure service for deaf men with 17 beds within the medium secure and learning disability/autism services (LD/A) wards. In addition, we reviewed 12 patient records, 26 incidents from across the forensic services (including medium and low secure, LD/A) and CAMHS ward via review of CCTV, spoke to 14 staff and undertook observations on 3 wards.

During the inspection we inspected 5 quality statements under 3 key lines of enquiry safe and caring, and 4 quality statements under well-led.

We found evidence of a hospital wide closed culture resulting in improper and abusive treatment of people and patients. We took urgent enforcement action to impose a condition on the provider’s registration to restrict new admissions across the entire location.

We rated the service as Inadequate.

The provider was previously in breach of the legal Regulations of safe care and treatment, safeguarding, good governance, and staffing. Improvements were not found at this inspection, and the provider remained in breach of these regulations.

The provider was also found to be in breach of the legal Regulation of dignity and respect.

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.

This service remains in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we user our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

Mental Health Act and Mental Capacity Act Compliance

Most patients were detained for treatment under the Mental Health Act 1983.

Staff stored copies of patients’ detention papers and associated records within the electronic health record. Staff could access them when needed.

Patients had access to an Independent Mental Health Advocate (IMHA). Posters were displayed on noticeboards on the wards with contact details to reach this service. However, the contract for providing advocacy services had recently changed. We were informed that contact with the new advocacy service had to be requested via an appointment system. We were concerned that the new arrangements for advocacy could have an adverse effect on patients being able to obtain independent advocacy support in a timely manner.

Due to staffing levels, staff were not always able to ensure that patients could take section 17 leave (permission to leave the hospital) when this was agreed by the multidisciplinary (MDT) team.

Staff explained to each patient their rights under the Mental Health Act. Rights were repeated to patients as required and this was recorded in patient records. Patients were provided with leaflets, and these were available in a different formats or languages if required. Patients told us they were informed of their rights.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff could access support from the provider’s Mental Health Act administration department.

Staff received and kept up to date with training on the Mental Health Act, this was mandatory for staff.

The service had relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice.

Mental Capacity Act

Staff generally had a good understanding of the Mental Capacity Act, in particular the five statutory principles

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it. Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff had assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. The service had arrangements to monitor adherence to the Mental Capacity Act.

On the child and adolescent mental health ward, staff considered Gillick competence (a test in medical law to decide whether a child of 16 years or younger is competent to consent to medical examination or treatment).

People’s experience of the service

During our inspection, we spoke to 7 patients (4 patients on Fairbairn and 3 patients on Brook ward). On Fairbairn Ward, 4 patients raised concerns regarding the lack of effective communication between staff and patients on the ward. Two of the four patients on Fairbairn ward told us that they felt “unheard”. One of the patients described feelings of “despair and isolation”, another patient spoke of “extreme loneliness, pain and lack of engagement from staff”.

Patients on Fairbairn ward told us of numerous consequences of ineffective communication. One patient raised frustration with staff, particularly around facial expressions and non-verbal cues, which they told us they found triggering. Another patient told us they had been falsely accused of aggression; they told us they felt misunderstood due to the lack of staff awareness of deaf culture and facial expressions. Concerns from patients on Fairbairn included allegations of “ongoing racial abuse from other patients”, which patients claimed were being ignored by staff members and management.

People on Brook ward were mostly positive about their care and treatment. However, one person told us that bank staff “grab your wrist”. The same person spoke to us about concerns relating to swearing on the ward and that there had been violence on the ward (for example a television had been smashed by a patient).

Updated 22 July 2025

This inspection of services for people with acquired brain injury at St Andrew’s Healthcare Northampton took place in July and August 2025. This inspection was undertaken due to ongoing concerns CQC had received about the service, including a poor standard of care and numerous safeguarding concerns of allegations of abuse from staff to patients.

St Andrew’s Healthcare Northampton is part of St Andrew’s Healthcare, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs.

In the neuropsychiatry division of the location, there were 5 wards for people with acquired brain injury at the time of the inspection. These consisted of; Tavener ward, Church ward, Allitsen ward, Elgar ward and Tallis ward. The service made the decision to close Church ward shortly following this inspection. The division also has Walton ward, a specialist ward for male people living with Huntington’s disease. During this inspection, we focused upon 3 of these wards:

• Tallis ward – an admission, assessment and rehabilitation ward for males (11 beds).
• Elgar ward – an admission, assessment and rehabilitation ward for females (12 beds).
• Walton ward – an admission, assessment and rehabilitation ward for males living with Huntington’s disease (14 beds).

The service was registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983.

There was no registered manager in post at the time of this inspection.

At this inspection, we identified breaches of regulations: 10 dignity and respect, 12 safe care and treatment, 13 safeguarding service users from abuse and improper treatment and 17 good governance.

We rated the service as Requires Improvement. We found breaches relating to a lack of risk mitigation, patients being kept safe from potential abuse, patients not being treated with dignity and respect, and some shortfalls with monitoring the service to make improvements in patient care. We found staff did not consistently protect people from abuse and improper treatment, staff did not always successfully mitigate individual patient risks where identified and governance systems and audits had not always been effective in identifying or addressing areas for improvement.

However, we found where possible, patients were supported to have choice and control and could give feedback on their care through regular community meetings. We noted the service had undertaken some work in relation to blanket restrictions following our previous inspection.

Staff we spoke with were happy working at the hospital and felt supported by their line managers. Ward managers had systems in place enabling them to monitor staff performance and care delivery, although poor practice had not always been identified. We met some staff who were very passionate about making a difference to patients they cared for. Patients were encouraged and supported to maintain contact with people who mattered to them.

Mental Health Act Compliance

Most patients were detained for treatment under the Mental Health Act 1983. Staff stored copies of patients’ detention papers and associated records within the electronic health record, which could be accessed when needed.

Staff received and kept up to date with training on the Mental Health Act, which was mandatory for staff. Compliance was over 90% at time of inspection.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff could access support from the providers’ Mental Health Act administration department.

The service had relevant and up-to-date policies and procedures that reflected relevant legislation and the Mental Health Act Code of Practice.

Staff explained to each patient their rights under the Mental Health Act. Rights were repeated to patients as required and this was recorded in patient records. Patients were provided with leaflets, and these were available in a different formats or languages if required.

Patients had access to an Independent Mental Health Advocate (IMHA). Posters were displayed on noticeboards on the wards with contact details to reach this service. Provision of the advocacy service had changed, with access through the Local Authority. This meant patients had access, but not as easily as previously where drop-in sessions had been facilitated by advocates visiting the wards.

Mental Capacity Act Compliance

Staff received training about the Mental Capacity Act and the five principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law. Compliance was over 90% at the time of inspection.

Individuals’ capacity to make decisions was monitored and recorded at multidisciplinary team meetings.

Updated 22 July 2025

This inspection of wards for older people with mental health problems at St Andrew’s Healthcare Northampton took place in July and August 2025. This inspection was undertaken due to ongoing concerns CQC had received about the service, including a poor standard of care and numerous safeguarding concerns of allegations of abuse from staff to patients.

St Andrew’s Healthcare Northampton is part of St Andrew’s Healthcare, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs.

In the neuropsychiatry division of the location there were 3 wards for older people with mental health problems. These consisted of Cherry ward, Aspen ward and Redwood ward. The service made the decision to close Elm ward before our inspection took place and Aspen ward closed immediately before our visit. During this inspection, we visited 1 ward (Redwood ward) and reviewed data for 3 wards:

• Redwood ward – a specialist older adult service for males with c complex dementia and / or progressive neurological conditions, who present with cognitive deficits (12 beds).
• Cherry ward - a specialist older adult service for females with complex dementia and / or progressive neurological conditions, including Huntington's disease, who present with cognitive deficits (12 beds).
• Aspen ward - an admissions service for males with complex dementia and / or progressive neurological conditions, who present with cognitive deficits (8 beds).

The service was registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983.

There was no registered manager in post at the time of this inspection.

At this inspection, we have rated the service Inadequate. The provider was in continued breach of 5 Regulations; person-centred care (Regulation 9), safe care and treatment (Regulation 12), safeguarding (Regulation 13), staffing (Regulation 18) and good governance (Regulation 17).

This was an unannounced inspection, which means the service was not told an inspection was going to be taking place beforehand. The inspection was carried out in response to a serious incident of concern. During this inspection we looked at quality statements within the Safe, Caring and Well-Led key questions. The scores for these areas have been combined with scores based on the rating from the previous inspection, which was rated as Inadequate.

Staff continued to not consistently deliver safe care and treatment to keep patients safe. Not all patients were supported to remain safe. Staffing numbers remained insufficient to meet patients’ needs or keep them safe. This had a significant negative impact on outcomes for patients and created barriers to staff members to provide good quality person centred care.

Patients continued to not receive person centred care because staff were not effectively applying the provider’s chosen model of care ‘enhanced dementia care’. Staff did not always have time to read care plans, so they fully understood patients’ needs and preferences.

The learning culture across the division remained ineffective. Patients were not always protected from improper treatment. There was no evidence of consideration of the least restrictive way to manage the personal care for 1 patient. This was causing the patient distress for most personal care interventions and a lack of clear therapeutic plan of care. Not enough action was taken to manage patient’s distress.

There was a delay in identifying injuries and records did not always provide enough detail or accurate detail. Body map records of injuries found on patient’s bodies were not always followed up or there was a delay. Not enough detail was provided about the nature of the injuries.

At our previous inspection we identified the blanket use of plastic cutlery, this was still the case at this inspection, however we were told plans were underway to carry out individual risk assessments.

Leaders continued to fail to have a clear oversight of risk and quality monitoring on the wards. Governance processes remained ineffective including seeking feedback from patients or establishing methods to gain an understanding of patient’s experience. However, communication with patients’ relatives or significant others was good.

This assessment service group was most recently inspected in March and April 2025 and rated as Inadequate.

This service remains in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we user our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

Mental Health Act and Mental Capacity Act Compliance

Most patients were detained for treatment under the Mental Health Act 1983.

Staff received training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Online training on the Mental Health Act was mandatory for all staff.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice.

The service had the relevant policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. The service had developed procedures for the implementation of the specific sections of the Act. These procedures each included a checklist for staff to complete to support legal compliance.

Patients had easy access to easy read information about their rights under the Mental Health Act. However, many patients had cognitive impairments which meant they had difficulties processing this information, so patients’ relatives were involved and consulted.

After our previous inspection the providers arrangements for accessing advocacy services changed. We were concerned this would result in a reduced access to these services. Clinical governance meetings recorded there were ongoing issues with access to advocacy and social work support because of known capacity issues in the wider Northamptonshire area.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to. SOAD’s were requested by the patient’s responsible clinician.

Staff stored copies of patients’ detention papers and associated records correctly and could access them when needed.

Managers and staff made sure the service applied the Mental Health Act 1983 correctly by completing audits and discussing the findings. The implementation of the policy was overseen by the Mental Health Act Steering Group comprising of the Mental Health Act lead, a clinical director, a solicitor, responsible clinicians, nurses and social workers.

Mental Capacity Act

Staff received training about the Mental Capacity Act and understood the five principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law.

Individuals’ capacity to make decisions was monitored and recorded at multidisciplinary team meetings. However, restrictions regarding access to ordinary cutlery had been imposed without appropriate consent or rationale. We were concerned this decision had not considered individual patients’ best interests as is required by the Mental Capacity Act 2005. The restriction was imposed as a blanket restriction to keep patients safe from others with an identified risk. Staff did not adopt the least restrictive principle such as facilitating access to cutlery in safe way or developing a person-centred care plan in relation to eating and drinking needs.

Updated 21 October 2025

St Andrew's Healthcare is a registered charity specialising in the assessment, treatment and rehabilitation of people with psychiatric disorders, including people with developmental disabilities and challenging behaviours. The providers' vision is to be the national leader in specialist mental health care.
St Andrews Hospital Northampton has five service divisions. These are:
• Child and Adolescent Mental Health Services (CAMHS),
• Autism Spectrum Disorder and Learning Disability Division (ASD/LD)
• Medium Secure Division,
• Low Secure and Specialist Rehabilitation Division, Acute and Psychiatric Intensive care units,
• Neuropsychiatry Division.

This assessment looked at services within the acute wards for adults of working age and psychiatric intensive care units. The wards included Naseby, a 15 bedded acute ward for males. Wards Heygete and Bayley, psychiatric intensive care unit for males, each offering 10 psychiatric intensive care unit for males. At the time of our assessment there was a low bed occupancy within all 3 of the locations. The two 10 bed psychiatric intensive care unit wards had 7 patients each and the 15 bed acute ward had 4 patients during our visit. Leaders stated that this was due to the service only accepting appropriate referrals while discharging patients at an appropriate rate.

The service provided mental health care to adult males across a spectrum of specialist mental disorders. Care is provided to those who need the relational, physical, and procedural security of a secure unit, in line with the National Medium Secure Specifications from NHS England.

The service was last rated as Requires Improvement (published September 2016). The report was published following Care Quality Commission's (CQC) old inspection approach using key lines of enquiry (KLOEs), prompts and ratings characteristics. This assessment has been completed following CQC's new approach to assessment; Single Assessment Framework (SAF).

This was an unannounced assessment, which means the service was not told an assessment was going to be taking place beforehand. During this assessment we looked at all quality statements across all 5 key questions. As we assessed all quality statements at this visit the current rating reflects the findings from this assessment.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

The organisation employed Mental Health Act caseworkers who all provided advice and support for staff. Caseworkers regularly visited the wards, and staff knew how to contact them for advice. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient's notes each time. Staff made sure patients could take section 17 leave (permission to leave the hospital) when this was agreed with the Responsible Clinician.

Patients had easy access to information about independent mental health advocacy and patients who lacked capacity were automatically referred to the service. Information about patients' rights under the Mental Health Act were displayed in an `easy-read' format on notice boards. Advocates visited the wards regularly. Advocates attended ward rounds and manager's hearings. Hospital managers requested advocates to be present at hearings where patients lacked capacity and were not represented by a solicitor.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to, and patients were able to request a SOAD by their responsible clinician. The Mental Health Act office reminded responsible clinicians of the need to contact a SOAD at least two weeks before their certification was required.

Managers and staff made sure the service applied the Mental Health Act correctly by completing audits and discussing the findings. The implementation of the policy was overseen by the Mental Health Act lead, a clinical director, a solicitor, responsible clinicians, nurses and social workers. The audit team conducted audits of specific matters relating to the Mental Health Act.

Mental Capacity Act

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

Staff assessed and recorded capacity to consent clearly each time a patient needed to make an important decision. Staff had assessed all patients' capacity to consent to treatment and to be in hospital. Assessments of capacity were routinely updated at multidisciplinary ward rounds. For patients detained under the Mental Health Act, responsible clinicians had completed the appropriate statutory certificates authorising treatment. Second opinion appointed doctors authorised treatment when patients lacked capacity to consent.

Staff received and kept up-to-date with training in the Mental Capacity Act and had a good understanding of the five principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law.

Staff gave patients all possible support to make specific decisions for themselves before deciding a patient did not have the capacity to do so. Staff sought to encourage patients to make decisions for themselves whenever possible. For example, when staff were supporting a patient to get dressed, they would lay out different clothes and help the patient to choose.

Updated 4 February 2025

We completed an assessment and inspection of St Andrews Healthcare Northampton on 12 and 13 March 2025.

This assessment was carried out following the CQC's new approach to assessment; Single Assessment Framework (SAF). We inspected the long stay rehabilitation mental health wards for adults of working age. We looked at all quality statements under each key question. We carried out a mix of onsite and offsite inspection and assessment activity between 12 March 2025 and 22 April 2025. This was an unannounced assessment, which means the provider was not told an assessment was going to be starting beforehand.

St Andrews Healthcare is a registered charity specialising in the assessment, treatment and rehabilitation of people with psychiatric disorders, including people with developmental disabilities and behaviours of distress.

The long stay or rehabilitation mental health wards for working age adults ASG (assessment service group) is made up of 5 wards/lodges. We assessed Silverstone, Watkins House and 37 Berkeley Close. We also assessed Berkeley Lodge and Sitwell Ward. At the time of the inspection there were 24 patients at the service in long-stay or rehabilitation mental health wards for working age adults.

We rated the service as Requires Improvement as we identified 6 breaches of the Health and Social Care Act 2012 regulations. Staff did not always record capacity and consent in relation to the clinical treatment model and support level framework on Silverstone ward. The service did not ensure to keep the clinic room clean and tidy and assess the risks to people's health and safety for safe care and treatment. Staff did not always use the least restrictive interventions. We found there were also blanket restrictions applied to patients on all wards.

The service did not ensure to manage and mitigate maintenance risks on premises in a timely manner. Governance systems and audits were not effective in identifying or addressing areas for improvement. The service did not always ensure that staff had the necessary specialist skills to support patients' needs and implement the proposed clinical treatment models.

However, the rehabilitative model was evident and there was good multi-disciplinary input into it. Care records including risk management were detailed and up to date. Many staff were compassionate caring and skilled.

During this assessment and inspection, we found 6 breaches of regulations.

The provider did not always:

• Ensure to obtain and record capacity and consent for care and treatment on Silverstone Ward
• Ensure care and treatment was provided in a safe way and to adhere to infection prevention and control processes.
• Ensure patients are safeguarded from abuse and improper treatment such as the application of blanket restrictions
• Ensure premises and equipment including maintenance risks are recorded and mitigated within a timely manner.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure there were sufficient, suitably competent, and experienced staff trained to apply and provide care within the clinical treatment model and dialectical behavioural approach for service users accessing specialist rehabilitation services

We have asked the provider for an action plan in response to the concerns found at this assessment.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

• Staff had received training in the Mental Health Act with a compliance of 95% and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.
• Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.
• The provider had relevant policies and procedures that reflected the most recent guidance.
• Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.
• Patients had easy access to information about independent mental health advocacy.
• There was a lack of information relating to the care of informal patients within the clinical treatment model and consent policies. The leave section of the clinical treatment model and support framework did not include guidance or information around rights of informal patients. Staff and patients did not have sufficient understanding of informal patient's rights and management of risks in relation to time away from the ward, as there was a serious incident reported where one patient accessed leave without it being agreed.
• Staff did not always ensure patients were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted due to lack of staff.
• Staff requested an opinion from a second opinion appointed doctor when necessary.
• Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.
• The service displayed a notice to tell informal patients that they could leave the ward freely.
• Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

• Staff had had training in the Mental Capacity Act with a compliance of 95%.
• Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles, however not on Silverstone Ward.
• The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.
• Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.
• Staff took all practical steps to enable patients to make their own decisions
• For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions, however not on Silverstone Ward.
• The service had arrangements to monitor adherence to the Mental Capacity Act.
• Staff audited the application of the Mental Capacity Act and took action on any learning that resulted from it.

Updated 29 July 2025

St Andrew's Healthcare Northampton is an independent hospital for people with mental health needs, people with a learning disability and/or autistic people. This assessment looked at the wards for people with a learning disability and autistic people which we rated as requires improvement. When we have reported on St Andrew’s Northampton’s wards for people with a learning disability before, we have included our assessments of the forensic low and medium secure services for people with a learning disability and autistic people. For this assessment, we have changed our approach. Our findings about forensic low and medium secure services for people with a learning disability and autistic people are now included in the mental health forensic inpatient or secure wards assessment report. This assessment was a comprehensive unannounced assessment where we looked at all quality statements across the key questions.

The wards for people with a learning disability and autistic people assessment related to 3 services at St Andrew's Healthcare Northampton which provided individual bespoke services for people in hospital but not in forensic secure care. Each of these 3 wards provided care and treatment for one person. These services were Glendale, Billing Lodge and Lime Trees Cottage. This unannounced assessment took place from 11 to 13 March 2025. We visited Glendale and Billing Lodge. We have also used data about Lime Trees cottages to form our judgement. In this report, we may not give as much detail as we usually do. This is because the report relates to just 3 people that may be identifiable if we gave fuller details. As part of the wider inspection, we did some out-of-hour visits.

We have assessed the wards against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

Right Support: People had complex needs and regular staff knew people well. However, people's care plans, positive behavioural support plans and risk assessments were not always clear and lacked the detail required to robustly guide staff on appropriate care and to help them to fully understand people’s distress. People were not always safeguarded from abuse. There were not enough suitably skilled staff to support people as staff had not received appropriate training to interact with people.

Right Care: People did not always receive person-centred care that promoted their dignity, privacy and human rights. Most staff were kind and caring but people reported that they were not always treated with respect and dignity, especially by staff who didn’t regularly work on the wards. People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible as staff had not looked at appropriate safeguards when caring for people away from others. Staff communicated with people in ways that met their needs.

Right Culture: Governance arrangements were not as effective or reliable as they should be. Some quality audits were in place; however, managers had not always ensured that the audits were relevant or specific to these wards. Managers recognised that improvements were needed (including the need for better, autism-informed care plans) but actions identified had not been followed through, and sustainability was not embedded into the service.

During this inspection we found regulatory breaches in regulations relating to person-centred care, safeguarding, safe care and treatment, good governance and staffing. We have asked the provider for an action plan in response to the concerns found at this assessment.

Updated 11 November 2024

The child and adolescent mental health service (CAMHS) at St Andrews hospital Northampton, has significantly reduced over time. The hospital has 2 CAMHS wards, but only one in use currently, which is Seacole ward. Stowe ward was closed at the time of assessment.

This onsite assessment of the CAMHS was undertaken on 27 November 2024. The off-site assessment concluded on 17 January 2024.

The assessment was prompted in part by notification of an incident to the CQC and feedback received from external agencies, including concerns about the menagement of risk. This assessment examined those risks.

The assessment examined 5 quality statements across 2 key questions; safe and well led. We found breaches of the regulations in relation to staffing. An action plan has been requested from the provider to address this.