St Andrews Healthcare Northampton

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Not all patients felt that staff treated them with kindness and compassion. Two patients told us that staff do not always wait for a response after knocking before entering their room. During our assessment we witnessed a staff member knocking on a patient's door and entering before awaiting a response. Most patients told us that they did not feel that they were treated as individuals. However, the provider shared evidence that 97% of care plans had patient identified goals documented. Although the provider shared evidence that 97% of care plans had patient identified goals documented, most patients told us that they had not been involved in their care planning or risk assessment process. All patients had behavioural support plans in place, and patients were aware of these. Patients were involved in ward rounds and could obtain support from the advocacy service. The provider has a range of mechanisms for communication and staff support. However, not all staff were happy raising concerns, as they felt that ‘nothing gets done’; and ‘there is a closed culture’. Although the provider gave us evidence of how staff well-being is promoted throughout the charity with events, tools and literature available to all staff, some staff did not feel that the provider promoted the wellbeing of staff, and they did not always feel safe at work.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Eleven patients told us that staff were not always kind, compassionate or treated them with dignity. Some patients told us that their privacy and dignity had not always been maintained. One patient told us that patients do not have access to a key for their room, however, the provider evidenced that this is individually risk assessed, and some patients do have access to room keys. Two patients told us that staff do not always knock and wait for a reply before entering a patients’ bedroom.

Staff told us that patients are always treated with kindness and compassion. One staff member told us that “staff are kind and understand patients’ difficulties during extremely challenging times”. One staff member told us that they were not aware of any time that a patient had not been treated kindly. Another staff member told us that they would raise a concern with the ward manager if they had any concerns and told us of one occasion where the language skills of one staff member was an issue, so had raised this to avoid confrontation.

During our assessment we observed a staff member knocking on a patient’s bedroom door and proceed to enter before the patient could respond.

Not all patients felt like they were treated as individuals. One patient told us that “we wait for everything, get nothing and lose so much”. Five out of seven (71%) patients we spoke with told us that they did not know what a risk assessment was. Ten out of 11 (91%) of patients told us that they hadn’t seen or were involved in their care plans.

Staff told us that patient needs and preferences were understood, and these needs were reflected in the patients care, treatment and support. One staff member told us that patients have monthly ward round and care plan update meetings, where patients are offered a copy of their care plan. All patients had a positive behavioural support plan (PBS) in place.

During our assessment, we reviewed 18 patients’ care plans. Most care plans were written in the third person. Staff had printed off copies of patients’ positive behaviour plans (PBS) which could be easily accessed in the office. However, we found that on Mackaness ward these plans were double sided, containing PBS plans for two different patients, one on either side. There was a risk that another patient’s confidential information could be viewed on the other side of the patient’s positive behaviour plans (PBS) plan.

Care and treatment plans were reviewed with patients at ward rounds and in care plan review meetings. The provider had community meetings in place on all wards where patients could share their views. However not all patients felt comfortable raising issues with other patients and staff. Patients could also raise concern in their weekly 1:1 care co-ordinator session, and via the patient advocacy and liaison service (PALS) and complaints department. From June to November 2024 patients raised 22 concerns of which 4 related to concern regarding clinical treatment and 3 related to staff availability.

Most patients did not feel that they had some control on a day-to-day basis with regard to making decisions about their care and treatment. Patients told us that care plans were discussed in the multi-disciplinary meetings which took place every 2 weeks. Patients told us that access to activities were limited and that they did not always have a choice regarding which activities they could attend.

Staff told us that they involved patients in the development of their care plans wherever possible. However, this was not always evidenced in the patients’ care plans. Staff had not always indicated within the patient’s records if patients had been involved in their care planning process and if not, the reason why the patient had not or could not be involved.

We observed that some patients had left the ward to attend activities off site. However, there were several patients on the wards who were not engaged in activities. The provider had a wide range of appropriate facilities to support and maximise people’s independence and outcomes from care and treatment. These included an accessible kitchen, activities room, gym and swimming pool.

Patient care plans did not always indicate if patients had been involved in making decisions about their care and support. However, the provider has shared evidence that 97% of patient care plans had patient identified goals documented, and 18% of care plans had documented a lack of involvement of patients due to the patient either being unable or unwilling to engage. Most patient care plans were written in the third person and were not written from the patient’s own perspective. However, patients’ behavioural support plans were written from the patients’ perspective. Patients were able to raise concerns or suggestions for improving the service directly to staff through regular community meetings, although not all patients we spoke with felt their concerns or suggestions would be listened to. However in the most recent patient survey patients scored 7.19 out of 10 in response to the question ‘I feel listened to by staff’

Patients told us that there were not always enough staff available on the wards to attend to patient’s immediate needs. One patient told us that staff are too busy adding “we have to wait’ for access to drinks, leave and activities”.

Most staff spoke to us about a lack of capacity to attend to patients’ immediate needs due to staffing levels. Staff told us that whilst patients’ needs, views, wishes and comfort were a priority, staff did not always have the capacity to quickly anticipate these to avoid any preventable discomfort, concern or distress. For example, one staff member told us that they “did not always have the staff to take patients to the toilet’. However, the provider has advised that there have been no incident reports or safeguarding referrals aised in relation to this. Two staff members spoke to us about one patient who was waiting to go out on leave and that he had waited in his coat all day. Another staff member told us that “patients are bored out of their mind”, adding that “nothing is going on, it’s all down to staffing”.

Staff did not always have the time to be alert to patients’ needs or to observe, communicate and engage people in discussions about their immediate needs . We were told that this had resulted in incidents of patient to staff and patient to patient assaults. Staff did not always have the time to find out how to respond in the most appropriate way to respect their wishes.

The provider had processes in place to enable ward staff to raise any concerns about staffing levels via a bleep system with a senior nurse. However, baseline staffing levels were based on the new establishment agreed via a comprehensive review of staffing. Staff told us that the new establishment did not meet the needs of the patients and acuity on the wards.

Staff have access to a range of methods for discussion, learning and exploration. Staff told us that the wards have daily handovers, morning huddles, monthly team meetings, access to supervision and have weekly reflective practice sessions. However, some staff told us that there is no point raising concerns. One staff member said, “there’s no point in raising an issue as nothing gets done”, adding that “there is generally a closed culture”, so they would not feel protected. A second staff member described a toxic culture. A third staff member stated that they wouldn’t bother speaking to managers, but that they would go to the CQC. A fourth staff member told us that managers do not promote the wellbeing of staff and that they didn’t always feel safe at work, so there was a high level of sickness and burnout. However, the provider shared evidence of several ways in which staff wellbeing is promoted, and the forums available for staff to seek support. The provider also shared evidence that the average days lost in the year due to sickness has reduced over the last 6 months, and that sickness levels had been at or below the average level. A fifth member of staff told us that the wellbeing of staff was not a priority adding that there was no presence of senior managers on the wards. A sixth staff member told us that they no longer feel part of a caring, supportive organisation. However, one staff member told us that there was an open door to managers.

The provider has systems and processes in place to enable staff to raise anonymous concerns (safe call). Between June and September 2024, there were 8 staff investigations within the medium secure division, and staff had raised 1 concern via safecall. Three concerns related to allegations of staff sleeping (one allegation upheld), 4 related to staff not undertaking duties in line with the provider’s policy (2 allegations upheld), and 2 additional concerns related to a staff member taking a mobile phone onto the ward and another where a patient was able to access a sweet wrapper. However not all staff felt that appropriate actions would be taken if they raised concerns internally. Although the provider shared evidence of several ways in which staff wellbeing is promoted, and the forums available for staff to seek support, some staff told us that the wellbeing of staff was not a priority, and that managers above ward manager level were not always fair. However, the provider shared evidence of several ways in which staff wellbeing is promoted, and the forums available for staff to seek support.