St Andrews Healthcare Northampton

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified a number of concerns under the well led key question which will require an action plan under the shared direction and culture, capable, compassionate, and inclusive leaders, freedom to speak up, governance, management and sustainability quality statements. Not all patients felt safe or had been protected from harm, however recent MyVoice (patient feedback) data showed patients scored an average of 7.53 out of 10 to the statement ‘I feel safe here’. While the provider had a range of governance systems and processes in place, these were not addressing the key concerns identified during our assessment in a timely way. Some of the actions required to address concerns which were identified during the last inspection, had taken a long time to be implemented. Working in collaboration with patients needed further work. Staff and patients said there were not enough staff to meet patients’ immediate needs, and that patients had to wait for treatment. There was still a sense of disconnect between the board and the wards. There had been numerous changes in ward managers and staff felt that some managers were being promoted too quickly.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Not all staff could articulate the vision of the hospital. The senior leadership team had a shared vision and strategy, but sadly this had not filtered down to all ward staff we spoke with. Most staff we spoke with were not aware of how the provider’s vision and values applied to their work. The provider promoted equality, diversity and inclusion; however, we were told of one patient who had been racially abused by patients on one of the wards.

The medium secure division had developed its own purpose and vision. However, staff we spoke with had not had the opportunity to contribute to discussions about the strategy for the service, especially where the service was changing. However, the provider gave us evidence of over 90% management supervision figures which the provider states is where the divisional strategy is discussed, and objectives are set in line with this. The overall vision of the services was to ‘continually improve our high-quality specialist service providing personalised patient care contributing to a better quality of life’. However not all patients believed that staff were promoting their recovery or delivering individualised, personalised care.

Some staff felt supported and guided by their leadership team. However, 9 staff members raised concerns regarding a lack of support and input from managers. One staff member told us that leaders are not fair, and another told us that managers do not promote staff wellbeing. However, the provider gave us evidence of several wellbeing initiatives they had introduced, and available forums for staff. A third staff member told us that managers do not have the skills. However, the provider gave us evidence of their Ward Manager Development Programme which seeks to support and equip managers with the skills required for their role. A further staff member told us that there had been "a breakdown in relationships with senior managers", whilst another staff member told us that "you do not see senior managers unless there is a serious incident" and that there was need for a good leader.

The service has access to a divisional risk register, which at the time of our assessment contained 8 divisional risks. Six of the divisional risks were rated as high risks and 2 were rated as major risks. The 2 major risks were associated with low levels of meaningful activity and consultant psychiatrist recruitment. The 6 high risks included 4 concerns highlighted during this assessment: adequate staffing levels, registered nurse vacancies, cultural change requirement (safe practice and creating an open and just culture), and inconsistent staffing due to high use of agency. These issues had been identified during recent CQC assessments of other services; however, the issues remain a high risk on the provider’s risk register. Two risks identified on the risk register not identified during this assessment were associated with emergency lighting at Fitzroy house and mandatory training.

Staff knew the freedom to speak up guardian process as safe call and knew how to contact them. Staff we spoke with told us they knew how to speak up if they had concerns, however not all staff felt that they would be able to raise concerns without the fear of retribution. Only 53% of staff who had responded to a recent staff survey conducted by the provider, indicated that they would feel safe to speak up about anything that concerns them at St. Andrews Healthcare.

The provider had a freedom to speak up process, with several Freedom to Speak Up guardians across the Charity. In addition to this, they have an external process via Safecall. Staff we spoke with told us they knew how to contact safe call, and some staff told us that they would speak up if they thought this would benefit patient care.

Not all staff we spoke with said they felt supported by their leaders and peers. This view was supported by the ‘your voice’ survey results for 03 to 24 June 2024, which showed that 33% of staff felt that senior managers act on staff feedback, 34% felt that communication between senior management and staff is effective and 53% would feel safe to ‘speak up about anything that concerns me at St. Andrews’. The provider is in the early stages of addressing these concerns via an action planning group, which was set up in October 2024. These actions fall into four main categories, visibility and communication of senior leadership, recognition within the divisions, and speaking up.

Leaders obtained feedback from staff at the hospital through surveys and monitored progress of actions identified, some of which related to equality, diversity and inclusion. Job advertisements stated the provider was an equal opportunities employer and celebrated diversity. Staff survey results at divisional level showed that 81% of staff had not experienced discrimination from managers or other colleagues. The provider had several Charity networks to promote inclusivity such as WiSH, BAME, DAWN, PRIDE and Unity. The provider had told us that at the time of the inspection, there were no reported incidents of racial abuse. Staff are encouraged to speak up and are aware of their right to report to the Police, and the support within the Charity.

We reviewed monthly ward and divisional governance meeting minutes. These were attended by a range of staff, however, were not attended by patients. Key performance indicators and monthly audit processes were in place to help give oversight of the service. Managers had clear expectations of what care and support the service aimed to provide. However, there was limited evidence that governance issues were being addressed in a timely manner. The provider had a risk register in place which clearly stated what the risk was, where and how it was raised and what mitigation should be put in place to help reduce the risk. However, 5 out of the 8 identified risks remained, 3 of which related to staffing levels and recruitment, one related to the high use of agency staff and a further risk was associated with the need for cultural change. In response some closed culture sessions have been held on Prichard and Rose ward.

Managers had governance arrangements in place, and had relevant information at hand to measure how well the service was performing. However, recent CQC assessments of other divisions at the hospital were highlighting similar concerns. Managers attended regular ward and divisional clinical governance meetings and had sufficient oversight from senior leaders within the organisation. Data and notifications are submitted to external organisations as required. The provider had robust arrangements for the availability, integrity and confidentiality of data, records and data management systems. Information was used to monitor and improve the quality of care.

Patients told us family members and external teams were involved in their care and treatment when they had consented to this.

Staff told us that they work collaboratively with a range of other agencies including other mental health providers, commissioners, advocacy, police county council and workbridge (a charity vocational education service based in Northampton).

The provider had ongoing reviews with external stakeholders such as the integrated care board who provided regular reviews and scrutiny. Commissioners told us they met with the provider regularly to discuss patient progress and the overall performance of the service. Some partners had ongoing concerns regarding patient safety.

The provider had processes including the care programme approach meetings, discharge meetings and ward rounds to ensure all relevant partners were involved in patient care.

Some staff said that there were opportunities to develop their skills. Examples included the ward manager development programme and healthcare assistant programme. Leaders supported staff to develop their skills around improvement and innovation. However, most staff we spoke to had not attended specialist training above the provider’s mandatory and non-mandatory training. The provider had a strategy for how to develop these capabilities and leaders encouraged staff to contribute to improvement initiatives.

The provider had relationships with external agencies that supported improvement and innovation. Staff and leaders engaged with external work, including research, and embedding evidence-based practice in the organisation. The provider had a medium secure quality network in place. Current themes included staffing, staff wellbeing, reducing unnecessary enhanced observations, increasing therapeutic meaningful activity, quality matron clinics, medication management, professional boundaries and your voice results. Action plans had been developed in response to all identified themes and were all in progress at the time of our assessment.