St Andrews Healthcare Northampton

Ratings - Acute wards for adults of working age and psychiatric intensive care units

• Overall

  Good

• Safe

  Good

• Effective

  Good

• Caring

  Good

• Responsive

  Good

• Well-led

  Good

Our view of the service

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.

People's experience of this service

During our visit, we spoke to 8 patients across the 3 wards and overall, the feedback from patients was positive. Patients felt safe and well supported on the ward. Staff treated them with kindness, compassion, dignity, and respect. They were always helpful, approachable and available with 1 patient telling us that this was the best ward that they had been on.  People important to patients were encouraged to be involved in their care and treatment planning with accommodation available for overnight stays on site. 

Patients were supported to be as independent as possible having both choice and control around their care, and treatment. Patients were observed engaging with staff and other patients in conversation and activities. All patients were treated as individuals, they were listened to and encouraged to feedback on their experience of care within the service.