Archived: St Andrews Healthcare Northampton

Ratings - Forensic inpatient or secure wards

• Overall

  Inadequate

• Safe

  Inadequate

• Effective

  Requires improvement

• Caring

  Requires improvement

• Responsive

  Requires improvement

• Well-led

  Inadequate

Our view of the service

Overall Summary

St. Andrews Hospital Northampton is an independent hospital, run by St Andrews Healthcare limited, which is a registered charity. During our inspection we visited wards across the forensic services and CAMHs. This included medium secure, low secure, child and adolescent and learning disability/autism services (LDA) wards.

An assessment 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.’

This was an unannounced inspection (undertaken between 11 and 13,18 and 20, 25 and 26 March), which was carried out firstly to determine if the provider had met the requirements laid out in the Section 29 warning notice, following our last inspection of the LDA wards, and secondly, in response to ongoing concerns received. These concerns had raised questions in relation to patient safety (incidents of deliberate self-harm, patient on patient assaults), alleged poor attitude of some staff, high use of agency and low staffing levels.

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

Across the forensic and CAMHs services, we visited a total of 14 wards. This included 5 medium secure wards, 2 low secure wards, 1 child and adolescent ward and 6 learning disability/autism (LDA) wards.

The medium secure wards provide secure mental healthcare to adults across a spectrum of specialist mental disorders: mental illness, personality disorder, borderline or mild learning disability and mentally disordered people who are deaf. Care is provided to those who need the relational, physical, and procedural security of a medium security unit, in line with the National Medium Secure Specifications from NHS England. The provider also provides a blended Secure Service for Women developed as part of a national pilot and meeting a draft service specification linked to the main medium secure service specification.

The low secure wards provide high-quality assessment, care, and treatment, helping patients to progress to the least restrictive setting by equipping them with the skills required to live as independently as possible, closer to communities of their choosing.

The Learning Disabilities and Autistic Spectrum Disorder (LDA) services are designed to help people living with a learning disability, autism and complex mental health needs to progress towards living in the community. The learning disability service provides a treatment therapy ethos based on Positive Behavioural Support (PBS). The learning disability service provides a treatment therapy ethos based on PBS; equipping people with the skills required to live as independently as possible.

The Child and Adolescent Mental Health Service (CAMHS) service is designed for young males and females aged 13 to 18 with complex mental disorders, severe emotional and behavioural difficulties, intellectual disabilities, mental illness and autistic spectrum disorders. The CAMHS is a trauma informed care service, ensuring that treatment is driven by an understanding of how trauma affects the whole person; physically, mentally and socially. The objective of the service is to enable young people to live well and to their full potential in the least restrictive environment possible.

We found that whilst there had been improvements in clinical supervision and mandatory training rates, the service still did not have enough regular staff who knew the people they were providing care and treatment for.

NARRATIVE SUMMARY

The governance systems in place had failed to identify and rectify the widespread and significant concerns found at this inspection. The rating for the safe domain from this inspection was inadequate. People were not receiving safe care and treatment that met their needs. This was because there were not enough suitably trained and skilled staff to provide continuity of care. Staffing levels did not always meet the requirements of the wards, and there was a high use of temporary staff,

Patients had not always been protected from harm. Patients did not always feel safe on the ward. There were incidents of harm or abuse from other patients, and staff had not always undertaken enhanced observation in line with provider policy. The risks to people had not been consistently recorded in a timely manner, and people had not always received their medicines safely or as prescribed. We found numerous concerns with the environment including poor maintenance of toilets and showers, lack of cleanliness, poor standards of the environment and Infection Prevention and Control (IPC) risks.

During inspection we found indicators of a closed culture, as defined by CQC guidance on closed cultures. This included inherent risk factors such as restrictive practices and low staff morale. We found that warning signs of a closed culture including care plans not reflecting the patient’s voice, poor or absent communication plans for patients who were deaf, and blanket restrictions are in place and are not necessarily the least restrictive option. Staff did not feel supported by leaders, who we were informed were rarely seen on the wards. Some staff told us that they were afraid to raise concerns as when they had raised concerns, these had been ignored.

The service was in breach of legal regulation in relation to Regulation 12: Safe Care and Treatment; Regulation 13: Safeguarding service users from abuse and improper treatment; Regulation 15: Premises and equipment; Regulation 18 (staffing):

We will publish this information on our website after any representations and/ or appeals have been concluded.

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.

This service is being placed 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

Mental Health Act

Ninety five percent of staff were trained in 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.

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. However, we were told that the provider was in the process of changing their advocacy provider. Staff told us that access to independent advocacy would be decreased.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. Due to available staffing, staff were not able to ensure that patients were always able to take Section 17 leave (permission for patients to leave hospital) when this had been granted.

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 they were available to all staff that needed access to them.

Staff did regular audits to ensure the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

Ninety five percent of staff of staff had had training in the 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).

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

People's experience of this service

Overall people’s experience commentary

During this inspection, we spoke with 41 patients across all services. Most patients we spoke with felt involved in their care and had contributed to their care plans and positive behavioural support plans, if they had wanted to.

Some patients told us that they did not feel safe on the wards, there was not enough staff, staff were not always visible, and their activities and leave was frequently cancelled. However the provider shared the MyVoice survey results for April 2025, which indicated that 71% of patient across the service felt safe.

Across the LDA wards, we spoke with 18 people who were using the service. The model of care and setting did not always maximise people’s choice, control and independence. Care was mostly person-centred. However, the ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives.

Of the people we spoke with, 15 out of 18 felt safe on the wards. Managers were aware of this and had taken measures to address this.

Five people out of 18 we spoke with using the service told us that staff lacked an understanding of autism and sensory needs, particularly in relation to noise. These people were on different wards, Acorn, Berry, Meadow and Sunley. This equates to approximately 27% of patients we spoke with.

Two people told us there was not enough activities to keep them busy on Meadow ward. One person on Berry ward referred to having been on “good trips out”.

People told us that staffing shortages had impacted their leave. Eight people across Berry, Oak, Sunley, and Acorn wards told us how they and others had experienced leave being delayed or cancelled. One person said, “it is hard not being able to go out regularly”.

One carer told us there were not enough activities to keep their relative occupied. They went on to state that some activities had been cancelled due to a lack of staff, which their relative found frustrating.