Archived: 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

This means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last inspection of forensic inpatient or secure wards, we rated this key question requires improvement. At this inspection, the rating has changed to inadequate. During this inspection we considered how people were receiving services in line with Right Support, Right Care, Right Culture. At our last inspections of LDA and CAMHS, we rated this key question good. At this inspection the rating has changed to inadequate. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

The provider did not treat people with kindness, empathy and compassion, or respect their privacy and dignity. Six patients told us that agency staff were not always respectful, and 3 patients told us that agency staff were not always interested in engaging with them. During our inspection we observed limited evidence of staff and patients interacting. A patient on one ward described how a patient on the ward (who has dementia) was frequently left all day in his wheelchair with limited interaction from staff. Another patient told us that during the previous evening a patient had spilled a hot drink on themselves, and that the patient had screamed. Staff were in the room at the time, however, took no action. The incident was not reported.

One patient on Fairbairn ward described how some staff were using nonverbal communication to antagonise patients. Another patient told us that they had heard staff discussing patient issues openly in the day area. One patient told us that the ward manager was acting like they were in the army, suggesting that the ward routine was regimented. However, we did not witness consistent kindness, compassion and dignity when we observed the 3 incidents of restraint on CCTV. In one incident we observed a staff member using an inappropriate intervention, by placing their elbow on the back of a patient’s neck.

Some people across the wards told us that most staff were kind and respected their need for privacy and dignity. We observed staff knocking on bedroom doors before they entered. Some regular staff could tell us all about the people they were caring for and knew them well.

The provider did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The provider did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

We reviewed patient records and observed that that risk assessment documentation had not always been updated after every risk event. Consequently, we could not be assured that care, support and treatment was always delivered in line with individual patient needs.

Due to a lack of interpreters and staff training in BSL, staff were not always able to communicate effectively with deaf patients. We found that staff did not understand deaf culture. The provider has advised that the staffing model (introduced in 2024) had significantly impacted Fairbairn Ward. The model’s heavy reliance on irregular staff was incompatible with the need for staff working in a specialist Deaf Mental Health Service to be highly skilled in both BSL and

Occupational therapists and activity co-ordinators (where staffing allowed) had plans in place to support patients to pursue their interests and hobbies. However, patients told us that they were not always able to attend due to staffing levels on the ward. For example, some patients were not always able to access the gym or section 17 leave.

Temporary staff did not have a good understanding of patient needs and plan of care. However, permanent staff within the service had a good understanding of each patient’s mental health, their previous risk history and their social circumstances outside hospital.

Patients came from diverse cultural backgrounds. Staff recognised this and provided facilities to meet patients cultural and religious needs. We saw some staff treat people as individuals and had considered any relevant protected equality characteristics. We observed staff using people’s preferred pronouns when speaking with them, and within care records reviewed. Staff had recorded people’s individual needs and preferences in relevant care and treatment records.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Not all patients could make phone calls when they wanted to. We found on Fairbairn ward there were rarely staff with enough experience in BSL to facilitate a phone call. However, patients who did not have hearing problems were able to make a phone call in private.

Staff told us that they tried to give people as much independence, choice and control over their lives as possible, while balancing this with individual risks. However, we did not find this to be the case. We found that several restrictions were in place which were blanket restrictions. These included all patients not having access to hot water to make a hot drink, not free access to cold drinks and snacks and not being able to freely access some ward areas due to previous incidents involving 1 or 2 people.

The service did not offer a variety of good quality food. Nine patients raised concerns about the food.

Staff made sure patients could access information on their rights and how to complain. Information about the Mental Health Act and making complaints was displayed on a notice board.

People using the service confirmed that they were generally supported to spend time with people who were important to them. Staff did not restrict patients’ access to their mobile telephones unless there was a clinical reason to do so. They were able to have regular telephone contact, make video calls, and where possible, arranged to meet up in person. The provider had arrangements in place for child visiting off the wards.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

During our inspection, we found that the overall treatment of deaf patients required significant improvement to ensure that deaf individuals received equal access to care and support. We were not assured that systems were sustained and embedded to ensure there was oversight of staff skills, experience and competence to communicate effectively with deaf service users using BSL to meet their needs. We found that there were inadequate levels of staff on the wards who were BSL trained. The provider shared daily staffing between 1 January 2025 and 31 March 2025 which outlined the BSL training details of all staff. During the 90-day shifts viewed, over 50 % of staff were not BSL trained. The highest percentage of staff not BSL trained per shift was 92%. The lowest percentage was 27%. The mean percentage of shifts where staff were not BSL trained per shift was 72%. However, staff told us that more BSL training was being arranged for later in the year.

Staff told us that when things happen on the ward, they didn’t know what to do. Most staff were unable to effectively communicate with patients, often there was no interpreter, and there was no manager support. For example, one patient said he felt ill and didn’t bother to explain as staff at the time don’t sign. In addition, one patient had blood in his pad. The attending doctor (due to communication difficulties) was unable to determine if the blood was in the patient’s stools or urine.

During our inspection, we spoke to all patients on the ward. The feedback received that the service was poor, and that staff could not effectively communicate with patients, especially at night and weekends when there were no interpreters. We were informed that there had been episodes of patient to patient bullying via sign language of which most staff were unaware (because they were not BSL trained). Two patients told us that they want to go back to mainstream prison “as it better than here”, and 3 patients told us that they wanted to be transferred to other providers. Staff were also unable to effectively respond to deaf patients’ needs on other wards.

Patients and staff told us that there was a need for better communication, cultural understanding, and the involvement of deaf professionals to create a more inclusive, respectful environment for both patients and staff. We found that there was a lack of understanding around deaf culture and that patients were unhappy on Fairbairn ward.

We found that not all staff on the LDA wards were aware of patients’ needs. For example, one staff member interviewed was not aware of any health issues associated with one patient. This was despite the patient’s care records referring to seizures. We were also aware of the noise related to staff alarms on the wards. These alarms were frequently being activated and were set to a loud volume. Staff appeared unaware of the adverse effect that the noise from these alarms could have on patients with autism.

Some people told us staff could not always attend to their immediate needs, particularly if there was a person on the ward who required support from several staff members. Examples given were making of a hot drink, being able to access leave and activities when they wanted and using the ward computer.

Patients could give feedback on the service and their treatment and staff supported them to do this. All wards held community meetings for patients. Staff had made sure patients could access advocacy services. Information on how to contact the independent mental health advocacy service was displayed on a notice board. However, the advocacy service was in the process of being changed. Staff and patients were concerned that patients would not have the same level of access to advocacy with the new service.

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff told us that there had been an increasing number of assaults against staff. We reviewed the minutes of the medium secure divisional governance meeting for held on 4 March 2025, where it had been recorded that there had been ‘multiple staff assaulted multiple times and then had to go back onto patient observations and unable to go home’. The minutes also stated that the ’response to traumatic experiences for nursing staff was poor’, and that there had been an ‘increase in racism and verbal abuse’ toward staff that had not been reported/escalated. Staff told us that the level of support post incident was poor and that they were not adequately supported by the organisation. The issues raised within the clinical governance meeting, reflect our findings during our assessment in relation to staffing. One staff member stopped the inspector in the car park and informed inspectors of the high number of assaults against staff

Some staff we spoke with on Oak ward described that experiencing verbal, racial or physical abuse from people who use the service happened regularly. Most staff we spoke with said they reported this in line with hospital guidance. The provider’s staff injury triage tracker for March 2025 showed there had been 21 reported incidents across the hospital. Of these, 11 were across the LDA wards under the forensic directorate. This equates to approximately 52%. This high proportion of staff assaults may demonstrate a lack of lessons learnt following incidents.

The hospital offers an employee assistance scheme, where support is available via telephone, online or face to face. For staff who experience a traumatic event at work, there is a trauma response service available, in addition to the general occupational health team who offer advice and guidance with returning to work.

Nursing staff told us that they always tried to ensure staff take their allocated breaks. Some ward managers and therapy staff we spoke with confirmed that they have had to request cover from other MDT members on occasions to ensure staff get rest breaks. The hospital did have staff room facilities as well as on site cafes which staff were able to use.