Archived: St Andrews Healthcare Northampton

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question as requires improvement. At this assessment the rating has remained the same. This means we looked for evidence that people's care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This key question has been rated requires improvement. This meant the effectiveness of people's care, treatment and support did not always achieve good outcomes or was inconsistent.

The service did not always tell people about their rights around consent and respect these when they delivered care and treatment. We were unable to view evidence of consideration of consent and capacity in relation to the clinical treatment model and support level framework on Silverstone ward. Staff told us informal patients were subject to restrictions based on `informal patient contracts' and in line with the support level framework. We requested records of these from the service but were informed documentation such as contracts, consent, and capacity assessments were not available.

However, patients told us the OT sessions and DBT sessions were good and useful. There were a lot of activities and patients could sign up to courses such as food hygiene and computing to develop their skills. Patients were supported and encouraged to make healthier choices to help promote and maintain their health and well-being.

We saw evidence of lack of ongoing engagement in discharge planning and records of meetings on Sitwell Ward and future action plans were unclear. On Watkins ward patient's discharge planning records lacked review and acknowledgement of treatment goals.

The service was in breach of regulations for capacity and consent for care and treatment.

We have not awarded this service a score for Effective.

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

The service did not always make sure patients’ care and treatment were effective because it did not always assess and review their health, care, wellbeing and communication needs with them.

We reviewed 11 care records across the long stay rehabilitation wards. Staff completed a comprehensive initial assessment with MDT involvement and physical health was also explored.

We observed evidence of risk and incident discussion in the MDT meeting records and updates to care plans, for example updates after a fall. One care plan was last updated in January 2024 but we were unsure if it had been evaluated. However, there was evidence of an up-to-date PBS (positive behavioural support) plan and a list of patient perceived goals. We saw evidence of care plan interventions being implemented and reviewed.

One carer told us the care coordinator would attend MDT meetings even if they weren’t on the rota for it. Carers said they have a say in the meetings and were asked for their opinion too. Doctors, have always kept them informed.

One carer told us generally there isn’t much ‘get up and go and there doesn’t seem to be any positive future or purpose’ for patients on the ward. The carer told us the only reason their relative has good things happen is because of the carer’s involvement, support and discussion with the service to be kept informed.

Care records we observed showed evidence of medicine reviews and monitoring. This also included the impact of smoking status on clozapine. Physical health management was good, including during a patient’s sign of deterioration e.g. when a patient’s National Early Warning Score (NEWS) was high and they were taken to the acute Northampton General Hospital (NGH). We saw good communication with the hospital noted where necessary. We saw evidence of good physical health checks and referrals in records and from interviews.

The service planned and delivered patient’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Staff provided patients with care and support that was evidence based and in line with good practice and standards. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). These included medication and psychological therapies in the rehabilitation wards.

Staff supported patients to be involved in activities, training and work opportunities intending to help them acquire independent daily living skills. For example, on Berkeley Lodge, one patient worked at a café, completed peer support and was paid for grounds work at the service. On Silverstone ward there were guinea pigs in the garden that patients looked after and cared for.

We observed a music teacher on the ward facilitating a session in the activity room and patients were engaging well. The activity kitchen was available on Berkeley Close where both patients were self-catering as were 3 patients on Silverstone ward. Some patients were also self-medicating (administered their own medication in line with their prescription) and this was reflected in their care plans.

There was a full-time occupational therapist on Silverstone ward and there were many activities that patients could be involved in. The occupational therapists were also available at the houses as well. The DBT programme was offered to the patients and they also had access to the gym and swimming pool. Patients could complete a food hygiene course and carry out a computer skills course for their own development.

Staff completed physical health observations and recorded these on the patient’s NEWS chart following administration of rapid tranquilisation medicines, where required.

Staff supported patients when wanting to go on leave and there was good community access and transport links.

The service mostly worked effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

Staff held regular and effective multidisciplinary meetings. Care coordinators were invited and attended MDT reviews to support with discharge planning. Staff had access to the information they needed to appropriately assess, plan and deliver patients care, treatment and support.

Staff shared information about patients at effective handover meetings within the team (for example, shift to shift).

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation (for example, care co-ordinators, community mental health teams, and the crisis team).

On Sitwell ward the, MDT progress notes were shared and included a regular review and invites for the local team. However, actions following meetings were unclear and the ongoing discharge plan was unclear. There was limited evidence of engagement since the package of care at Sitwell was agreed.

The psychiatrist was unsure of the next steps but stated that the admission at Sitwell was not a long-term plan. The psychiatrist enlisted support of the tribunal judge to put pressure on the responsible provider.

The service supported people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives – for example, through participation in smoking cessation schemes and healthy eating advice. There was evidence of this on the ward boards to promote healthy living.

Staff encouraged patients to be involved in ward activities to help promote a healthy lifestyle, for example walking groups, sports activities and cooking healthy meals. The service also had good physical health care provided by the hospital.

The service mostly monitored patient’s care and treatment to continuously improve it and to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Leaders used recognised rating scales to assess and record severity and outcomes. Evidence showed the use of Recovering Quality of Life (ReQoL) and Clinical Global Impressions (CGI) to show patient outcomes and improvements. The ReQoL scale included activity, belonging, choice, hope, self-perception and well-being and the CGI showed the improvements and severity of patients in the form of a bar chart.

The service also received feedback from patients via the community meetings and patient survey results.

Ward staff and managers had limited knowledge on the outcome measures that were used in the service, and this was monitored by senior leadership.

The service did not always tell people about their rights around consent and respect these when they delivered care and treatment.

We were unable to view evidence of consideration of consent and capacity in relation to the clinical treatment model and support level framework on Silverstone ward.

We were told that informal patients complete an informal contract when they enter the programme and may be subject to restrictions in line with the support level framework. We asked for copies of these contracts, and consent and capacity assessments relating to the clinical treatment model and were informed that documentation was not available.

Following a serious incident in November 2024 involving an informal patient, an investigation and section 42 enquiry was completed. The outcomes and learning from this were added to the ward action log. This included a need for training around the care of informal patients, particularly in relation to clinical and risk needs for patients with EUPD and application of the support level framework. This training had not been completed and there was no proposed date at the time of inspection.

There was a lack of information relating to the care of informal patients within the clinical treatment model and consent policy. The leave section of the clinical treatment model and support framework did not include guidance or information around rights of informal patients. The provider stated that they were developing the relevant paperwork and processes for this.

The pre-admission and admission section of the clinical treatment model referred to a process of introducing patients to the clinical treatment model before they make a ‘commitment’ to DBT. We asked to view the DBT contracts but were informed that these were held by patients. The DBT commitment was described as ‘ultimately gain the patient’s explicit agreement to target problematic behaviours and commit to DBT for the period of a year.’

Staff on Silverstone ward did not always evidence a good understanding of consent and capacity. Staff were unable to describe how consent had been obtained and recorded, or when capacity assessments were completed. Staff referred to action being taken in patients’ ‘best interests’ on 2 occasions when discussing blanket restrictions, and had not referred to individual needs or capacity in relation to these actions.

However, on the other wards we saw evidence that when patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

We reviewed patient care records and found that consent to treatment records in relation to medicines were complete and up to date.