St Andrews Healthcare Northampton

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last assessment we rated this key question as Good. This means we looked for evidence that the service met people's needs.

At this assessment the rating has changed to requires improvement. This meant people's needs were not always met. One carer told us the carer's package is out of date and has not been updated. Leaflets are stored but not shared and they feel not listened to. Carer's are not allowed to visit patients in their rooms and some carer's do not get invites to meetings with the care co-ordinator. On Sitwell ward, although multidisciplinary team (MDT) progress notes were shared and included regular reviews and invites for the local team to attend, we observed, minutes and actions following professionals meetings were not always recorded, and ongoing discharge plans were unclear.

However, on other wards patients told us they understood their care plans, goals and needs. Patients felt confident in their treatment and understood their medicines and their side effects. On Berkeley close one patient told us their family can come whenever the patient likes but cannot come in, just to pick up. Feedback from patients regarding access to the community and meeting friends and family was positive.

Patients told us they were supported into work such as working with the chefs, ground maintenance, volunteering, cooking and using transport.

We have not awarded this service a score for Responsive.

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

The service did not always make sure people were at the centre of their care and treatment choices and to decide, in partnership with them, how to respond to any relevant changes in their needs.

Some carers we spoke to told us they were not always kept up to date with their relatives planning and decisions about their care and treatment. They told us the carer's package was out of date too.

Carers told us they communicated with staff what they needed but this still didn't lead to any improvements. One carer told us they would like to know who the staff and management team were and to be introduced, but the Carer was not aware and not told.

However, most patients we spoke with told us they were involved in their care planning but they did not always want their carer involved in this process.

Carers told us they were not allowed to visit patients in their rooms and felt concerned at not knowing the environment their family member spent time in. One parent told us ` they wanted to view their relatives room when they couldn't see other patients anyway, but they said it was all excuses made by staff.'

Some carers told us they didn't get invites or had not been made aware of meetings. They said if they knew they would have attended. Carers told us most people need to travel and make arrangements prior to the visit for a meeting, so would need time to prepare, but they were either not given the information or there was not enough notice.

Some carer's told us that care was not always person-centered and they didn't feel involved in discussions about their relatives needs. However, one carer told us they raised the issue about not being informed and since then the service had involved them in meetings and discussions about the care and treatment of their relative.

On Berkeley house patients told us they understood their care plans, goals and needs. They also felt confident in their treatment and understood medicines and their side effects.

On Berkeley Lodge, one patient told us it was clean and tidy and that it felt like their home. The patient said they had independence and their doctor promoted their independence. The patient could leave the ward unrestricted and also go for a walk. The patient said they were happy to stay there or in their own flat. However, they sometimes felt unsafe at night.

The service understood the diverse health and care needs of people and the local communities, so care was joined-up, flexible and mostly supported choice and continuity.

The service worked with local health providers, including healthcare specialists and the GP’s to ensure patients received continuous care for their physical health. On Berkeley Close, patients said their care and treatment was delivered in a way that met their needs from services that were coordinated and responsive. They said their family were involved for continuity.

There was positive feedback from patients having access to community and seeing friends and family.

Staff supported patients to go into work (such as a chef, grounds maintenance), volunteering, cooking, and using transport. Patients were supported by staff to go exercising, swimming etc. and utilise the education facilities on site as well as having access to work opportunities e.g. the café.

The service did not always provide appropriate, accurate and up-to-date information in formats that they would tailor to individual needs.

One carer we spoke with raised a number of concerns about Berkeley Lodge. They said there was either lack of information or no updates communicated with them. They stated that the service got rid of the carer’s staff for the centre and wouldn’t allow carers to complete the carer newsletter, as they felt leaders were concerned about what the carers would say.

There were information and posters on the notice boards which included CQC information, advocacy, complaints process, chaplaincy, healthy eating and BMI, meet the team and ward monthly menu’s. However these were not available in easy read format. We also saw an informal patient notice at the front door of wards.

We saw evidence of a care plan that was pictorial, to meet the requirements of the patient.

The service did not always make it easy for people to share feedback and ideas or raise complaints about their care, treatment and support. They mostly involved them in decisions about their care and tell them what’s changed as a result.

Patients utilised community meetings and raised concerns with managers. Patients received feedback from managers. Patient surveys were requested but not provided by the service for our review, as these were not broken down by wards. Data requested from the provider stated, 'to check community meeting minutes,' but when checked, they weren’t fully representative of the patient voice data or action plans. For example, on Berkeley Lodge patients raised concerns about the issues with the TV connection and installations, however it had been 2 years and still had not been resolved.

There were no complaints or compliments recorded across all of the wards for long stay rehabilitation. Patients knew how to complain or raise concerns.

Advocacy was available and utilised by patients.

The service mostly made sure that everyone could access the care, support and treatment they needed when they needed it.

The service ensured patients could expect their care, treatment and support to be accessible, timely and in line with best practice, quality standards and legal requirements including those on the equality and human rights. This included making reasonable adjustments for disabled people, addressing communication barriers and having accessible premises.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospital was close to the local acute hospital. We saw care records with evidence of good physical health management, including during deterioration e.g. if a patients’ NEWS score is high, they would be taken to the local acute hospital. There was evidence of good communication with the local acute hospital.

The service provider actively seeked out and listened to information about people who are most likely to experience inequality in experience or outcomes. The service tailored the care, support and treatment in response to this.

The service, staff and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Staff had various ways in which to raise any concerns such as staff surveys, freedom to speak up guardians and a confidential service called ‘Safe call.’ However, staff didn’t always feel listened to, respected, supported and valued. Where staff had raised concerns to senior managers, they did not always feel listened to and to support them to deliver person centred, quality care.

Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people using their services, whether from wider society, organisational process and culture or from individuals. However, the service did not always proactively seek ways to address barriers to improve patients’ experience and act on information about patients experiences and outcomes. For example, there were no female staff to support patients access to the toilets on Silverstone Ward and there were lack of improvements made following concerns raised by patients and staff at community meetings. However, the service allocated resources and opportunities to achieve equity. For example, the service showed equity and respect for a new admission who was catholic, and a chaplaincy referral was sent to meet their cultural and religious needs.

Staff were trained in equality, diversity, inclusion and human rights.

The service mostly supported people to plan for important life changes, so they can have enough time to make informed decisions about their future.

Staff supported patients to make informed choices about their care and plan their future. We found evidence of discharge planning in care records and patient involvement.

Overall, the service mostly implemented a recovery and rehabilitative approach in collaboration with patients. Patients told us they were supported to develop their skills and work towards increased their independence and involvement in the community.

We observed a care record on Sitwell ward which included MDT progress notes, regular reviews and invites for the local team. However, actions following meetings were unclear and ongoing plans were also unclear.

On Berkeley Lodge patients told us they were involved in their discharge planning and these were discussed with the doctor. We reviewed care records which were positive and evidenced patient involvement in discharge planning. There was evidence of good co-production and most patients understood their condition, care and treatment options during interviews. Goals were individualised and we saw a pictorial care plan for one patient.

At Watkins House there was evidence of patients being at a higher risk. We saw care plans where the service had faced challenges to facilitate a patients discharge and made attempts to resolve the pathway.

There was evidence in care plans of person centred care planning and the appropriate interventions being implemented and reviewed. However, MDT assessments had limited evidence of patient views and involvement. There was less OT input at Watkins ward and patient risks were noted to be high. However, we saw evidence of Cognitive Behavioural Therapy (CBT) input from psychologists and psychology notes in care records.

Discharge planning lacked review and acknowledgement of treatment goals on Watkins House. For example discharge plans often stated that the ward remained appropriate and the patients were not ready for discharge. There was a lack of evidence of rehabilitative and recovery approaches in follow up to this statement.