St Andrews Healthcare Northampton

Ratings - Services for people with acquired brain injury

• Overall

  Good

• Safe

  Requires improvement

• Effective

  Good

• Caring

  Good

• Responsive

  Good

• Well-led

  Good

Our view of the service

This assessment of services for people with acquired brain injury at St Andrew’s hospital Northampton took place in March and April 2025. St Andrews Hospital Northampton is an independent hospital run by St Andrews Healthcare Limited, which is a registered charity. The charity provides specialist mental health care, to meet the needs of people with psychiatric illness, developmental disability, acquired brain injury and related disorders. The assessment was carried out to ascertain whether concerns raised following an assessment in August 2024 had been addressed.

This assessment covered services for people with acquired brain injury. During this assessment, we focused on a sample of 4 out of 10 wards at St Andrew’s Hospital Northampton that admitted patients with acquired brain injury. These were:

• Elgar Ward admitted up to 12 female patients for rehabilitation.
• Allitsen Ward admitted up to 14 male patients for continuing care and rehabilitation.
• Tallis Ward admitted up to 11 male patients for acute care and stabilisation.
• Walton Ward admitted up to 14 male patients with Huntington’s disease.

We also assessed 2 houses at 19 The Avenue and 38 Berkeley Close that provided community facing rehabilitation for 2 patients. Patients were admitted to the service from across the United Kingdom.

The service was registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983.

There was no registered manager in post at the time of the inspection.

We rated this service as good. The service had made improvements. The service managed risks well through comprehensive assessments, personal behaviour support plans and daily safety huddles. Staff assessed patients’ needs and provided appropriate care and treatment. Care plans reflected patients’ individual needs. Staff treated patients with kindness compassion and dignity. They understood patients’ needs, aspirations and preferences. They offered patients choices and encouraged patients to make decisions about their daily lives. Leaders were visible and engaged with staff at all levels. Ward managers actively sought to address the risks associated with closed cultures. Staff felt confident to raise concerns. Clinical governance meetings provided a thorough oversight of performance within the service. Staff made good use of data to identify trends and inform clinical decisions.

The service had conducted extensive recruitment to increase the number of staff working on each ward. There were now sufficient staff to meet patients’ needs.

We found one breach of regulation in relation to safeguarding.

Patients had restricted access to drinks, food and vaping. On one patient’s record, we found that the reasons for this had not been included in the care plan. This meant that staff were failing to safeguard service users from abuse and improper treatment.

We have asked the provider for an action plan, setting out how they will address this matter.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

Most patients were detained for treatment under the Mental Health Act. A handful of patients were detained under the Mental Health Act by an order of the court or had been transferred from prison.

Staff received and kept up-to-date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Online training on the Mental Health Act was mandatory for all staff. The training covered the most frequently used sections of the Mental Health Act, the provisions of the Code of Practice, restrictions on patients, the role of the Ministry of Justice and information about where staff can go for advice.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. The organisation employed 6 Mental Health Act caseworkers and a senior caseworker who all provided advice and support for staff. Caseworkers regularly visited the wards, and staff knew how to contact them for advice.

The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. The service had developed procedures for the implementation of the specific sections of the Act. These procedures each included a checklist for staff to complete, in order to confirm legal compliance.

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 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. The Mental Health Act office sent reminders to staff to talk to

patients about their rights under the Act whenever a patient was admitted, when their period of detention was renewed, when there was a change to their section or when the requirements for consent to treatment changed. Each ward had a dashboard showing when staff last discussed each patient’s rights with them.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to. SOAD’s were requested by the patient’s 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. Typically, SOADs visited the hospital twice every month.

Staff stored copies of patients’ detention papers and associated records correctly and staff could access them when needed. Detention papers were uploaded to the electronic patient record. Original documents were stored in locked filing cabinets in rooms adjacent to the Mental Health Act Office.

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 Steering Group comprising of 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. For example, the team had recently conducted an audit of certificates authorising treatment without consent to ensure they were being reviewed by clinicians.

Mental Capacity Act

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.

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.

People's experience of this service

Patients said staff treated them well and behaved kindly. Most patients spoke positively about staff. These patients said that staff were nice and that they were good friends. A small number of patients were more negative. One patient said at times they felt ignored. Some patients had profound communication needs which meant we were unable to discuss their experiences of being in hospital. These patients appeared to be happy. They were engaged in activities such as watching television, tidying their room or sitting in the garden. One patient was able to give short responses to prompts. He said he was having a good day. Interactions with staff appeared positive. Staff spoke to patients in a kind and gentle manner. One member of staff was playing football with a patient, which they were both enjoying.