St Andrews Healthcare Northampton

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There was a positive approach to safety. Staff reported incidents. Incidents were investigated and learning from these incidents was used to develop good practices. There was a strong understanding of safeguarding, and effective systems to ensure people were protected from abuse and neglect. Risk assessments were person centred, proportionate and regularly reviewed. Restraint was only used as a last resort. The service was recruiting to increase the number of permanent staff. The service had appropriate systems and audits in place to manage the risk of infections. The effects of medicines were monitored, and people’s behaviour was not inappropriately controlled by medicines.

However, although the service had increased the number of permanent staff, the use of agency staff remained high. The ward environments appeared in need of modernisation. Staff had not included the reasons for restrictions on one patient’s care plan. This was a breach of regulations.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety based on openness and honesty, in which concerns about safety were listened to, safety events were investigated, reported thoroughly, and lessons learned to continually identify and embed good practices.

Staff knew what incidents to report and how to report them. The provider had a comprehensive Patient Safety Incident Response Policy. Staff reported incidents on an electronic incident reporting system.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation when things went wrong. When incidents occurred, staff wrote to family members with details of the investigation they were conducting and giving an assurance that the service was committed to full transparency .

Managers debriefed and supported staff after any serious incident. Managers maintained a good oversight of incidents. Incidents were discussed at the daily safety huddle on each ward. These meetings provided an opportunity for managers to debrief and support all staff. More serious incidents were escalated to the daily divisional safety huddle. During our inspection, a member of staff sustained an injury during an incident. All managers in the division were aware of the incident. The ward manager had spoken to the member of staff about how they were feeling and whether they needed time off work.

Managers investigated incidents thoroughly. Patients and their families were involved in these investigations. Investigations were proportionate to the nature of the incidents. Records of any incidents classified as, or above moderate harm were automatically escalated to a central team within the hospital. Staff investigated incidents on the wards and discussed their findings at multidisciplinary team meetings.

Staff received feedback from investigations of incidents, both internal and external to the service. For example, managers circulated bulletins to all staff providing details of lessons learned from incidents. Staff discussed incidents and lessons learned in team meetings.

Staff met to discuss the feedback and look at improvements to patient care. The wards held regular sessions with staff, facilitated by a clinical psychologist, to discuss incidents and lessons learned. This included discussions about incidents on that ward, and more serious incidents across the organisation. Quality matrons regularly sent staff information about incidents and lessons learned in an email bulletin. The multidisciplinary team discussed and monitored trends in incidents at monthly clinical supervision meetings.

There was evidence that changes had been made as a result of feedback and investigations. For example, an investigation into a serious incident in another division of the organisation had identified concerns about the use of enhanced observations at five-minute intervals. Staff had immediately conducted a review and found only one patient within the division on that level of observation. The division agreed a point of action that if any patient remained on five-minute observations for more than 48 hours, an independent clinical review would be required.

The service worked with people and partners to establish and maintain safe systems of care, in which safety was managed, monitored and assured. The service ensured continuity of care, including when people moved between different services.

Staff and patients told us that they felt safe on the ward. At our last inspection, staff raised many concerns about them not feeling safe, being moved between wards during shifts and being taken off enhanced observations to provide personal care. At this inspection, staff told us there had been considerable improvements in the number of staff working on each ward and this had meant the wards felt safer. Patients said there was enough staff and there was always someone to talk to.

Observations of patients were carried out in accordance with the organisation's policies and procedures. The level of support ranged from general support, involving checks every hour, to continuous enhanced support within arm’s reach with up to 4 members of staff. The policy stated that intermittent enhanced support be carried out at unpredictable intervals, for example not at quarter past or half past the hour. Staff entered observation records onto an electronic tablet. Data was collated on a dashboard to enable senior staff to assess the compliance of observations with the policy.

Staff referred patients to other services if those services were more appropriate for the patient. For example, staff on Walton Ward were considering a placement on a medium secure neuropsychiatry ward for a patient whose mental health had deteriorated.

Patients did not stay on the wards longer than necessary. Tallis ward was an admission ward, focusing on acute care and supporting patients to achieve stabilisation. Eight of the 11 patients had been on the ward for less than 6 months. Most patients moved along a care pathway towards providing rehabilitation and continuing care. Three patients had been on Tallis for more than 2 years. This was due to difficulties in achieving stabilization or finding alternative placements. Staff on Allitsen ward commented that there had been a change in the ward culture, and that staff were now more pro-active in arranging for patients to move on. On Elgar ward, staff had an understanding of the accommodation or placement that each patient would require when they left. One patient had recently been home on leave for a week in preparation for a permanent discharge. For one patient, a specialist care home was being built for them in their local area.

The service worked with people to understand what being safe means to them as well as partners on the best way to achieve this. The service concentrated on improving people's lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. However, there was scope for improvement in how staff recorded restrictions on one patient's care plan.

The provider had a `least restrictive practice policy' dated November 2024 to promote the reduction of restrictive practices. This policy stated restrictions should only be applied for the shortest possible time. Each ward maintained a restrictive practice log. This log included the reasons for the restriction and an action plan to eliminate or reduce the restriction. All restrictions were overseen by the divisional multi-disciplinary team. However most restrictions had been there for several months/a year with no amendments to any restrictions despite several reviews. On Walton Ward, there were restrictions in place for the times that all patients were permitted to smoke in the ward garden under staff supervision. This was every hour from 6am until midnight. Not all patients were able to freely access hot and cold drinks and snacks across all wards when they wanted, without having to ask staff, who may not be able to fulfil a patients request immediately. The service should ensure that restrictions placed on patients are individually risk assessed and not blanket across the ward. We found one instance where the care plan was not consistent with the requirements of the restrictive practice log. For example, on one ward, restrictions on vaping could be imposed based on care planning and capacity assessments, but there was no reference to this in the relevant care plan. We were concerned there was not always a therapeutic or clinical risk need for the application of these restrictions and that the least restrictive principle was not always applied. These blanket restrictions may be degrading for patients, some of whom had been on the wards for several years.

Staff received training on how to recognise and report abuse, appropriate for their role. The organisation had a comprehensive policy on safeguarding vulnerable adults and children. On average, staff across the neuropsychiatry division raised 21 safeguarding referrals each month. The number of referrals had been above average since April 2024, reaching a peak of 34 referrals during February 2025. Staff said this increase was the result of enhanced awareness among staff, following the introduction of the role of `safeguarding navigator' on each ward.

Staff kept up-to-date with their safeguarding training. The service required all registered nurses to complete training on safeguarding to level 3. Other staff were required to complete safeguarding for children, young people and adults to levels 1 and 2. Compliance with safeguarding level 3 was 100%. Compliance with levels 1 and 2 was above 90%.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act 2010. All staff completed training on equality, diversity and human rights.

Staff knew how to recognise adults at risk of suffering harm and worked with other agencies to protect them. Social workers referred safeguarding matters to the local authority. They said that staff at the local authority had a good understanding of the needs and complexity of patients. The lead social worker kept track of all matters that had been referred to the local authority. They monitored the progress and outcomes of any investigations by the local authority and discussed this with colleagues at a weekly divisional safeguarding meeting. Overall, staff felt the process was robust and were confident that safeguarding concerns did not get hidden. Staff also gave examples of where measures had been introduced to safeguard patients following incidents.

Staff followed clear procedures to keep children visiting the ward safe. Visits from children were facilitated off the wards and there was a large room in the café that was used for these visits.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. For example, staff told us they had raised concerns about conflict between patients. This included informing their managers, recording the incident and making a safeguarding referral. Safeguarding referrals were sent to the local authority and, when necessary, referred to the police. The service had introduced the role of a safeguarding champion on each ward. Safeguarding champions had completed the safeguarding navigator training programme. Social workers and ward managers investigated all allegations made about staff. Investigations included interviews with staff, patients and reviews of records. Staff invited an advocate to meet with any patients who made an allegation.

Managers took part in serious case reviews and made changes based on the outcomes. However, there had not been any serious case reviews within the division recently.

The service worked with people to understand and manage risks by thinking holistically so that care met their needs in a way that was safe and supportive and enabled them to do the things that matter to them.

Staff completed risk assessments for each patient on admission, using a recognised tool, and reviewed this regularly, including after any incident. All patients received a comprehensive risk assessment on admission to the ward. Patients on Walton ward presented a particularly high risk of falls and choking. These patients received a specialist risk assessment completed by a physiotherapist or speech and language therapist. These assessments were reviewed an updated after any incident involving a fall or choking. Staff reviewed these assessments at ward rounds and typically updated them every month.

Staff used a recognised risk assessment tool. Staff across the service used the Short-Term Assessment of Risk and Treatability tool to assess patients’ risks. They also completed a personal behaviour support plan for each patient. Staff completed a Historical, Clinical and Risk Assessment – 20 (HCR-20) for patients with a risk of violence or a history of offending.

Staff knew about any risks to each patient and acted to prevent or reduce risks. Handover meetings took place at the start of each shift. Each ward held a daily safety huddle. During these meetings staff discussed incidents, falls, self-harm, staffing, patients with heightened physical health observations, patients receiving treatment at the general hospitals and safeguarding. Concerns raised at these meetings were escalated to the divisional safety huddle that took place immediately afterwards. This meant that senior staff were aware of any patients who may be deteriorating and any other issues on the wards. During our inspection, we attended a divisional safety huddle. The meeting was well-run with reference to data and dashboards throughout. This enabled staff to discuss a considerable amount of information in a short period of time. Physiotherapists provided equipment to patients to reduce the risks of falls. Speech and language therapists created dysphagia care plans for all patients at risk of choking. Staff supervised meals to ensure these care plans were implemented.

Staff identified and responded to any changes in risks to, or posed by, patients. Any changes to a patient’s presentation were discussed in multidisciplinary team meetings. Staff responded to changes in risks presented by patients by changing the level of observation and reviewing medication. Some wards employed a registered general nurse to assist the team in managing patients’ physical health. Staff monitored patients’ vital signs each day.

Levels of restrictive interventions were monitored closely by managers. In the 3 months from December 2024 to February 2025, staff on the 4 wards covered by the inspection had reported 629 incidents. This included 209 instances of restraint, 64 instances of self-harm, 41 instances of rapid tranquilisation and 13 instances of seclusion. The frequency and type of incidents varied between the wards. Elgar ward provided care and treatment for female patients. This ward accounted for 37 of the 41 incidents involving rapid tranquilisation and 60 of the 64 incidents involving self-harm. Although seclusion had not been used on Elgar, one patient had been placed in long-term segregation for 3 weeks. There had been 6 instances of seclusion on Tallis Ward and 6 on Walton Ward. The service very rarely used prone restraint. The service had not used prone restraint since March 2024. One patient wore mittens to minimise the impact of any instances of aggression. This measure had been risk assessed by the multidisciplinary team, and care planned by an occupational therapist.

Staff participated in the provider’s restrictive interventions reduction programme. The service had introduced a least restrictive practice policy in November 2024. Managers on Tallis and Walton Wards were considering changes to the ward environment to enable a reduction in restrictive interventions, such as seclusion. On Tallis Ward, the service was planning a sensory de-escalation room as an alternative to using the seclusion room. Walton Ward was considering building an extra care unit where patients could be nursed instead of being transferred to the medium secure unit.

Staff made every attempt to avoid using restraint by using de-escalation techniques and restrained patients only when these failed and when necessary to keep the patient or others safe. For example, a doctor commented that staff always attempted to de-escalate situations before administering medicine prescribed on an ‘as required basis.

Staff usually followed national guidance when using rapid tranquilisation. Staff ensured that patients were placed on enhanced observations after receiving rapid tranquilisation and usually carried out checks of the patient’s vital signs. Staff usually recorded these checks on a specific form and within the progress notes. However, the records for some patients who had recently received rapid tranquilisation did not include an appropriate record of post-rapid tranquilisation physical health observations. The service should ensure that all observations following rapid tranquilisation are recorded in a manner consistent with national guidance.

The service detected and controlled potential risks in the care environment. They made sure that the equipment, facilities and technology supported the delivery of safe care. However, the environment on some wards needed updating.

Staff could observe patients in all areas. Wards were large and spacious. Most wards had a high staff to patient ratio, usually with at least an equal number of staff and patients. This meant that there were sufficient staff to easily observe patients in all parts of the wards.

Staff completed and regularly updated thorough risk assessments of all ward areas and removed or reduced any risks they identified. The provider had completed a health and safety risk assessment for each ward. These assessments included details of mitigations to address the risks. Staff conducted an environment safety check of each ward as part of each shift. A more comprehensive audit of ward environments was completed each month by a specialist team. All actions from these audits were recorded and monitored on a ward action log.

The ward complied with guidance and there was no mixed sex accommodation. All the wards admitted only male or female patients.

Staff knew about any potential ligature anchor points and mitigated the risks to keep patients safe. The provider completed a ligature risk assessment for each ward. These assessments were reviewed every 12 months. The assessments were stored in the nurses’ offices. All staff were encouraged to familiarise themselves with the location of ligature risks. Ligature cutters were stored in locked boxes throughout the wards. Senior staff had reviewed the arrangements for managing ligature risks at the divisional governance meeting in February 2025. The meeting agreed to conduct follow-up work to ensure all appropriate checks were in place. However, on Allitsen Ward, the ligature ‘heat map’ for staff indicated that bedrooms were medium risk, whilst the risk assessment indicated they were high risk. This could cause confusion for staff.

Staff had easy access to alarms and patients had easy access to nurse call systems. Staff carried alarms at all times. The service had installed nurse call buttons in patients’ bedrooms and throughout communal areas of the wards.

Ward areas were clean, well maintained, well-furnished and fit for purpose. Overall, the wards were reasonably clean and well maintained. When repairs took longer than expected, the concerns were escalated to senior managers for investigation. However, the quality of the internal decoration on some wards appeared outdated, and there was scope for some improvements to environments to make wards appear fresher and brighter. Some staff commented that wards could be more homely and that some of the rooms were outdated. Premises at 19 The Avenue and 38 Berkley Close were houses situated in a quiet residential area near to the hospital. Both houses had accommodation for up to 2 patients. These houses provided a comfortable and homely environment.

The seclusion rooms allowed clear observation and two-way communication. They had a toilet, clock and natural daylight. The facilities were compliant with the requirements of the Mental Health Act Code of Practice.

Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff checked regularly. Resuscitation equipment was stored in a bag in the clinic room. This was checked by registered nurses each week. Some clinic rooms did not have an examination couch. If patients required a medical examination, this would be carried out at the GP practice on the hospital site.

Staff checked, maintained, and cleaned equipment. Each clinic room had equipment to measure blood pressure, blood glucose levels, weight, height and oxygen saturation. All the equipment was labelled with stickers showing when it had last been cleaned and calibrated.

Each patient had their own bedroom, which they could personalise. All patients stayed at the hospital for long periods of time, typically around 2 years. Patient rooms provided a homely environment which patients personalised with posters, personal possessions and family photographs. On some wards, some bedrooms had ensuite facilities.

Patients had a secure place to store personal possessions. Patients could store their possessions in their room. Valuable possessions could be stored in locked facilities on the ward.

Staff used a full range of rooms and equipment to support treatment and care. All wards had bedrooms, dining rooms, meeting rooms, activity rooms and communal areas. Bathrooms were fitted with hoists and other adaptations for patients with physical disabilities. All areas of the wards were spacious and able to accommodate wheelchairs. On Walton ward, staff were seeking to use their space more creatively by using one room to recreate the environment of a pub.

The service had quiet areas and a room where patients could meet with visitors in private. Visits to the wards were facilitated in a manner that ensured the safety of visitors and patients. Wards had designated rooms for visitors. On Tallis Ward, staff used a room with external access. The hospital was able to provide accommodation for visitors who had travelled long distances.

Patients had access to outdoor space. Each ward had its own garden. Whenever possible, staff accompanied patients on leave around the hospital grounds.

The service made sure there were enough qualified, skilled and experienced people, who receive effective support, supervision and development and worked together effectively to provide safe care that met people's individual needs. However, some wards frequently used agency staff and relied on staff working overtime.

The service had enough nursing and support staff to keep patients safe. During our last inspection in August 2024, we found there were insufficient staff to ensure safe care and treatment. At this inspection, the number of staff on the wards had increased. For example, on Tallis Ward, the number of healthcare assistants assigned to the ward had increased from 13 to 16. In order to accommodate the increase in the establishment, the ward were recruiting 15 additional healthcare assistants. Staff on Walton ward said they had not been short staffed since November 2024. Staff said the increase in staffing numbers meant they could plan personal care for patients more easily to ensure that personal care was only provided by permanent staff.

The service had reducing vacancy rates. Each ward was either fully staffed or was actively recruiting new staff. Across the division, 60 additional members of staff were being recruited to enhance staffing levels on all the wards. At the time of the inspection, the service had sent out job offer letters to 52 applicants.

The service frequently used bank and agency staff. At our last inspection in August 2024, we found that 19% of shifts were filled by bank staff and 9% were filled by agency staff. The service had embarked on an extensive programme to recruit 60 new permanent members of staff to address this. However, between December 2024 and February 2025, the use of agency staff across Elgar, Tallis, Walton and Allitsen wards was 20%. Elgar ward had higher use of agency at 29%. The service was also heavily dependent on staff carrying out overtime. During this period, overtime accounted for 19% of staff on duty. Staff on Elgar ward said that high use of agency continued to be a challenge and this put pressure on the permanent staff. This meant that, whilst there had been considerable work to increase the number of permanent staff, the new staffing arrangements had not yet been imbedded into practice.

Managers limited their use of bank and agency staff and requested staff familiar with the service. Ward managers always tried to make block bookings of agency staff and requested staff who had previously worked on the ward.

Managers made sure all bank and agency staff had a full induction and understood the service before starting their shift. Bank staff had access to all training delivered through St Andrew's online training programme. When agency staff joined the service, they received informal training on the management of patients at risk of falls from a physiotherapist. Agency staff said that they completed training in acquired brain injury provided by their agency.

Ward managers could adjust staffing levels according to the needs of the patients. For example, on Walton Ward, the number of healthcare assistants varied during the day to ensure there were sufficient staff to assist patients with personal care. Wards were also assigned an additional healthcare assistant on the day of the ward round.

Patients rarely had their escorted leave or activities cancelled. Staff facilitated leave and activities with patients as part of their care and treatment. These activities were incorporated into the staff allocations at the start of each shift.

The service had enough staff on each shift to carry out any physical interventions safely. There was a high staff to patient ratio on each ward, usually leading to there being at least one member of staff for each patient. This meant there were plenty of staff to assist with physical interventions safely. When patients required additional staff for personal care, staff were assigned to this role through the shift allocations.

Staff shared key information to keep patients safe when handing over their care to others. Staff held a handover meeting at the start of each shift. Staff were required to sign the notes of these meetings to show they had read them.

The service had enough daytime and nighttime medical cover and a doctor available to go to the ward quickly in an emergency. Duty cover was available for the whole hospital. Two speciality doctors were on duty between 5pm and 11pm. One specialty doctor was on duty overnight. Outside of office hours, a consultant was on-call. In the event of a medical emergency, staff would contact emergency services.

Staff had completed and kept up-to-date with their mandatory training. Compliance with mandatory training was above 90% on all wards. Over 90% of staff had completed each of the mandatory training courses. Compliance with mandatory training on immediate life support and personal behaviour support (PBS) planning was 100%.

The mandatory training programme was comprehensive and met the needs of patients and staff. This included training on safeguarding, immediate life support, infection control and Oliver McGowan training on learning disability and autism. Some mandatory training was specific to the needs of patients within the division, such as mandatory training on falls.

Managers monitored mandatory training and alerted staff when they needed to update their training. The service collected data on compliance with mandatory training. This data was available for managers. Compliance with mandatory training was monitored through the clinical governance process.

The service assessed and managed the risk of infection, detected and controlled the risk of it spreading and shared any concerns with appropriate agencies promptly.

Staff made sure cleaning records were up-to-date and the premises were clean. Cleaning schedules and checklists were kept on the premises. These documents were checked as part of the monthly infection prevention audit for each ward.

Staff followed infection control policy, including handwashing. The service had an infection prevention and control policy. The service displayed instructions on hand washing in toilets. Compliance with the requirements for hand washing was checked during the monthly audit. In February 2025, all wards scored 100% in that part of the audit. All staff were required to complete mandatory training on infection prevention and control every year. Ninety-six percent of staff on the wards we inspected were up to date with this training.

The service ensured that medicines and treatments were safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely. The service monitored medicines errors closely. There had been only one medicines error across the neuropsychiatry division in February 2025, and no more than 3 in any of the months since July 2024. The hospital pharmacy department completed audits of medicines held in clinic rooms each month.

Staff reviewed each patient’s medicines regularly and provided advice to patients and carers about their medicines. Multidisciplinary teams conducted a thorough review of each patient’s medication at ward rounds.

Staff completed medicines records accurately and kept them up-to-date. Staff completed medicines administration records.

Staff stored and managed all medicines and prescribing documents safely. Controlled drugs were stored, and records kept, in accordance with national guidance. Fridge and room temperatures were monitored each day. These temperatures were within the recommended range. Sharps bins were available and indicated the date on which they were opened.

Staff reviewed the effects of medication on patients’ physical health regularly and in line with National Institute of Health and Care Excellence (NICE) guidance, especially when the patient was prescribed a high dose of antipsychotic medication. On Walton ward, 3 patients were receiving doses of medication above the limits recommended in the British National Formulary (BNF). The medication for these patients had been approved by a second opinion appointed doctor (SOAD). Staff monitored the effects of this medication in accordance with the providers policy, through electrocardiograms, blood tests, glucose tests and checks of cholesterol levels.

Staff learned from safety alerts and incidents to improve practice. The quality matron circulated Patient Safety Action Notices to all staff.

The service ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines. The service sought to manage impulsive and aggressive behaviour through positive behaviour support plans. Whilst some incidents did lead to patients receiving medication, prescribed on an as required basis, staff sought to avoid using medicine that would restrict patients and cause them to feel sedated.

Staff reviewed the effects of each patient’s medicines on their physical health according to NICE guidance. Staff monitored and recorded patients’ vital signs each day. The multidisciplinary team reviewed the effects of medicines at ward rounds held at least once a month. Staff conducted additional monitoring through blood tests, tests of sodium and potassium levels and electrocardiograms when required.