Archived: St Andrews Healthcare Northampton

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The service had a shared vision and strategy that was communicated well to staff. Staff understood the organisational values. Leaders were experienced in worked with patients with acquired brain injuries. They were visible on the wards and were pro-active in engaging with staff at all levels. Staff said they felt confident to raise concerns, if they identified poor practice. Managers took positive steps to address the risks associated with closed cultures. The service took steps to be inclusive and support staff to address racism. The service had effective systems for clinical governance and made very good of data in clinical decision making. Staff engaged well with commissioners and other organisations that supported people with brain injuries. The service was involved in improvement programme and had achieved accreditation from national brain injury associations. We found no breaches of regulations in relation to this key question.

We have not awarded this service a score for Well-led.

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

The service had a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and communities.

Staff felt that the service had made considerable positive progress since the last CQC inspection in August 2024. Most staff commented that staffing had improved and that there was more stability in multidisciplinary teams.

St Andrew’s guiding principles were compassion, accountability, respect and excellence. These values were frequently set out in documents relating to the running of the service. These principles were incorporated in a strategic plan for staff entitled “Your guide to getting to good.” The programme of work was widely publicised in colourful and engaging literature.

Staff had been involved in strategic planning exercises to discuss short-term and long-term objectives. Staff recognised that the division was striving to improve and were keen to be involved in that.

Staff acknowledged that, at times, their work could be very challenging. They explained that many patients had complex needs and conditions characterised by impulsive and potentially aggressive behaviours. However, all staff said they responded to patients with care and kindness. Staff took pride in patients being able to sustain an improved quality of life during and after their admission.

The service conducted an annual survey of the views of staff. The last survey was carried out in June 2024. The results varied considerably between the different wards. The overall engagement score for Allitsen was 82%, although this fell to 59% for Tallis and 46% for 19 The Avenue and 38 Berkley Close. Questions about fairness in career progression and being valued by line managers received consistently high scores over 80%. Questions about being valued by the provider and senior managers acting on feedback received low scores of between 25% and 50%.

Staff said there were opportunities to develop within the organisation. Many staff had worked at St Andrew’s a long time, in many cases over 20 years. Many senior staff said they had started at St Andrew’s as a healthcare assistant and worked their way up to more senior roles.

The provider recognised staff achievements through annual awards. Individual staff and teams within the neuropsychiatry division had been nominated for their care and compassion towards patients.

The service had inclusive leaders with the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

The senior leadership of the division comprised of a service director, an associate director of nursing and a clinical director. These leaders were pro-active in engaging with staff at all levels through weekly emails to staff, monthly newsletters, coffee mornings for staff and participating in staff training. Ward managers frequently worked night shifts to ensure that night staff were a fully integrated part of the ward team.

Staff at all levels of the services said they found managers and the divisional leadership team to be helpful and supportive. Feedback was consistently positive. They said they received support from managers whenever they needed it.

Leaders had considerable experience. Ward managers were all registered nurses with extensive experience of working with patients with acquired brain injuries, both at St Anderw’s and within the National Health Service (NHS). All senior staff had a good understanding of their patients.

Staff felt there was a positive culture on the wards. They said that morale was high and felt well supported. Almost all the staff we spoke with said they enjoyed working at the service. All staff we spoke with said they would feel confident in raising concerns if they witnessed poor practice or poor attitudes towards patients. However, one member of staff told us that when they raised a concern, their name was disclosed to the person they raised concern about. This meant they would be very reluctant to raise a concern again. Information on how to contact the freedom to speak up guardian was displayed in all nurses’ offices.

The service presented a risk of closed cultures. For example, patients were highly dependent on staff, less able to speak up for themselves, subject to the long-term use of the Mental Health Act and stayed in hospital for many months or years. Ward managers and senior leaders actively sought to mitigate these risks. For example, managers ensured they were frequently present on the wards, conducted supervision and facilitated team meetings. On one ward, a new manager had been appointed to address dynamics in the staff team. This manager had changed the allocations of staff working day shifts and night shifts, introduced additional team meetings and ensured they were accessible for all staff. They worked one nursing shift each week, on either a day, night or weekend shift to ensure they had regular contact with all the staff. Senior leaders conducted out of hours visits to each ward once a month. Leaders felt confident that their quality and performance reviews, which took place within the clinical governance process, would identify any concerns about closed cultures.

The service worked towards an inclusive and fair culture by improving equality and equity for people who worked there.

Staff said there were initiatives in place to support their well-being. For example, the provider provided a trauma response service for staff who had been involved in serious incidents.

The provider had produced a diversity and inclusion report for 2023/24. The report provided data on how many employees were from minority groups, data on gender and ethnicity pay gaps, and analysis of grievance and disciplinary action classified by ethnic groups. The provider co-ordinated networks for staff from minority groups. Staff from black and minority ethnic communities said they were treated fairly and equally.

Staff from black and minority ethnic communities said they frequently received racism from patients, either as verbal abuse or physical aggression. Staff said they recognised that this was not always personal towards them and could be indicative of the patient’s mental state. However, staff discussed all instances of racism at daily safety huddles. If a member of staff felt targeted by a patient, they could report the matter to the police, and managers supported staff in doing so.

The service had clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support.

Each ward held a clinical governance meeting every month. These meetings were chaired by a consultant psychiatrist and attended by the multidisciplinary team. Each meeting followed a standard agenda covering incidents, key performance indicators, training, recruitment, safeguarding and feedback from patients and their families. More broadly, these meetings provided the opportunity for staff to consider what was going well and where improvements were needed. In February 2025, the service had reviewed and updated the format of these meetings to ensure alignment with the strategic objectives.

A similar meeting at a divisional level also took place every month. The meeting was attended by the divisional senior leadership and members of multidisciplinary teams across all the wards. The structure and agenda of the meeting was aligned to strategic objectives. Minutes of these meetings demonstrated good oversight and understanding of specific risks and challenges on the wards. For example, at the meeting in February 2025, staff discussed an increase in agitation, aggression and safeguarding concerns on a specific ward. Staff discussed the specific reasons for this and how the challenges could be addressed. Similarly, there was a discussion about an increase in acuity on another ward, and how this was leading to an increase in restrictive interventions. Quality improvements were agreed, and their progress was monitored at each meeting.

The provider made exceptionally good use of data to monitor performance and trends. The service monitored data using statistical process charts. These charts monitored performance over the last 2 years in relation to the average, the upper control level and lower control level. If data was outside the upper or lower control level, managers would investigate the reasons for that. For example, in November 2024, there was a spike of 484 incidents. This was close to the upper control level of 517. Managers investigated and concluded that this predominantly related to patients who had recently been admitted, and challenges in helping these patients to settle on the wards. This meant that although there were significant fluctuations in data, managers could identify anomalies and quickly escalate matters for investigation.

The service maintained a divisional risk register, including 21 risks. Risks rated as high related to safety of staff and patients, dysphagia, manual handling, staff alarms, staffing, enhanced support for patients and ward keys. The risk register provided details of each risk, measures in place to mitigate the risk and long-term actions to resolve the risk. The risk register was reviewed at clinical governance meetings. All actions were assigned a target date for completion.

The service understood its duty to collaborate and work in partnership, so their services work seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service worked closely with commissioners to ensure they kept up to date with patients’ progress.

A psychiatrist on Walton ward conducted a clinic on an honorary basis, at the National Huntington’s Disease clinic every 2 weeks. This enabled them to work alongside national experts in the disease with whom they could discuss research and developments in good practice. The psychiatrist said that St Andrew’s Healthcare Northampton was very supportive of this arrangement.

The service focussed on continuous learning, innovation and improvement across the organisation and the local system.

Staff carried out quality improvement initiatives using well-established methodology.

The service was involved in 17 research programmes. Four of these programmes were specific to neuro rehabilitation services. The division was involved in 4 research programmes. These included research into assessing sleep quality for people with dementia, risk profiling incidents for people with Huntington’s disease and using computer-based systems to provide meaningful cognitive activities. The other research programmes were being conducted in collaboration with other divisions.

Staff on the wards were able to give examples of where they had made changes to improve patient’s quality of life. For example, on one ward, they ensured that most patients’ clothes were washed on the ward, rather than sending them to the hospital laundry service. This meant there were fewer instances of clothes going missing.

The service had achieved accreditation by Headway, a brain injury charity, and the Huntington’s Disease Association.