- Independent mental health service
St Andrews Healthcare Northampton
We have taken urgent enforcement action by imposing a condition on St Andrew's Healthcare's registration on 14 July 2025 to keep service users safe by restricting new admissions at St Andrew's Healthcare Northampton. We have also imposed a number of conditions on St Andrew's Healthcare registration on 10 November 2025 to require the provider to make improvements in the safety and quality of care provided relating to; staffing, ward environments, blanket restrictions, risk management, observations, incident management, governance and systems and processes.
Report from 4 February 2025 assessment
Contents
- Back to service
- Overall
- Acute wards for adults of working age and psychiatric intensive care units
- Forensic inpatient or secure wards
- Long stay or rehabilitation mental health wards for working age adults
- Services for people with acquired brain injury
- Wards for older people with mental health problems
- Wards for people with learning disabilities or autism
Ratings - Wards for older people with mental health problems
Our view of the service
St Andrew's Healthcare is a registered charity specialising in the assessment, treatment and rehabilitation of people with psychiatric disorders, including people with developmental disabilities. The providers’ vision is to be the national leader in specialist mental health care.
St Andrews Hospital Northampton has five service divisions. These are:
• Child and Adolescent Mental Health Services (CAMHS),
• Autism Spectrum Disorder and Learning Disability Division (ASD/LD)
• Medium Secure Division,
• Low Secure and Specialist Rehabilitation Division, Acute and Psychiatric Intensive care units,
• Neuropsychiatry Division.
This assessment looked at services for older people with mental health needs. We assessed 3 wards (Elm, Cherry and Aspen wards). Elm ward has 10 beds and is a specialist older adult service for males with complex dementia and / or progressive neurological conditions, who present with cognitive deficits.
Cherry ward has 12 beds and is a specialist older adult service for females with complex dementia and / or progressive neurological conditions, including Huntington's disease, who present with cognitive deficits.
Aspen Ward has 8 beds and is a specialist older adult Admission service for males with complex dementia and / or progressive neurological conditions, who present with cognitive deficits.
The service was last rated as Good in August 2017. The report was published following Care Quality Commission’s (CQC) previous inspection approach using key lines of enquiry (KLOEs), prompts and ratings characteristics. This assessment has been completed following CQC’s new approach to assessment; Single Assessment Framework (SAF).
This was an unannounced assessment, which means the service was not told an assessment was going to be taking place beforehand. During this assessment we looked at all quality statements across all 5 key questions. As we assessed all quality statements at this visit the current rating reflects the findings from this assessment.
We rated the service Inadequate. The provider was in breach of 5 regulations in relation to person-centred care (regulation 9), safe care and treatment (regulation 12), safeguarding (regulation 13), staffing (regulation 18) and good governance (regulation 17).
Patients were not receiving person centred care because staff were not effectively applying the providers chosen model of care ‘enhanced dementia care’. Positive behaviour support (PBS) plans and care plans did not contain all the information staff required to meet patients’ individual needs or in the way they preferred.
Staff did not consistently deliver safe care and treatment to keep patients safe. Not all patients were assisted with adequate food and fluid intake. Not all staff adhered to the provider’s enhanced observation policy. We saw poor management of risks in the environment, including infection prevention and control. The learning culture across the wards was ineffective.
Patients were not always protected from improper treatment because restrictions imposed across all 3 wards did not adhere to the ‘least restrictive principle’.
Leaders did not have a clear oversight of risk and quality monitoring on the wards. Governance processes were ineffective including seeking feedback from patients or establishing methods to gain an understanding of patient’s experience.
Staffing arrangements did not provide a sufficient skill mix or continuity of care, treatment and support. This had a significant negative impact on outcomes for patients and created barriers to staffs ability to provide good quality person centred care.
There was no registered manager in post at the time of the inspection.
Action we have taken
The provider was in breach of 5 regulations in relation to person-centred care (regulation 9), safe care and treatment (regulation 12), safeguarding (regulation 13), staffing (regulation 18) and good governance (regulation 17). In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.
This service is being placed in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.
Mental Health Act and Mental Capacity Act Compliance
Mental Health Act
Most patients were detained for treatment under the Mental Health Act 1983.
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. Compliance with this training was above 87% across all 3 wards. 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 the relevant and 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 to support legal compliance.
Patients had easy access to easy read information about their rights under the Mental Health Act. However, many patients had cognitive impairments which meant they had difficulties processing this information, so patients’ relatives were involved and consulted.
At the time of our inspection, changes were being made to advocacy service arrangements and there was some concern access to advocates would be reduced.
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. There were at times a delay in responses to these requests. There is a national shortage of SOAD’s so this was not within the provider’s control.
Staff stored copies of patients’ detention papers and associated records correctly and could access them when needed.
Managers and staff made sure the service applied the Mental Health Act 1983 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.
Mental Capacity Act
Staff received training about the Mental Capacity Act and understood the five principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law and compliance with this training was above 87% across all 3 wards.
Individuals capacity to make decisions was monitored and recorded at multidisciplinary team meetings. However, restrictions regarding access to snacks, use of ordinary cutlery and access to alcohol as described in the safeguarding quality statement within this report had been imposed without appropriate consent or rationale. We were concerned these decisions had not considered individual patients’ best interests as is required by the Mental Capacity Act 2005 and were imposed as a blanket restriction to keep patients safe from others with an identified risk. Staff did not adopt the least restrictive principle such as facilitating access to cutlery in safe way or developing a person-centred care plan in relation to eating and drinking needs.
People's experience of this service
Mental Health Act and Mental Capacity Act Compliance
Mental Health Act
Most patients were detained for treatment under the Mental Health Act 1983.
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. Compliance with this training was above 87% across all 3 wards. 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 the relevant and 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 to support legal compliance.
Patients had easy access to easy read information about their rights under the Mental Health Act. However, many patients had cognitive impairments which meant they had difficulties processing this information, so patients' relatives were involved and consulted.
At the time of our inspection, changes were being made to advocacy service arrangements and there was some concern access to advocates would be reduced.
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. There were at times a delay in responses to these requests. There is a national shortage of SOAD's so this was not within the provider's control.
Staff stored copies of patients' detention papers and associated records correctly and could access them when needed.
Managers and staff made sure the service applied the Mental Health Act 1983 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.
Mental Capacity Act
Staff received training about the Mental Capacity Act and understood the five principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law and compliance with this training was above 87% across all 3 wards.
Individuals capacity to make decisions was monitored and recorded at multidisciplinary team meetings. However, restrictions regarding access to snacks, use of ordinary cutlery and access to alcohol as described in the safeguarding quality statement within this report had been imposed without appropriate consent or rationale. We were concerned these decisions had not considered individual patients' best interests as is required by the Mental Capacity Act 2005 and were imposed as a blanket restriction to keep patients safe from others with an identified risk. Staff did not adopt the least restrictive principle such as facilitating access to cutlery in safe way or developing a person-centred care plan in relation to eating and drinking needs.
Patients' experience
We spoke with 3 patients and 6 family members across the 3 wards. We used `observation' within communal across all 3 wards to understand the experience of people who could not talk with us.
While patients and relatives expressed general satisfaction with their care and treatment, our assessment found elements of care and treatment did not meet the expected standards. Most patients and family members said they liked and trusted the staff who were kind. A family member said, "Staff knowledge is excellent. Compassion and communication is also excellent when compared with the previous place. Weekend staffing levels need to be improved and a few more trips out would be nice."
There were several patients across all 3 wards who were not from the local area so did not see family members as much as they would like. There was accommodation for family members to use. Family members told us communication was good and they were kept informed of any changes or updates. One patient out of the 3 we spoke with did not feel there were always enough staff resulting in long delays when they required care treatment or support.
Many patients were unoccupied or not engaged in any meaningful activities for long periods of time. We observed this during periods of observation on all 3 wards and saw in records that patients had limited opportunities to access activities they were known to enjoy. While staff were physically present, they did not always optimise opportunities for engagement or activity. There was a high usage or agency and bank staff who did not know the wards or the patients and this meant there was a lack of consistency for patients. The lack of therapeutic care, treatment and support and an environment which was not `dementia friendly' had a significant negative impact on patients because this did not support their wellbeing or promote comfort and quality of life.