St Andrews Healthcare Northampton

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective - this means we looked for evidence that people's care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people's care, treatment and support did not always achieve good outcomes or was inconsistent.

We have not awarded this service a score for Effective.

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

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 12 patients care records across all 3 wards and found that staff had completed a comprehensive mental and physical health assessment of each patient, either on admission or soon after. Where possible, assessments had captured all relevant information and evidenced involvement from the patient and/or relative. However, we found some assessments had not been regularly reviewed. For example, some positive behaviour support (PBS) plans had not been reviewed for a 4-month period. After our inspection, the provider told us the standard is that PBS plans are updated at a minimum every 6 months. The majority of PBS plan update and reviews did not include the views of patients or their partners in care. Some activity care plans were generic and not specific to the patient’s individual likes, preferences and life history.

Patients were offered care coordinator meetings with an an allocated staff member to review their care, treatment and support. Records showed where patients had displayed distress or had unmet communication needs, these incidents were not always effectively explored regarding emotional and psychological needs or the underlying triggers and reasons for distress. This meant the reasons or triggers were not always established so that care, treatment and support could be changed in response. For example, records in progress notes stated ‘mood and mental state variable’ when the patient had displayed physical aggression but the reasons for this were not explored. A care coordinator session for another patient recorded the patient had ‘been generally aggressive and hostile’ towards staff. The patient declined to participate in the care coordinator session. There was limited evidence of any exploration of unmet needs or a plan of action to establish the reasons for this distressed behaviour.

The provider did not plan and deliver people's care and treatment with them, including what was important and mattered to them. They did not always follow legislation and current evidence-based good practice and standards.

The provider followed a `Dementia and Huntingdon's disease wards clinical treatment model which included the `enriched model of dementia care' (a biopsychosocial approach by Tom Kitwood 1993). This model included best practice guidance to inform the care and treatment offered. We were not assured the aims and objectives set out in the model were embedded into ways of working on all 3 wards or that a dementia friendly therapeutic environment was provided. We were not assured patient's care, treatment and support was delivered in line with relevant legislation, national standards and evidence-based good practice guidance.

For example, the provider's clinical model's objectives included using psychological and occupational interventions; `including cognitive stimulation and reminiscence. Using clinical skills and patient-centred care, develop meaningful therapeutic activities that maintain and improve quality of life in acquired and progressive brain conditions and managing environmental risk.'

We were not assured these objectives were always met because opportunities for patients to access psychological and occupational interventions were limited and were not always meaningful. The wards high reliance on non-permanent staff who did not know patients well and the limited training provided to staff about the `enhanced model' of dementia care were contributory factors.

The provider told us their dementia wards were `a specialist provision for the care of patients with dementia and cognitive deficits due to other neuropsychiatric conditions and mental illness.' Lowther (the wards for older people with mental health problems) was conceived under the dementia village model, inspired by the Dutch care model and promotes a community living aspect for patients with dementia with the primary goals of remaining active and retaining independence. However, we found the environment on all 3 wards was not always safe or dementia friendly.

The wards appeared clinical and did not provide familiarity or any sense of comfort for patients as is promoted by Kitwood's model of `enhanced dementia care'. There was limited space or areas for patients to spend time away from other patients or to take part in activities. There was a quiet room on Elm ward and an activities room on Cherry ward. All dining areas were locked and inaccessible to patients except at mealtimes. We were told the toilet in the activities room on Cherry ward was for staff use only. The dementia village was an outside area with a shop and a post office and a separate room for activities. However, we did not observe any patients or staff using these areas. We did not see in care records we reviewed that patients were utilising the dementia village. Some staff told us they had limited time to facilitate activities for patients. Many staff were unfamiliar with the ward and did not know patients well or fully understand their needs.

Patients had their risk of malnutrition and dehydration assessed and were referred to the dietetic team when risk was identified. However, we were not assured that best practice guidance for nutrition and hydration was always followed. The British Dietetic Association (BDA) recommends for older people; `Drinking enough fluids is also important in this group, due to a reduction in regular thirst signals. Women should aim for around 1600ml/day and men around 2000 ml/day.' We saw this recommendation was not being met for 2 people. For people with dementia the BDA recommends; the availability of finger food/cutlery free menus for patients unable to use cutlery but who can still feed themselves and a `flexible approach where possible e.g. facilitating `grazing' or `little and often' approach.' We did not see any evidence of these recommendations being implemented even when a patient was found to be eating insufficient amounts each day.

Records for patients with dysphagia (swallowing difficulties) had improved since our last inspection. However, not all staff had received training about dysphagia and how to keep patients identified as at risk of choking because of swallowing difficulties safe.

Staff told us they had good access to clinical supervision to discuss their learning and development needs. Data provided recorded 100% compliance for all staff groups.

The provider did not always work well across teams and services to support people.

While staff told us they worked well as a team, some staff were concerned about the high usage of agency and bank staff who may not know or understand patient’s needs. Important information from reviews was recorded within progress notes and was not always easily accessible or used to provide the required care, treatment and support. Some care records lacked the detail required to ensure staff knew how to deliver care treatment and support. For example, there was no detail recorded for staff about how to administer covert medicines (giving a patient medicine without their knowledge) for 1 patient. Records for another patient with identified risk of aggression did not provide enough detail about what staff should do to manage this risk. A patient identified as at high risk for malnutrition and dehydration did not have a care plan for this. We were not assured staff had access to all the information they required to assess, plan deliver care, treatment and support.

We observed a handover from day to night staff on Elm ward. The handover was detailed and comprehensive. However, there were 3 agency staff who had not worked on the ward recently on the night shift and none of the 3 had received training in dysphagia (difficulties swallowing creating a choking risk). There were 4 patients on the ward with swallowing difficulties and risk of choking. This meant the regular staff had to attend to patient’s personal care needs because they had a better understanding of these needs. The provider had identified this risk on their ‘risk register as ‘high risk’ due to the number of staff who had not received dysphasia training. Agency staff were tasked with providing the enhanced care support for patients requiring one to one or two to one support.

There were multidisciplinary teams with their own distinct roles and responsibilities. Regular meetings were held to discuss ongoing care, treatment and support. However, staff were not always proactive in working with other services when multidisciplinary involvement was required, and actions were not always followed up on as needed. For example, a dietitian had recorded specific guidance staff should follow but there was no corresponding plan of care and limited evidence staff were following this. The psychology team were available to support de-briefs following incidents, but these did not always take place because staff were busy. This meant there were missed opportunities for learning and improvements to occur.

Positive behaviour support (PBS) plans developed with the psychology team were not always followed, often because non-permanent staff did not have the required knowledge or understanding of the ward or the patient’s needs. Some PBS plans lacked detail, and other records showed the patients preferences regarding likes, hobbies and interests were not used to plan activities.

There was a lack of oversight and coordination to ensure different teams fully understood specialised input from multidisciplinary teams and were providing continuity of care, treatment and support.

The physiotherapy team told us all patients were assessed within 24 hours using an elderly frailty score assessment and falls multifactorial risk assessment. However, interventions to prevent falls were not effective for 1 patient and records lacked detail about how to keep another patient safe, despite a known risk of falling.

Team meeting minutes for Aspen ward 2025 stated that team working was affected by staffing levels, psychology support was limited and social work support sporadic. There were vacancies in the social work team and this meant there was no social worker allocated to the older people’s wards and this impacted the team’s ability to attend multidisciplinary meetings. However, the provider had recently recruited a social worker and were reviewing the team structure to improve team working.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Many patients had high dependency and complex physical and mental health needs.

Some staff told us that patients had limited access for walks outside of the ward or within the ward courtyard areas because staff were so busy providing personal care.

On Elm ward we observed 3 patients were in bed from 16.00hrs and this was their usual routine. These patients had mobility needs requiring a hoist and 2 staff to support. There was no clear indication from patients or staff that patients were supported outside to access fresh air regularly. At handover on Elm ward, it was indicated that most patients had spent the whole day in the lounge or in their bedrooms.

Staff did not take enough action where patients were identified at risk of malnutrition or were above a healthy weight. There was no eating and drinking care plans for staff to follow in order to promote a healthy diet based on individual needs.

There was a central physical health team staff could request when patients’ health deteriorated. There was emergency lifesaving equipment including a defibrillator available to the wards.

The physiotherapy team told us patients had access to groups designed to improve strength through exercise. We did not observe any patients attending these sessions during our visits or see any evidence of this in our records review.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Patient’s health and wellbeing was not always effectively monitored. There was limited evidence of improving outcomes for health and wellbeing for some patients or evaluation of the chosen clinical models in use. For example, the enriched model of dementia care was not being effectively applied. There was not a robust approach to monitoring the effectiveness of patients care, treatment and support and action were not always taken to continuously improve it. We found limited evidence of change or improvement to quality of life or progress towards discharge to a less restrictive setting.

The psychology team were responsible for carrying out assessments and developing PBS plans. These were based on a psychology model known as RAID (reinforce appropriate, implode disruptive). This model focused on nurturing positive behaviour (known as green behaviours) while reducing the occurrences of challenging (red) behaviours. However, it was not clear how this model could be applied to patients with advanced dementia and associated cognitive limitations to learn, remember and understand reinforcement of positive behaviour. For example, the PBS for a patient with dementia asked staff to offer immediate verbal feedback for positive behaviour (green) and to provide space and offer meaningful activity and opportunities to discuss feelings. This patient had limited verbal communication and may not have been able to discuss their feelings. As well as this, the ‘enriched model of dementia care’ understands behaviours as a form of communication of an unmet need. Rather than labelling behaviours as challenging, the enriched model of dementia care requires staff to interpret them as a way of understanding distress and finding solutions. It was not clear how the RAID model and the ‘enriched dementia care model’ were being applied to support the identification or solution to unmet needs or if these models were entirely compatible. Staff training compliance for RAID was at 56% at the time of our inspection. This was low, and combined with the high usage of non-permanent staff, it was not clear if it was being effectively applied or how this was being monitored

Multidisciplinary team meetings, care coordinator meetings and psychology reflective meetings were held to discuss and review individual patients. These meetings and reviews were recorded within electronic care records. Physical and mental health needs were reviewed, however, we were not assured these systems provided sufficient monitoring and oversight for each individual patient with regards to the effectiveness of care and treatment or that information was always used to continuously improve. We found limited evidence of change or improvement to quality of life, or progress towards discharge to a less restrictive setting.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service had a process in place to ensure that staff informed patients of their rights around consent. This information was available in an accessible format and patients’ family members, or significant others were involved when patients lacked capacity to make a decision. For example, staff contacted a family member regarding the administration of a vaccine and their views were taken into account within the best interest decision made. Staff assessed each patient’s capacity to consent to admission and treatment on admission and this was reviewed within multidisciplinary meetings. Capacity was monitored and recorded at multi-disciplinary meetings.

Staff complied with the requirements laid out in Mental Health Act 1983, and the arrangements for patients’ detention and treatment were consistent with the requirements of the Act and accompanying code of practice. Staff generally supported patients to understand their rights.

Patients had access to independent advocacy services, however, at the time of our inspection the current arrangements for accessing advocacy services were changing and some staff were concerned that patients would not have the level of access they required.