St Andrews Healthcare Northampton

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive - this means we looked for evidence that the provider met people's needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people's needs were not always met.

The service was in breach of legal regulation 9 in relation to person centred care.

We have not awarded this service a score for Responsive.

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

The provider did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Care and treatment plans did not sufficiently ensure patients’ needs were met or were reflective of their preferences. We reviewed records for 12 patients across Elm, Cherry and Aspen wards. Each patient had an ‘all about me’ document and a PBS plan. These documents contained information about the patients likes and dislikes and life histories. However, there was very limited evidence of any of this information being used to support therapeutic interventions and care planning in 10 of the 12 records reviewed. We also saw examples of the same information in different care plans, some information was generic and not individualised to the patient.

The provider’s chosen model of care ‘the enriched model of dementia care’ (Kitwood 1997) was not effectively applied or implemented. Dementia care mapping (an observation tool to measure the effectiveness of dementia care) was carried by the provider on all 3 wards in March 2025. Shortfalls were identified on all 3 wards and recommendations were made as follows;

• Provide more regular staff.
• Introduce sensory resources to engage patients and mitigate service user distress.
• Make more food choices available, picture menu for patients.
• Provide more activities for patients to reduce service user distress.”
• Consider what activities could be done with patients whilst on enhanced support.
• Consider cleaning the corridor floor at an alternative time when a patient is not sat there due to the loud noise from the equipment.”
• Not enough staff on the ward to meet patient’s needs.

These concerns regarding a lack of effective therapeutic dementia care were ongoing during our inspection visits in March and April 2025.

The environment on Elm, Cherry and Aspen wards were not dementia friendly and did not provide a therapeutic space. Kitwood’s person centred approach emphasises the importance of a positive environment. All 3 wards were clinical and sparse in appearance, with limited objects of interest or familiarity. The calendar on Cherry ward was found to be set at the incorrect date on 2 occasions (11 March and 9 April) which would be potentially disorientating to patients. The courtyard areas on Elm and Cherry wards were visibly dirty and unkempt.

On Aspen ward, we observed 3 patients in the communal lounge area. There were 8 members of staff sitting in the lounge. None of the staff members were seen speaking to any of the patients or providing any opportunities for meaningful activities for a 30-minute period.

We spoke with 18 staff members across all 3 wards. Staff members we spoke with described the weekly activity timetable which included group activities, such as breakfast clubs, craft sessions and a catch-up café. However, these activities described did not consider the person-centred approach described in the model of enriched dementia care (Kitwood 1997) and did not fully consider patients individual needs and preferences. There was minimal focus on sensory activities or on utilising known skills and abilities, past skills and interests.

Weekly ward activity timetables offered basic and limited opportunities for meaningful activity. Clinical governance meetings instructed staff to include activities of daily living such as medication and mealtimes as meaningful activities. One patient told us the activities on offer were not relevant to them.

There was a team of occupational therapists and therapy assistants, psychologists and psychology assistants. However, their availability to support therapeutic activities was limited because there not enough of them to meet the needs of patients on all 3 wards.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Staff understood the processes for pathways and admissions, transfers and discharges. Multi-disciplinary team meetings and care programme approach (CPA) meetings took place. Where possible patients and/or their relatives were invited. However, many patients had cognitive impairment and had limited ability to participate. Staff did not always follow the providers chosen model of care 'the enriched model of dementia care' to ensure care and treatment was flexible and supportive of choice.

A number of patients were from out of area many miles away from the hospital and experienced significant delays waiting for discharge and alternative placements. Reasons for these were often out of the providers hands and varied between a change in circumstances, funding issues or a lack of a suitable placement.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Patients’ individual communication needs were not fully explored or planned for. While information was recorded within PBS plans, this information did not provide enough information about the most effective way to communicate. Information did not include the use of communication aids such as visual aids or pictorial information which may support some patients living with cognitive impairments.

Staff did have access to easy read and pictorial information; however, it had not been established how and when these aids should be used.

Training about information governance and information security was provided to all staff and compliance with this training was high (above 93%). They understood their responsibility to keep information safe and secure.

Relatives we spoke with told us communication was good and staff contacted the about any changes.

Staff made notifications to external bodies as needed.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Community meetings were held weekly to gather feedback from patients about their experience of care, treatment and support. Some patients told us staff routinely asked them for their feedback. However, community meetings were not an effective method for many patients on the wards because this format did not meet their communication needs.

We looked at community meeting minutes and saw many patients did not engage and possibly did not understand what was being asked. For example, minutes for 9 community meetings held across the 3 wards from December 2024 to February 2025, showed many patients did not engage at all, many gave one-word answers, and some said they did not understand. Some negative feedback was provided about the quality of food and some people asked for specific food items or activities they would like. There were no formulated action plans to address where negative feedback was provided or specific foods and activities requested.

Community meetings were an agenda item at each staff governance team meeting. However, there was no records of issues discussed or analyses of themes and trends or action taken to responses received. Each ward had a ‘you said, we did’ board to record what action staff had taken in response to feedback. However, the information was minimal and undated. For example, ‘you asked to speak with the chef so the chef attended a community meeting’ and ‘you asked for a bird feeder, so a bird feeder has been requested’.

The divisional governance meeting minutes for February 2025 recorded a concern regarding the suitability of the ‘your voice’ template for patients on Elm ward with cognitive impairment. There was a discussion about finding an alternative method which did not rely on verbal communication. At the time of this assessment an alternative method was not in place.

Patients and staff, we spoke with told us they would feel confident making a complaint. Staff understood the process for receiving and escalating a compliant to the correct team. However, we were not assured staff were effectively engaging patients to share feedback or using innovative ways to establish how patients were feeling about their experience.

Complaints were a standard agenda item at ward clinical government meetings, very few complaints were recorded and where they were, there was no action plan recorded about how these were responded to or resolved.

The divisional clinical governance meeting for February 2025 recorded an increase in complaints about staff attitudes on Aspen ward. There was no clear evidence of action taken to investigate or resolve these concerns. Data provided regarding complaints received in the 3 month period December 2024 to February 2025 showed 3 complaints were received during this time period. Not all complaints referred to within governance meetings were included in this data. This meant managers did not have oversight of all complaints received.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Patient's culture, social and religious needs were not always supported. Non-permanent staff did not fully understand all patient’s needs. Where cultural needs were recorded, there was not always evidence to show how these were met.

Reasonable adjustments were not always considered or implemented such as addressing communication barriers. On Cherry ward (female) some staff were concerned about the numbers of male staff because many patients did not want personal care support from male staff.

Occupational therapy teams assessed patients’ needs for specialist equipment and adaptations they required to improve their ability to participate in daily life activities.

Staff received training about equality and diversity and supporting patients with a learning disability. Interpreters were available to translate for patients if required. The wards were accessible to patients with mobility issues including wheelchair users.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people's care was not always tailored in response to this.

Care planning and delivery did not always support equity in experience and outcomes. On Elm ward 3 people with physical disabilities routinely went to bed in the late afternoon and remained there until the following morning. Staff said this was patient choice. However, it was not entirely clear how this had been established or if this practice had been reviewed. It was unclear how much access these patients had to spend time in communal areas or go outside.

Communal areas were available but limited for space. There were quiet areas and a separate activities room on Cherry ward. Ward and outside areas were accessible to patients with mobility difficulties. There was an outside space known as the `Lowther village' which included a laundry, post office and a social hub. There was also a café within the hospital grounds. Therapy assistants supported patients to access these areas. However, the staffing establishment meant access to these areas was limited especially when patients required one to one or two to one support because staff were busy attending to patients needs and did not have the time. A small number of patients on the wards were supported to regularly go out and access these areas.

The advocacy arrangements had recently changed across the hospital. Some staff were concerned there would be a reduction in the advocacy service availability.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Most patients had discharge care plans in place. Discharge plans were discussed at weekly ward rounds by the multi-disciplinary team. However, discharge planning was not always comprehensive. For example, for 1 patient it was recorded that discharge would be considered once there had been a period of stability of mood for a 6-week period for 1 patient, but it was not clear how this would be achieved.

Staff told us patients were encouraged to make advanced decisions to record their wishes about future care and treatment including end of life decisions.

Patient's wishes regarding resuscitation were recorded so staff knew each patient's status regarding this. This information could be accessed quickly by staff on the wards in the event of an emergency. All staff received basic life support training and compliance with this training was high (above 88%).