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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation 17 in relation to good governance.

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 provider did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

The provider did have a clear vision, strategy and purpose which was to inspire ‘hope’ for those living with complex mental health needs. However, they did not always understand the challenges patients experienced, or the barriers staff faced providing care, treatment and support to patients in a person-centred way.

Staff had some knowledge of the provider’s vision and values and told us how well supported they were by their team and ward managers. However, there was less engagement with senior managers and several obstacles to staff achieving what was expected of them. The providers chosen model of care for the older people’s wards was not effectively followed or implemented.

The required multidisciplinary teams were in place such as psychology, occupational and other therapy staff. However, there was a lack of effective team working between these staff groups and ward-based staff because the staffing establishment and time pressures faced by permanent staff were great. This resulted in teams at times working separately despite their best efforts to work in a more collaborative way.

The provider's policies were in line with current best practice and guidance. However, systems and processes failed to always identify when they were not followed. The environment was not effective for patients living with complex mental and physical health needs and did not always protect patients from the harms associated with receiving care, treatment and support. This resulted in some patients experiencing a less than optimum quality of life and remaining on the wards for longer than necessary because their outcomes were not improving.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

Leaders did not always demonstrate a positive, compassionate, listening culture that promoted trust and understanding. Staff told us while they were happy with the support of their direct team and line managers, they did not feel senior leaders were visible or accessible. This had been raised by staff and recorded in staff clinical governance meetings. These meeting minutes were shared at divisional governance meetings but there was no evidence this concern was discussed or any action planned to resolve.

Leaders were not alert to any examples of poor culture that may affect the quality of patients care and have a detrimental impact on staff. While some concerns we identified had been discussed at ward and divisional governance meetings such as high use of agency staff, e-observation recording and ineffective formats for patient feedback. Not enough action had been taken to resolve these issues or to ensure patients experienced good outcomes and quality of life and staff had the resources and support they required to deliver person centred care.

Some staff did say they were confident improvements were on their way and felt leaders understood their concerns. Leaders had since taken proactive steps to improve engagement, including weekly staff emails, monthly newsletters, coffee mornings, and participation in staff training.

The provider used a staff survey known as ‘your voice’ to seek feedback from staff. Staff survey results for Elm dated June 2024 scored low for the questions ‘senior managers act on staff feedback’ (36%) and Communication between senior management and staff is effective (36%).Only 50% of staff felt they were satisfied with the quality of care provided to patients.

People did not always feel they could speak up and that their voice would be heard.

Staff we spoke with were aware of the provider’s whistle blowing policy. Most said they would raise concerns with their line manager. Ward team governance meeting records showed staff had raised some of the concerns we identified at this inspection.

Staff survey results from June 2024 were low (27%) for the question, ‘would feel safe to speak up about anything thing that concerns me at St Andrews.’

The culture of speaking up was poor beyond staff speaking to their immediate line managers. This was further demonstrated through incidents currently under investigation.

Staff understood their ‘duty of candour’ responsibilities to apologise when things went wrong. However, we were not assured action would always be taken to prevent the same thing happening again.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider employed a diverse workforce. Staff told us they were treated fairly regarding their equality and diversity needs. Ward governance meeting minutes recorded discussions when staff had experienced discrimination from patients and had provided support to staff.

Staff survey results from June 2024 scored high (91%) for the question ‘St Andrew's acts fairly with regard to career progression/promotion.’ The question, ‘Not experienced discrimination from manager/team leader or other colleagues scored 81%.

The provider produced a diversity and inclusion report which included diversity data of staff employed, support networks available to staff and priorities for the following year.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was an ongoing lack of oversight, risk management and quality monitoring. Systems and processes for governance and audit were not effective. Ward and divisional governance meeting were not always comprehensively recorded and where concerns were raised or identified, the action required to resolve and ensure patient safety and quality or care treatment was not clear. Many concerns, such as staffing, a lack of meaningful activity and physical and verbal aggression which had been identified and discussed at team meetings in December 2024, were ongoing at the time of our inspection in March and April 2025.

The provider's risk register did not include all the risks we identified or effectively manage known risks. For example, the high use of agency to support an increase in enhanced observation requirements was recorded as high risk. However, action recorded to manage this, ( easy read care plans and block booking of agency staff) was not effective. Staff told us about a continued use of agency staff not known to the ward continued to impact their ability to provide care treatment and support.

Despite the provider's ongoing programme of audits to check compliance with best practice and quality and safety, we identified ongoing issues with staffing skill mix, a lack of specialised training for staff, a lack of appropriate escalation and action when patients did not have enough to eat or drink and ongoing late recordings of enhanced observations. There was a failure to plan for ongoing requirements for one-to-one and two-to-one staff support and a lack of continuity of staff. This had a negative impact on patients.

Patients were not always protected from harm and were not receiving person centred care, treatment and support. Unnecessary restrictions were in place also affecting quality of life, these were not clearly justified and did not meet the required principle of the `least restrictive' option as set out in the Mental Capacity Act 2025. for patients. The ward environments were not dementia friendly and did not provide a therapeutic environment. Some patients had lived on these wards for several years.

Staff were mostly motivated to improve outcomes for patients and were frustrated with the lack of resource and support preventing them from achieving this.

Leaders had failed to establish effective methods of communication with many patients who had various degrees of cognitive abilities, which could provide valuable feedback and insights into individual experiences. Processes for gathering feedback for many patients were ineffective.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people.

The provider worked with external stakeholder agencies and key organisations such as commissioners and the local authority to support care provision.

Staff and leaders engaged with patients and family members and invited them to care programme and approach meetings. Updates regarding the patient's progress were shared with family members where this was appropriate.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Staff and leaders did not have a good understanding of how to make improvements happen. There was a lack of a consistent approach for measuring outcomes and impact for patients and staff.

When things went wrong, this was discussed at ward and divisional team meetings and lessons learned emails were sent to staff, however improvements were not achieved in a timely manner so that patient’s safety and quality of life was improved. For example, an email was shared with staff regarding enhanced observation recording and care plans for patients on enhanced observations, but late recordings continued.

Staffing and the high use of non-permanent staff was an ongoing concern throughout the hospital and had been identified as a concern by CQC in 2020 as well as other breaches to regulations. Not enough action had been taken to address these concerns.

Staff were not sufficiently supported to develop their skills around improvement and innovation and there was not a clear strategy to develop improvement initiatives. Quality improvement initiatives (QIP’s) were ongoing throughout the neuropsychiatry division (within which the older people’s wards sit). However, these did not address all concerns we identified at this inspection. Records showed the concerns about staffing and enhanced observations had been part of this initiative since 2023 yet the concerns were ongoing in 2025.

The provider had produced a document for staff about improvements required known as the ‘guide to getting to good’. This document focused on the following priorities; care planning, accurate record-keeping, meaningful activity, training and supervision and optimising environments. While it was evident the provider had identified shortfalls and priorities appropriately, not enough action had been taken to make the necessary improvements in all these areas because concerns and breaches of regulation were found at this assessment. We were not assured the provider’s intended actions would be sufficient. For example, for training this document highlighted the need for mandatory and specialist training to be complete and up to date. However, the training for staff about ‘enhanced dementia care’ was a 1-hour online course. This did not sufficiently equip staff with sufficient knowledge and skills to implement this training and to ensure this clinical model of care was fully understood. As well as this, continuous pressures on staff resource were a barrier to their ability to implement this model.

The physiotherapy team told us their proposal to introduce a clinic for the management of spasticity (increased muscle tone and stiffness) had been accepted and agreed by the clinical effectiveness group. This meant physiotherapists trained to administer botulinum toxin to treat contracted muscles would be offering this treatment to patients affected by this condition in the future.

The occupational therapy (OT) team told us some OTs were becoming qualified for using a ‘sensory approach ‘and would be introducing a sensory screening tool and clinic. A significant amount of sensory equipment had been funded for and was on order. This would have a significant positive impact for patients living with advanced dementia.