St Andrews Healthcare Northampton

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment for the wards for people with a learning disability and autistic people, we rated this key question as good. At this assessment we changed our approach, and we now report on most of the wards for people with a learning disability in the forensic ward report as they provide medium or low secure services. At this assessment we rated the wards for people with a learning disability and autistic people as requires improvement.

At our last assessment we rated this key question as good. At this assessment the rating has changed to requires improvement.

This meant people did not always feel well-supported, cared for or treated with dignity and respect. People were not always offered choice and control to engage fully in their care and progress.

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

We have not awarded this service a score for Caring.

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

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

People gave us mixed feedback about kindness, compassion and dignity. One person told us that they felt staff deliberately wound them up at times. Both said that permanent staff were Ok but they did not feel that agency staff supported them well. These concerns were fedback to the senior managers at the time of the site visit.

Where people had raised concerns, staff told us this was dealt with via the provider’s complaints procedure. Staff told us they aimed to work as a core team to provide consistency, they aimed to meet people’s needs in relation to their preferences around the gender of staff supporting them and support staff knowledge of the people they were providing care to. However this was not always possible due to the high levels of temporary staff. In addition, although staff could accommodate this for support work staff; often nursing staff were not always familiar with people or they did not match people’s preferred gender.

We observed staff treating one person in a kind and caring way and were engaging with them in a friendly and approachable manner.

We had concerns that high levels of restraint and restrictive practice impacted on the dignity of people. People were not afforded contact with other peers, but people were not afforded the safeguards as a segregated patient. We also heard that staff had moved items within their room from one person which caused them distress due to their needs. We were concerned that this, combined with the restrictive nature of the wards and the high levels of restrictions impacted on whether people were always treated with kindness, dignity and respect.

The provider did not always treat people as individuals or make sure people's care, support and treatment met people's needs and preferences. They did not always take account of people's strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff told us that people were encouraged wherever possible to be involved in care planning. Staff told us that understanding cultural diversity was part of the trust's workforce development.

We observed people taking part in activities, but these were not always personalised or focused on community involvement. The admission document of both people we reviewed commented on both people working towards attending the provider's work placement venture. There was no individualised assessment to see if this was the most suitable pathway or offer for each person. We observed people accessing the hospital services and one person able to access the ground of the hospital with escorting staff. People had access to food to meet their dietary and religious needs at the hospital with vegan/vegetarian, gluten-free, Halal and Kosher food being available.

People's rooms were personalised and decorated in accordance with their preferences.

People had access to a multi-faith room. One person was able to practice their faith and had access to spiritual literature.

Care plans contained information on people's preferences on how they wished to receive care and their likes and dislikes. However there was no detail to consider how the person's choices or preferences could be met.

The provider did not always promote people's independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

People told us they felt staff did not always support them to have choice and control. One person did not feel there were enough activities on the ward and their leave had been stopped.

Staff told us they supported, informed and involved people and their families in decision making. Staff discussed family involvement and support with people using the wards

We observed people being able to access activities but these were limited due to the restrictions faced by people. We also observed restrictions that were not always fully recorded or reviewed. We had concerns regarding the impact this had on people's independence, choice and control. One person had been moved into a seclusion area due to a change in their presentation. However, their independence was restricted due to the environment they were living in during this period as they were segregated on a ward with a different cohort of people and a different gender.

People identified their own goals in their care plans. There was no detail in that person's care plan on how their goals could be achieved or alternatives offered

Care records contained communication plans so patients' rights could be explained to them in a manner they understood. They also evidenced that people were involved in decisions about their care and treatment.

Staff encouraged people to maintain relationships with people who mattered to them. This included facilitating communication via the use of computer tablets and mobile phones. There were quiet areas of the wards including lounges and access to fresh air. There was access to sensory rooms.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did act to minimise any discomfort, concern or distress.

People gave us mixed feedback about responding to people’s immediate needs. Whilst people told us that some staff worked with them well, were responsive and met their needs; they also reported that some staff were not as responsive and did not always know them leaving them in situations that compromised people’s needs.

There were sufficient staff to respond to people’s needs in a timely manner. However, sometimes the number of staff in close proximity to each person appeared overwhelming and appeared to escalate risks. Staff could not always be alert to people’ needs or to observe and engage people in discussions about their immediate needs because of the number of temporary staff that did not know each person well. We were told that this had resulted in incidents of patient to staff and patient to patient assaults.

Care records contained some evidence that staff used de-escalation techniques when peoples distress became heightened. However, care records and positive behavioural support plans sometimes lacked the detail needed to support people effectively including how to prevent distress and learn from past incidents. People had a communications passport in place and communication cards to support interactions between themselves and staff to ensure their needs, views and wishes were responded to appropriately.

The provider had systems to promote the wellbeing of their staff. They did not always fully support or enable staff to deliver person-centred care and there was a high level of sickness and morale was low.

Some staff told us that morale was low and some staff told us they did not feel safe coming to work. Staff told us about incidents in which staff were assaulted by a person's increasing distress and the opportunities in the environment meant that one assault was serious. One staff member told us they had concerns about the skills mix of staff with lots of bank or agency staff used to assist on observations with limited experience of working with autistic people.

One staff member told us that managers do not promote the wellbeing of staff and that they didn't always feel safe at work, so there was a high level of sickness and burnout. However, the provider had several ways in which staff wellbeing was promoted, including forums available for staff to seek support. These included employee assistance programme, a zero tolerance approach to violence and aggression, speak up channels, wellbeing events and flexible working arrangements.

The provider ran an annual staff survey where staff could share their thoughts on their experience of working at St Andrew's hospitals and comment on their wellbeing. In the learning disability and autism directorate, only 53% of staff who completed the survey scored their experience of the hospital considering their health and wellbeing favourably.

The provider offered a range of initiatives to support staff wellbeing including a designated occupational health team and an Employee Assistance Programme.