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

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 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. This meant the effectiveness of people's care, treatment and support did not always achieve good outcomes or was inconsistent. The wards was in breach of legal regulation in relation to person-centred care and meeting best practice guidance.

People had assessments in place but then the outcomes of these assessments were not always translated into the care delivered. Care plans were reviewed regularly. People's physical health needs were assessed and monitored. Care and treatment was not always delivered in line with national guidance and best practice. The model of care provided was not fully autism-informed and leaders accepted that there was further improvements to meet people's needs, working fully using positive behavioural approaches and ensure staff receive better training.

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 was effective by assessing and reviewing their health in a timely way. There were delays in ongoing assessments and staff did not always fully use these assessments to inform and update people's care, to promote people's wellbeing and meet their needs.

People had an assessment of their needs prior to their admission to hospital. Carers had been involved in their relative's care and treatment, with the patient's consent, which included attending multidisciplinary team meetings.

We reviewed 2 care records and found each had an assessment in place which captured information about the person and demonstrated the involvement of the patient, their family members, and other services involved in the patient's care. However in one case, key information had not been updated following key events for one person. There were delays in starting key assessments such as sensory assessments to understand people's needs and once this assessment had occurred this was not reflected in the person's care plan and PBS plan. The occupational therapist reported that recruitment to the OT department had improved caseloads enabling them to focus on quality. The occupational therapist recognised the need to start to embed sensory passports into care plans and care delivered. We also heard that some allied health professionals were asked to help with observations when staffing issues occured, but this happens less now.

Staff could describe the assessment process and their role in it. People had specialist assessments carried out by the medical staff, psychology and nursing teams. These informed each person's care plans and risk assessments. On admission, people had their physical health assessed, and this continued to be monitored throughout their stay.

The provider did not always plan and deliver people's care and treatment with them, including what was important and mattered to them.

People had access to psychological therapies. People told us they had access to occupational therapy and activities, but these were not always provided in a timely manner.

Staff were able to describe the range of professional input, treatment and care options available to patients in line with national guidance.

Staff from all disciplines worked together to provide evidence-based care for patients. This included a range of individual psychological therapies. However sometimes there was a delay in providing key assessments for people. For example, in one case a sensory assessment was delayed.

Staff delivered care and treatment in line with best practice but care plans did not reflect this best practice. Staff completed care plans for most people's individual needs leading to a separate care plan for each need. Most care plans provided a reasonable level of detail included which would enable new staff to provide person-centred care and support. However it was not fully clear how people's autism impacts on their day to day functioning. We saw some needs which had been identified in other parts of the record which were not fully reflected or reviewed in people's care plans. For example one person's sensory needs were not fully reflected in their care plan. From their own audits, the hospital were aware of the need to improve consistency in care planning. One leader reported that their 'pet peeve' was that care plans were not autism friendly, and they were looking at improving them. There was no timeframe to achieve this. Staff were not able to confidently report on people's individual needs as reflected in their care plan.

Care plans were personalised but not always strengths based. For example the language used did not follow best practice around using more positive and autism informed approaches. Examples we saw in care plans included'stopping my problem behaviours' and `reduce any incidents where any aggressive/disruptive behaviour is displayed' — this does not evidence that staff understood how people's neurodiversity impacted on their ability to manage their distress.

Care plans did not always meaningfully detail how staff could maximise recovery from mental health and physical health problems, improve functional ability, self-care and, where possible, look to meet the person's own goals. Care records did not always evidence that staff provided practical assistance to people to fully aid their independence. For example, supporting people with help with budgeting and assistance with activities of daily living, such as shopping, cooking and cleaning.

Positive behaviour support plans were present but were not always fully informed by a full functional assessment to ensure that the PBS plan were evidence based and informed by an understanding of people's distress and behavioural analysis approaches.

The provider's policies were written referencing appropriate national guidance. The ward completed ward-based routine clinical audits to ensure compliance with relevant standards and guidance. This included audits on care plans, hand hygiene, ward cleanliness and medicines management.

Each person's programme did not offer sufficiently intensive learning opportunities to promote skills acquisition, support community inclusion and reflect planning for the future discharge. People's care and support were not reviewed to ensure it met their needs. There was no proper or full evaluation of care plans against the care received to promote people's autonomy and independence in line with the right support, right care and right culture guidance. All care plans included a section for staff to record people's own goals. None of the plans we reviewed consistently recorded a proper evaluation of people's achievements. Monthly reviews did not fully reflect the people's progress against each of their needs and/or whether their care plan had been implemented. Recent care and treatment reviews had identified either shortfalls in recording, a need for further work or rated some key lines of enquiry relating to people's progress as amber corresponding with action for the provider. For example, one person had been appointed a senior intervenor due to the complexities of their case and their lack of progress.

People's care and treatment did not focus on their quality of life outcomes and did not meet best practice. People had care needs written into the care plans which if implemented would promote social inclusion and community involvement. People had a list of activities which included a range of activities in the community and what they liked doing but the evaluation of the care received did not show that they were offered these activities. For example, one person was recorded as liking to have walks and go swimming but they had gone for 7 weeks without having escorted ground leave. They understood this was because they were refusing part of their treatment. This appeared restrictive and punitive.

People did not receive care and support from the full range of specialists to ensure care was delivered and outcomes achieved in line with their care plans. Despite people having particular needs, recent ward review meetings showed that people had not benefitted from timely occupational therapist or speech and language input or reports.

People did not have access to a range of psychological approaches to support them and help staff understand their behaviour support needs and better understand their distress. There were no assistant psychologists assigned to the staffing establishment. There was therefore no detailed look at incidents and creation of graphs and functional analysis to understand people's distress in meaningful ways.

Staff used a range of tools to assess and monitor patients' mental and physical health. This included National Institute for Care and Health Excellence (NICE) guidance, and guidance and tools from recognised bodies in relation to medicines.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People generally felt informed about their care and treatment. One person was exceptionally complimentary about the care and support they received from the consultant psychiatrist. People had the opportunity to attend their multidisciplinary team meeting to discuss their care, treatment and future plans.

Staff were part of a multidisciplinary team and were positive about how the different professions valued and respected each other. They were able to describe links with other services and organisations and explain how they worked together.

Staff had access to the information they required to appropriately assess, plan and deliver patients’ care and treatment. Staff were able to describe the processes and guidelines for sharing information within the multidisciplinary team and with external services. They were able to discuss examples where they had worked collaboratively with relevant staff, teams and services to deliver care and treatment, and to support patients’ pathways.

Staff attended a handover meeting at the beginning of their shift to get updated information on each person. A handover document was completed throughout the day, with key information about each person and other events on the ward.

One person had information on display in their room that told staff how they could communicate with and support the person if they were struggling or in distress.

Each person had a multidisciplinary team meeting at least once every 4 weeks and a care programme approach meeting every 6 months, to review their current care and future plans. These were attended by the person and their relatives and staff from across the multidisciplinary team; staff from the person’s local community team were also invited.

People had hospital passports and health action plans which could be used when people went to the general hospital to ensure staff made appropriate reasonable adjustments to a person’s care arising from their autism and/or learning disability.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The wards had processes to monitor physical health and identify possible physical health and healthy living interventions. These included a physical health assessment on admission and ongoing physical health care.

People had access to an on-site GP. People did not raise any specific concerns about this quality statement. People had support for their physical health needs and access to interventions and activities that promoted healthier living. Staff ensured that people received appropriate physical and dental health care including attending primary and secondary medical care appointments.

Staff completed regular physical health checks with patients. They used the National Early Warning Score (NEWS) system to flag any concerns. Staff discussed physical health with people as part of those checks and in ongoing care reviews.

People had individual care plans to support them with their care needs arising from any identified physical health need, dietary and nutritional needs, and their approach to exercise. However in one case there was contradictory information in one person's records about whether they had a specific long-term physical health condition that required ongoing monitoring. We raised this on the day and leaders said they would look into it.

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.

People had mixed views but were mostly frustrated about their time at their time at the hospital and the lack of progress they had made.

Staff used recognised rating scales to assess and record the severity of patient conditions and care and treatment outcomes. The service completed Health of the Nation Outcome Scales (HoNOS) for patients. The occupational therapists used a range of tools including interest checklists and the model of human occupation screening tool (MoHOST). The psychology team used a range of evidence-based rating scales and outcome measures with people.

Staff took part in ward-based audit to oversee and check on the day-to-day running of the wards. Nursing staff conducted several monthly audits in relation to care planning, enhanced support, hand hygiene, waste management, sharps disposal, equipment, and ward cleanliness. Audits of medicines, controlled drugs, fire drills, ligatures and health and safety risk assessments were undertaken 3 monthly.

Many of the prescribed annual or company-wide audits from the provider were not fully relevant to the separate transitions services, such as falls prevention and people on specific medicines monitoring regimes. Many of the prescribed audits were specific to the forensic wards because they related to how the hospital was managing the actual or procedural security arrangements. As a results audits and quality assurance processes were not always relevant, did not include the supported transition services and it was not always clear therefore how they were used to generate improvements for the separate transition services.

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

People were informed about their care and treatment and could speak with staff if they required further information or support. People were aware of the advocacy service that visited them.

People were asked about how much information they wanted sharing with their relatives, and their views were respected. Where people refused care interventions, staff respected people’s wishes.

Staff had completed training in the Mental Health Act and Mental Capacity Act. Staff were familiar with the use of the Mental Health Act and could describe the limitations this placed on people. Staff had completed training on the Mental Capacity Act.

People were detained under the Mental Health Act and the service adhered to the rules within the Mental Health Act. The hospital had policies and systems to ensure they followed the Mental Health Act. The hospital had a Mental Health Act administrator. They supported medical and nursing staff to adhere to the Act, and that patients’ rights were given and upheld.

Through looking at 2 records we saw that people were given their rights as detained patients, medical staff authorised leave from the hospital appropriately, consent to treatment rules were adhered to and the provider had appropriate systems to remind them to refer people to tribunals at the correct intervals where they did not or could not appeal to a tribunal.