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

This means we looked for evidence that the provider met people’s needs.

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 people’s needs were not always met.

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

People told us that they did not always feel listened to. They reported issues to more senior staff but did not receive information or updates to help them understand what was being done about these issues.

Staff told us that they aimed to provide person-centred care and that this was directed by ongoing multi disciplinary reviews.

We did not always observe people being cared for in a way that was person centred. Staff observing care did not always fully engage the person. Where staffing numbers were high due to risks, staff did not recognise the number of staff in the person’s immediate vicinity may lead to distress.

Records showed incidents and decisions that felt overly restrictive in relation to risks presented. Care plans did not always detail strategies to support people in a person-centred way during episodes of distress and when risks were increasing. People had positive behaviour support plans in place which included some strategies for managing people’s distress. However, these also did not always include enough detail to support staff to respond in a person-centred way or they were not always informed by analysis to understand the function of people’s distress.

Care records contained information on occupational therapy and Speech and Language Therapist (SALT) assessments to meet people’s needs. One person had received a sensory assessment to better understand their sensory needs but this was not then reflected in their care or PBS plan. In one person's care plan, there were details of how the person could maintain family contact.

Care plans reflected people's physical, emotional, mental and social needs. However, due to the higher levels of restrictions, against peoples wishes, we were not always assured that care was entirely person centred as the ward didn’t take into account how such restrictive practice made people feel.

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.

People did not raise concerns with us about the working relationships that the ward had with external teams and organisations.

People had received a recent care and treatment review (CTR) while an inpatient at the hospital. The purpose of the CTR is to consider reasonable adjustments in care, consider safety and plan for discharge for people diagnosed with autism and/or people with learning disabilities. The CTRs showed a significant number of recommendations which evidenced that the hospital had more to do to ensure that they met the person’s needs and more work with system partners to support the person and work towards progressing discharge.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People gave us feedback around the provision of information and felt that staff did make efforts to help them understand information.

Staff understood people could have information in different formats in line with the Accessible Information Standards. People had communication plans in place to help staff understand their needs. One person had communication tools in their tablet device which had been developed to use when they were distressed. Staff we spoke to knew about these.

People had information available to them on notice boards outside of their bedrooms. The content of this information was adapted to the communication needs of each person. For example, one person had information using pictures and plain English.

Staff in the hospital had developed information covering changes to the advocacy service in easy-read form.

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.

Both people we spoke with had raised informal concerns about aspects of their care, but they had not received a response back into their specific concerns. For one of these, we looked at the records and spoke with staff, who confirmed that they recall the concerns being raised but the concerns have not been recorded or addressed as part of the local resolution.

The provider had a complaints policy and process which had been reviewed in March 2025. This policy provided details of the provider's processes to effectively identify, receive, record, handle and respond to complaints. The policy informed people that they could escalate their complaint to the parliamentary and health service ombudsman and CQC. However, it did not describe that the CQC only has powers to look at complaints relating to the powers and duties under the Mental Health Act. On the provider's website, there was no mention of CQC's role in dealing with complaints on the compliments and complaints section.

In the last 12 months up to March 2025, the provider reported that they had received no formal complaints or concerns from people on Billing Lodge, Glendale and Lime Tree Cottage about their care and treatment. We saw other complaints that had been upheld in the learning disability and autism directorate but action to address the complaint was slow. For example, an easy read care plan was recommended but took 3 months to provide one for the person and access to the gym was another issue that took some time to consider.

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

Admissions were planned in advance. The draft model of care did not provide clear detail about the admission and exclusion criteria for admission of people into the single transition services. One person was admitted into the service but it was not clear that their needs or risks could be met in the environment they were placed in.

Staff 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. One person had been moved into a seclusion area on another ward due to a change in their presentation. However, their independence was restricted due to the environment they were in as they were segregated on a ward with a different cohort of people of a different gender.

People had the opportunity to attend their multi-disciplinary meetings if they wished so they could share their views on the care provided.

People could access care and treatment at other healthcare services and staff facilitated this for them by arranging appointments or making referrals. However the service was described as a community facing service, people were not given a full choice of accessing community services and were instead offered services available on-site in the hospital instead.

Staff and leaders did not always actively listened 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.

People we spoke with were not positive about how staff ensured they met their individual needs and helped them to manage their distress.

Leaders within the service recognised they had more action to take to ensure the service were fully autism-informed.

People were not always supported to overcome barriers to access opportunities and experiences. For example, one person had identified their own goals in their care plans – this included visiting a specific shop and also to go to a specific town. There was no detail in that person’s care plan on how their goals could be achieved or alternatives offered. People were not able to access the community due to their Section 17 leave.

People were not supported to access community facilities. People used all the facilities on the St Andrew’s Healthcare Northampton location site including using the hospital gym and GP service. Even though this was a transition service to assist people to move to the community, there was no plan or detail about supporting the person towards accessing community facilities instead.

Reasonable adjustments were in place for patients, including communication plans.

People were not always 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.

People had complex needs so discharge planning involved several steps and the involvement of partner agencies. People did not always understand the next steps or the expected length of time towards discharge.

The discharge element of people’s care plans did not clearly outline where people were on NHS England’s 12 point discharge plan to understand what steps had already occurred, what steps still needed to be taken and what the hospital team were doing to progress any delay. NHS England’s 12 point discharge plan is there to specifically guide and assist providers and stakeholders to help discharge autistic people and people with a learning disability.

Staff told us that although they supported people with plans for discharge into the community that some delays were largely due to external factors.