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

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 for the wards for people with a learning disability and autistic people, we rated this key question as requires improvement. 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 not providing secure care as requires improvement

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service continued to be in breach of regulation in relation to governance at the service.

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 clear shared vision, strategy and culture for the service but this was not based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

St Andrew’s Healthcare was a provider that provided specialist mental healthcare for people with complex mental health needs. By 2028 the provider aimed to be a leading voice in helping people with complex mental health needs transform their lives. The provider defined their purpose as ‘Hope’. The provider states they are inspired by those they work with to do the right thing every day and live by CARE values which stands for:

• Care
• Accountability
• Respect
• Excellence

The provider had two shorter-term priorities to take them to March 2026

• Getting to Good - which was about ensuring the provider have the fundamentals in place to deliver high quality services every day, so that everyone knows what to do, why it needs doing and how to do it.
• Growth and Innovation – which was about developing new services, with a focus on helping people to live in the community. St Andrew’s Healthcare must grow and innovate to remain a thriving, vibrant and relevant provider.

Clinical leaders of the wards for people with a learning disability had developed a draft supported transition services clinical model of care and were looking to expand this type of service further. The supported transition services aimed to ‘provide a safe, hospital-registered environment with a homely feel, supporting individuals with complex needs, including those with autism, learning disabilities, and complex mental health conditions.’

Through looking at the model of care and speaking to leaders it was not clear that the ward leaders had understood fully the context of national policy relating to the transforming care agenda and to reduce the amount of segregation or people with a learning disability or autistic people in hospital. Leaders and the service model did not recognise the effect of the bespoke placements may amount to long term segregation or similiar set ups. Subsequently leaders did not prescribe or consider important rights and safeguards such as external reviews of long term segregation and/or affording relevant people the right to independent care education and treatment reviews which were in depth clinical reviews of autistic people and people with a learning disability where they are segregated or receive care away from others for more than 48 hours.

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

The supported transition services came under the oversight of the provider’s learning disability directorate; most of these services were designated forensic services for people with a learning disability – either medium or secure services. The supported transition services were deemed to be an alternative to secure care. The provider in their model of care stated that the primary intentions of these wards were to avoid secure care admission, facilitate a move out of secure care, facilitate an essential step towards community discharge and/or provide an alternative hospital setting [to avoid] the sometimes detrimental impact of secure/conventional inpatient care admission.’ It was not clear from the model of care and through speaking to leaders that in developing the model that they had full regard to our statutory guidance – Right Support, Right Care, Right Culture. For example, this statutory guidance states that hospitals should show that the service has been requested by, or has been agreed with, local commissioning partnerships and that it was just being developed for local people to meet a local need but that was not evident from the discussion and the model of care.

Leaders told us that there were plans to consider having a separate directorate for the supported transition services. The draft model of care did not prescribe what the leadership of the supported transition services were currently or what the future leadership arrangements were as an intended growing area. There was limited oversight and audits specific to the supported transition services to understand whether the model was effective and the day-to-day practice met the objectives set out in the draft model of care document.

Each of the supported transition services were staffed by a nurse who carried out day to day operational nursing responsibilities. The written service model document for the supportive transition services did not make clinical leadership roles clear and not all staff could describe this to us. Staff we spoke with were not aware of leadership oversight or checks to show that they were meeting their intended aim to be community focused, with clear recovery outcomes, providing person-centred care and in line with the priorities, values and purpose. The hospital had employed an autism practitioner to help inform and develop hospital practice and improve staff training. They recognised that there was more work to do to ensure that the ward staff provided autism-informed care which was fully underpinned by positive behavioural approaches.

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

The provider ran an annual staff survey where staff could share their thoughts on their experience of working at St Andrew's hospitals. The results of the 2024 survey received a 60% response rate. The 2024 employee engagement score was 63%. In the learning disability directorate, the survey areas with the lowest results were:

• Senior managers act on staff feedback,
• Communication between senior management and staff is effective,
• Satisfied with the extent St Andrew's values my work,
• New therapies and services introduced by St Andrew's closely match what patients/service users want
• Staff could feel safe to speak up about anything that concerns me at St Andrew's

This included a mean average of 40% of staff reported that they would feel safe to speak up about anything that concerns me at St Andrew's and only 30% stated that senior managers act on staff feedback. However the more detailed results broken down by ward provided by the hospital did not have any results for any of the 3 supported transition services. There was no narrative to explain this further. For example, whether this was because there had been no results and to provide an explanation why this may be.

The hospital operated a `Safe call' system, (a confidential reporting line where staff can report complaints or concerns,), the number of concerns raised by staff were low. The hospital provided details of the concerns raised through this confidential reporting line across all wards. Between September 2024 and February 2025, staff had raised 1 concern relating to any of the 3 supported transition service — this related to an allegation of staff sleeping on duty in one identified ward This was reported as still being investigated.

The provider had a Freedom to Speak Up Guardian Team which consisted of one lead Guardian and 8 Freedom to Speak Up Guardians who were located across all sites. The lead guardian was the Associate Director for Patient Safety. As a team, they have been actively working to raise the profile of `speaking up' as well as sharing the learning from themes raised.

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 has 4 focused employee networks that support the provider’s diversity and inclusion strategy. These were WiSH (Women in St Andrew’s Healthcare), Unity (focusing on Black, Asian, Minority and Ethnic employees), DAWN (focusing on disability and wellbeing) and PRIDE (focusing on LGBTQ+ employees).

All these networks have an executive sponsor who take part in network meetings and events, and ensure the Board are sighted on discussions, themes or issues from these networks.

The provider employed a diverse team of staff including staff from international backgrounds specifically recruited to fill staff vacancies. Employment practices promoted equality of opportunity. Managers stated in their quality accounts that they promoted equal opportunities, did not discriminate against staff from minority groups and worked to reduce pay gaps where they were based on protected characteristics. Staff we spoke with on the supported transition services did not raise any concerns about discrimination.

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.

The provider had an audit schedule which included central audits which were required across all St Andrews Healthcare services and those which were service specific. The provider-wide central audits included audits on do not attempt cardiopulmonary resuscitation, patient involvement in least restrictive practice, enhanced support arrangements and searching. The only service specific prescribed audit for the wards for people with a learning disability was the green light toolkit. The goal of the Green Light Toolkit is to support mental health services as they work on improving their response to three groups of people. The three groups are autistic people, people with learning disabilities and autistic people who have learning disabilities.

The green light toolkit audit was marked as in progress so had not been fully completed to understand what adjustments or recommendations for improvements.

There were no designated audit to benchmark the wards against the requirements of Right Support, Right Care, Right Culture. Right Support Right Care Right Culture is statutory guidance produced by CQC relating to how services can evidence that they are providing good quality care. For example, the fundamental intention is that the STS aimed to provide as much community-facing provision as possible from admission, replicate as much of a supported community living setting as possible and provide a time-limited opportunity to demonstrate that community living will be safe and sustainable. This fitted in with one of the principles of our guidance, but staff were not always evidencing community facing support.

Staff we spoke to were not able to fully identify any identified improvements from recent audits. This meant that audits were not fully effective in improving care as staff delivering care could not explain how they had led to improved practice or care.

We found ongoing issues across a number of regulations which showed that the hospital’s governance systems were not effective or embedded to identify and mitigate risks to the service. This included shortfalls around safe care and treatment, safeguarding, person centred care and staffing. Where the provider had identified the shortfalls themselves such as a lack of specialised training for staff or the need for more autism-informed care plans and practice, action to address these shortfalls were slow or weak.

The provider was working to collaborate and work in partnership, so services worked seamlessly for people. However the systems and processes to share information and learning with partners or collaborate for improvement was still in progress and had not been fully embedded.

Staff told us that they work collaboratively with a range of other agencies including other health and mental health providers, commissioners, and the police.

Commissioners reviewed people’s care regularly in line with the safeguards of the national transforming care agenda.

People told us that their family members and external teams were involved in their care and treatment when they consented. The provider had processes including the care programme approach, care and treatment review meetings and ward rounds were staff external to the hospital were invited. This ensured staff from relevant external partners were involved in decisions around patient care.

The provider was part of a regional alliance of health providers which aimed to improve the quality and effectiveness of mental health and learning disability services in the region, through working together, sharing best practice, and learning. The alliance’s work also involved support to St Andrews Healthcare from other parent health services. Some of the buddy support arrangements were still being fully embedded across the hospital. NHS England was in process of offering further support to the hospital regarding patient safety and safeguarding processes.

Staff had not considered that the people cared for in supported transition services cared away from others in line with national guidance from Baroness Hollins’ final report. Staff had not identified these people to commissioners as being eligible for the safeguard of an independent care (education) and treatment review.

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

Staff working on the wards said that there were limited opportunities to develop their skills. Most staff we spoke to had not attended specialist training above the provider’s mandatory and essential training.

The provider had relationships with external agencies that supported improvement and innovation. Staff and leaders engaged with external work, including research, and embedding evidence-based practice in the organisation.

The hospital had created a practical admission-to-discharge flowchart. This used insights from the National Institute Health and Care research report aroundbarriers to people with learning disabilities and autistic people leaving ‘long-stay’ hospital and its widely shared 10 Top Tips. The hospital planned to trial the flowchart on one of the wards within the learning disability directorate. This aimed to embed good practice into everyday planning and decision-making around discharging people and assist in developing tailored resources to help teams apply the 10 Top Tips in everyday situations.

The hospital had recently hosted a conference about improving its services which included the NHS England national learning disability lead and prominent national spokesperson with lived experience who was a champion on the rights of autistic people.

Although some other wards in the hospital had received National Autistic Society (NAS) Autism Accreditation for their autism informed environments. the 3 supported transition services had not applied or received the accreditation.