St Andrews Healthcare Northampton

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• 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 inspection we rated this key question inadequate. At this inspection the rating has remained inadequate. This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The provider was previously in breach of the legal Regulations in relation to good governance Regulation (17). Improvements were not found at this inspection, and the provider remained in breach of these Regulations.

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 evidence showed significant shortfalls. The service 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’s senior leadership team had developed the provider’s vision and values. However, whilst the provider had a vision and strategy in place, this had not been translated into the standard of care patients received. Between 11 July and end of August 2025, the provider reported 14 incidents of alleged staff assaults on patients, and 3 incidents of alleged staff aggression toward patients. During the time of our inspection, the hospital did not have a Registered Manager in place, which at the time of writing remains unchanged.

This service demonstrated a closed culture. Well known risk factors were evident on the wards we visited. Staff spoke to us about ‘not being listened to’ by senior managers, staff also told us that there was a fear across the service of possible reprisals if concerns were raised. One whistle blower had told us that they were “shouted down” every time that they raised a clinical concern. Another staff member told us that they had witnessed other colleagues raising issues, who were then viewed as a problem.

Staff also told us that they were concerned about the future of the hospital. Due to the significant concerns raised by CQC and partner agencies during this inspection, the[CH1] provider was taking action to address concerns identified, which included an independent review of the culture of the hospital. Additionally, individual patient safety interviews had been conducted across the site. CQC agreed with the provider for them to undertake regular reviews of incidents involving restraint which included watching relevant CCTV footage, as well as maintaining efforts with staff training and awareness around closed cultures, with weekly reporting to CQC on the outcomes.

The evidence showed significant shortfalls. People did not feel they could speak up and that their voice would be heard.

Staff had not felt they could speak up and that their voice would be heard. The provider had a freedom to speak up process in place. Information received from the provider, showed that during the previous 3 months staff had raised concerns regarding the restrictive language used, breaches in professional standards, staff behaviour and the fair treatment of staff by managers, including shift allocations and staffing levels. Between 21 July and 28 August 2025, staff raised 21 concerns, of which 11 were from medium secure, 8 low secure and 2 low secure ward staff. The highest concerns raised (6 concerns) related to professional behaviours, followed by management: alleged unfair treatment (5 concerns) and professional standards (3 concerns). Despite these significant warning signs, the provider failed to take sufficient action to protect patients from abuse and the impact of a closed culture.

However, not all staff felt safe using the provider’s freedom to speak up process. One staff member told us they would be worried to raise concerns through fear of what would happen (for example suspension). A second staff member told us they would be fearful to raise concerns as they would be seen as a whistleblower, and they had informed human resources (HR) how they felt. The staff member stated they had witnessed other colleagues raising issues, who were then “seen as a problem”.

During the inspection, CQC received 3 whistleblowing concerns from staff. During the time of our inspection, we observed evidence of a closed culture. We were informed that 17 staff members had witnessed a serious incident which included safeguarding issues, however none of the staff involved had raised a concern. We also heard of historic incidents relating to another ward, which had not been reported at the time the incident had taken place. Staff told us they were reluctant to raise concerns, due to fear of repercussions, and we had received whistleblowing concerns raised by staff in respect of this closed culture. Following our inspection, we received 2 whistleblowing concerns raised by staff regarding a lack of access to the Chairman of the trust. Staff told us that they had concerns regarding members of the executive team. The provider has told us any concerns relating to the executive team should be directed to the Director of HR and that the Chairman has a dedicated email address. However, staff did not feel happy with the current process.

Due to the significant concerns raised by CQC and partner agencies during this inspection, the provider was taking action to address concerns identified, which included an independent review of the culture of the hospital. Additionally, individual patient safety interviews had been conducted across the site; CQC agreed with the provider for them to undertake regular reviews of incidents involving restraint which included watching relevant CCTV footage, as well as maintaining efforts with staff training and awareness around closed cultures, with weekly reporting to CQC on the outcomes.

Managers and staff had access to the feedback from patients, and staff. Patients had opportunities to give feedback on the service they received. As part of the inspection we requested and reviewed minutes of community minutes from all wards across the forensic services. The main themes coming from these included concerns about the food (portion sizes and choice) and maintenance issues (particularly showers). On Lower Harlestone ward 3 patients had told staff they were unhappy on the ward. All 3 patients referenced the attitude of staff, 2 of the 3 patients explicitly referenced bullying by staff. Whilst most wards presented feedback from community meetings in the format of ‘you said, we did’, not all minutes from community meetings evidenced that concerns raised by patients in the community meetings were being addressed. For example, in the community meeting held on Mackaness ward on 11 July 2025, an issue relating to a ‘lack of staff and healthcare provision’ was raised. An update in relation to this concern was not raised in either community meetings held on the 18 and 25 July 2025.

Patients were also able to provide feedback via the patient survey ‘My Voice’. Minutes of the medium secure governance meeting minutes (June 2025) identified that Fairbairn and Bracken wards had low participation due to communication barriers and patient disengagement. Staff had also recorded that negative feedback had been “notable in Cranford and Fairbairn”. Staff had recorded that this had “been linked to perceived lack of action on staffing and safety concerns”.

The evidence showed some shortfalls. The service did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The provider had a diversity and inclusion policy in place for staff which was reviewed regularly. The hospital was an equal opportunities employer, welcoming a diverse workforce. The hospital had employee networks and forums in place for staff which enabled ongoing dialogue, learning opportunities and support. Examples included a disability and wellbeing network, and a PRIDE network. However, we were informed by staff, that there were some splits between staff from different ethnic minority backgrounds, which had created some conflict on the wards.

Minutes of ward meetings confirmed that some staff were unhappy with the recent changes in shifts. Leaders had decided that the shift patterns which had previously been used to schedule shifts had been changed. This change was made as part of the wider, closed culture work taking place across the hospital, and staff were expected to work more flexibly. Managers said staff were able to apply to work flexibly if they had caring responsibilities or other special circumstances, such as health issues. Requests were considered by the managers in collaboration with the human resources department. Fair treatment of staff and flexibility with planning shifts had been raised recently through the freedom to speak up process.

We were informed by staff, that some staff members were regularly found to be talking in languages other than English on the wards. This can lead to patients feeling isolated and could lead to feelings of paranoia. Staff speaking in languages patients do not understand is not conducive to people’s recovery and is not respectful. Staff had to be reminded not to talk in their native language of the wards. Minutes of team meetings confirm that staff have been reminded of this requirement.

Staff we spoke with gave positive feedback about the diverse workforce and available opportunities open to all.

The evidence showed significant shortfalls. The service 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 evidence from the other key questions demonstrates that whilst governance processes were in place, these did not operate effectively at team, service or hospital level. The evidence showed significant shortfalls in the quality of care delivery. The service did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment, and support.

Leaders did not demonstrate they had the skills, knowledge and experience to perform their roles. Leaders did not have a good understanding of the services they managed. They could not explain clearly how the teams were working to provide high quality care, due to the number of concerns regarding a lack of patient safety and appropriate care and treatment.

We found concerns remained from our previous inspections in many areas including the use of inappropriate restraint techniques, staffing, learning from incidents, a lack of dignity and respect and the treatment of people by staff, including allegations of staff assaults (physical, verbal and sexual abuse) on people.

The provider had not always made timely referrals to registered bodies when staff actions or omissions in care, which had resulted in harm to patients. For example, referrals to the Disclosure and Barring Service (DBS) and/or the Nursing and Midwifery Council (NMC) had not always been made in a timely manner when required. This was despite requests made by the CQC to the provider to ensure these referrals were made. This created a risk that staff (for whom there were existing concerns about their practice) could be able to commence work in other care settings. This could result in other patients being exposed to poor standards of care, ill treatment or abuse.

Several staff we spoke to had not felt listened to by leaders. For example, one staff member told us that “staff do not feel that senior management considers what works at ward level. Senior managers are not visible unless something has gone wrong”.

The provider shared the outcome of the staff survey ‘your voice data’ Data was collected between 3 to 24 June 2024, and staff were asked a range of questions relating to pride, energy and optimism. The highest average response rate across wards, related to teamwork and energy, with an average score of 76%, followed by diversity and inclusion with an average score of 72%. However, the 5 lowest scores for all wards, related to senior managers act on staff feedback (lowest score: 24%, highest score: 64%, average score 37%, communication between senior management and staff is effective (lowest score: 24%, highest score:77%, average score 49%, staff satisfaction with extent St Andrew's values their work (lowest score: 29%, highest score: 67%, average: 45%), new therapies and services introduced by St Andrew's closely match what our patients/service users want (lowest score: 50%, highest score: 62%, average: 56%), Would feel safe to speak up about anything that concerns me at St Andrew's lowest score: 21%, highest score: 62%, average 41%.

Some staff told us leaders were not always visible in the service and approachable for patients and staff. One staff member told us they were unsure of who the managers were.

There was a clear framework of what must be discussed at a ward, team or divisional level in meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. However, these were not effective. For example, not all staff had been made aware of an ongoing and serious incident. Despite processes being in place, these had not been translated into ongoing improvements in patients care and treatment. Staff had not reported all incidents. Not all incidents which met the threshold for referral to the local safeguarding team had been raised.

The provider had not always acted on information about risk to improve patient experience. Systems to ensure that wards were safe were not effective. The minutes of Spencer North and Souths’ joint clinical governance meeting for July 2025, states that “The last heatwave raised some concerns around the bedroom corridors for both wards, with temperatures reaching 33°C at one point”. The minutes state that when requested, the charity leadership were unwilling to provide portable aircon units. However, the provider has advised that they took active steps to ensure that systems were in place to lower the temperature in patient and staff areas such as clinics.

The provider did not have effective oversight of safety. The provider had not ensured their safe staffing numbers were met on a day to day basis, to ensure the facilitation of activities and patients’ leave. The high number of incidents of alleged assaults by staff members on patients is of extreme concern and required CQC intervention. During our review of CCTV, we have observed 2 incidents of staff assaults on patients. Between 11 July and end of August 2025, the CQC received 7 allegations of assault by staff on patients including allegations physical assaults, sexual assault, and financial abuse.

Staff undertook or participated in local clinical audits. The provider had a central audit schedule including local audits (for example, clinical supervision, search, care plan and community meetings), 4 national audits on falls, end of life and 2 medication audits.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients.

The service had plans in place for emergencies, for example, adverse weather or a flu outbreak.

Where cost improvements were taking place, they had affected plans which could compromise patient care. For example, in the minutes of the divisional clinical governance meeting for low secure and the CAMHS ward (June 2025) it had been recorded that “There is no budget this year for ward away days”. Away days for ward staff offer benefits including improved teamwork and communication, increased staff morale and motivation, better staff retention, and a positive impact on overall patient care.

The service used systems to collect data from wards and directorates that were not over-burdensome for frontline staff. Staff had access to the equipment and information technology needed to do their work. Information governance systems included confidentiality of patient records.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. However, this was not always used to ensure improvements to the quality and safety of care.

The provider has required extensive input from senior external stakeholders, including weekly strategic meetings and monthly intensive oversight meetings to ensure patients are kept safe and improvements are made to the quality and safety of care provided.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.