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

Caring – this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our previous inspection we rated this key question good. At this inspection, the rating changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of legal regulation 10 in relation to dignity and respect.

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 evidence showed significant shortfalls. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

Most patients we spoke with using the service (7 out of 10) spoke positively about staff, in relation to attitude and helpfulness. Three patients we spoke with raised issues in relation to the treatment they received from staff. One patient said, “they do not go out of their way to help you”. One patient said “staff did not interact with patients when on their observations, but talked to other staff members, not always in English”. One patient found it hard to understand and communicate with some staff due to what they described as “language barriers”.

Some carers and relatives had shared some feedback with us about the service, which was mixed. Please refer to the ‘People’s experience of the service’ section for further details. Concerns were shared with us around general care and treatment. A relative had observed numerous unexplained injuries on a patient and were concerned staff told them they did not know how these had been sustained. Further concerns had been raised around the lack of diligent physical healthcare monitoring. These concerns were being investigated or had been investigated by the provider.

Through statutory notifications, ongoing monitoring of the service, and communication with external agencies, CQC were made aware that there were ongoing investigations within the neuropsychiatry service. These related to potential abuse of patients, by staff, including verbal, psychological and physical abuse. Formal CQC actions had been taken to protect patients, as well as actions by the provider. At time of this inspection, investigations continued.

We observed how some staff interacted with patients on Tallis ward, in the evening, for a period of 20 minutes. We observed 2 different members of staff who were undertaking one to one observations. One patient was sat in their bedroom, was observed to be awake and was seen to be making efforts to communicate with the allocated staff member. The staff member was sat in a chair in the doorway to the bedroom, watching the patient, but making no attempts at all to engage during this period of observation.

A second staff member observing a patient was sat in a chair outside of the patient’s bedroom, slightly to one side. The patient was in their room, and we observed them to be pacing around continuously. The staff member from their position could not see the entire room. Throughout this period of observation, the staff member made no attempts to communicate with the patient.

However, we did see one positive interaction between a staff member and one patient on Tallis ward. A staff member and a patient were interacting well and laughing, talking about music. Despite this one positive interaction, we then saw the patient walked towards their bedroom and passed 2 further staff members. Neither staff member acknowledged or communicated with the patient as they passed them.

Later in the evening we observed some positive interactions between a staff member and a patient who were engaged in a game of pool.

On Elgar ward we observed a staff member sitting with a patient who appeared anxious and was asking if they could speak to a relative on the phone, as this would reassure them and make them feel better. The staff member showed kindness and took some time to sit with the patient and offered them reassurance. Shortly after this interaction, we saw the patient had been given a phone and was speaking with their relative, as requested. This had appeared to soothe the patient.

On Walton ward we undertook an observation during a mealtime. We observed staff present in the dining room and were available to support patients as and when required. We saw requests from patients, for example a drink, were met in a timely way. We observed staff encourage and support independent eating, yet they made sure patients could call upon them for assistance if this was needed. When patients had finished their meal, we saw staff assist them with washing their hands and face, where appropriate.

We were concerned that the dignity of patients could be compromised when staff had to support them to seclusion on another ward. There had been a recent seclusion of a patient from Walton ward. As the ward did not have a seclusion facility, the patient had to be taken to a ward close by. We observed that to get from one ward to the next ward, the patient would have to pass communal areas of the ward, as well as some patient bedrooms.

On Tallis ward, the seclusion room was located at the far end of the ward. Some staff we spoke with said that the location of the room was not ideal, in terms of supporting a patient through the ward to get to it. This room had been used frequently on a short-term basis, for 4 patients on the ward between April and July 2025.

Elgar ward did not have a seclusion room. Patients would need to use a room on another ward. However, there had been no reported seclusion over the previous 12 months.

The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The wards visited were very spacious and accessible for people who had mobility difficulties, and / or used a wheelchair.

Patients had access to multidisciplinary teams (MDT). These included access to occupational therapy, psychology and speech and language therapists. Appropriate assessments of communication needs were undertaken for patients. A range of aids were available to support and enhance staff communication with patients. This included information about patient’s rights, how to complain, and how to seek advocacy.

Where appropriate, pictorial / easy read material was available. Staff could access information in different languages for patients who required this. British sign language interpreters were available for staff to request to maximise understanding and involvement if needed.

During the admission and assessment process, staff routinely asked patients what mattered to them. This included access to chaplains or faith leaders, any religious practices and rituals, spiritual beliefs, as well as any dietary requirements or preferences. Staff were then able to include relevant details within care plans and facilitate appropriate activities.

In care records we reviewed, we saw numerous examples of individual preferences reflected, such as wearing of dentures, preferred vaping times and frequency, regularity of having a shower, and how patients liked to enjoy their leave.

The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Staff supported patients to understand their rights by using different ways to communicate. During MDT reviews, understanding was assessed and recorded where appropriate. Patients could give their views and wishes during MDT meetings, where able.

Patients and carers we spoke with confirmed that people using the service were supported by staff to maintain relationships that were important to them. Staff supported regular contact with significant others via telephone, video calls and facilitating visits. Patients chose who the clinical team could relay information too, regarding their care and treatment, which was respected and recorded.

The wards offered a variety of activities that patients could choose to participate in. Activities were discussed in the ward community meetings. Patients were routinely asked what they had enjoyed and if they had any suggestions for future activities. Examples of activities patients had said they had enjoyed included a walk around the hospital grounds, visit to the library, bingo and latch hooking.

On Walton ward we saw staff had involved patients with some refurbishment of the ward ideas, to include colour schemes and murals. Some patients had expressed the desire to be able to go to the pub. While this was not always possible, staff were trying to bring the ‘pub’ to the ward. An area off the lounge was being turned into a’ bar, with an area for serving drinks, a television, darts board, comfortable seating, and this opened directly to the vaping area outside. One of the patients told us they had been testing the non-alcoholic spirits so the ward manager could purchase, which would help create the feel of the pub. The staff and patients had named this “The Walton Arms”.

Patients were able to have leave following relevant assessments to ensure this was safe. Where patients needed to be escorted by staff, the reason was explained to them. Where possible, patient choice (for example the gender of escorting staff) would be considered and facilitated if appropriate.

The evidence showed significant shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Most staff were able to give an overview of presenting risks for patients on their wards, and how to manage these. For example, staff on Walton ward told us about the high risk of falls for some patients, along with how staff assisted them, while encouraging independence. Some patients had walking aids, others were assisted by staff to perform certain daily tasks, and some were observed more frequently. Staff recorded specific risk issues and reviewed these regularly.

We saw that one patient on a ward had struck another in the face. The patient who had hit their peer discussed this incident with a psychologist. The patient described seeking support from staff who were present at the time of the incident. Their peer was shouting out repetitively. Staff were asked to intervene. However, the patient said the intervention was not quick enough, his peer continued to shout, so they hit the other patient so they would stop. We were concerned to learn of this, as relevant risks, behaviours and what may trigger aggression had been recorded by staff in both patients’ records.

We went on to review records of the patient who had been struck, witnessed by staff. We could not be clear what time this incident occurred, it was thought to be at around 9pm. Staff did not inform the nurse in charge until almost 5 hours post incident. This meant that neuro-observations were delayed. The nurse did report this to the doctor as soon as they were made aware. This time lapse in reporting was unsafe and did not provide assurances that patient safety was a priority.

All staff we spoke with told us that they used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened. However, this was not always evident in clinical records we reviewed.

Most staff we spoke with said they were able to respond to individual patients’ needs in a timely way. However, this was not consistently evident in records. Most patients we spoke with said there was enough staff on the wards. Staff we spoke with said recent uplift to staffing helped them to meet patients needs, which had been difficult in the past.

One carer did not feel staff were responsive to their relative’s physical health care needs and had made a complaint. The relative had continued to express disappointment in a delay in assessment and treatment for a physical health condition, which had required a specialist assessment. This had been significantly delayed. The provider had since resolved this, and appropriate treatment sought.

The evidence showed some shortfalls. The service promoted the wellbeing of their staff and supported staff to deliver person-centred care.

We spoke with 16 staff members across the wards visited. Most of these (14) said they felt respected, supported and valued as employees. Staff told us they felt proud to work for the service, and felt the neuropsychiatry division was supportive, with good team working.

Staff told us they often worked long hours to cover staffing gaps across the wards, with many working regular overtime. Staff had raised concerns internally about staffing levels, lack of communication, and fair treatment of staff around flexibility with shifts.

Staff told us they were aware they could access support for their own physical and emotional health needs and knew this could be accessed through the hospital’s occupational health department. Several staff confirmed there were de-briefs available for staff following some incidents. Psychologists also offered reflective practice sessions, which were open to all staff.

All staff received annual appraisals of their work which included conversations on how they could be further supported to develop. There had been internal promotions for some staff within the service.

Sickness rates were not above the national average, ranging from between 0.8% and 5.1%.

The provider recognised staff success within the service – for example, through staff awards. The staff team on Tallis ward had been nominated for a care award in July 2025 for compassion.