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

Well Led - 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 previous inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the service 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 was in breach of legal Regulation 17: Good Governance.

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.

Staff we spoke with understood patients were at the hospital to try to improve in their day-to-day skills, for them to be transferred into a less restrictive or community setting. The provider’s guiding principles were compassion, accountability, respect and excellence.. However, we did not always see these principles applied in practice as we have outlined within this report.

Most staff told us senior leaders had visited the wards in the past but did not spend long periods of time with the ward staff. Some staff highlighted the Chief Executive Officer was available and had advised and encouraged staff to speak up, share ideas, feedback or concerns. None of the staff we spoke with had done this, but they were aware the invitation was open to all.

Staff on the wards explained that most communication regarding the hospital and changes came through the ward managers. Staff were encouraged to relay ideas or concerns in ward meetings, or during supervision. Ward managers then escalated themes to senior staff as and when necessary. Staff we spoke with at ward level had not felt fully consulted in proposed changes. An example was the changes to the rota system and shift pattern.

On Church ward, which since this inspection had closed, there were a number of concerns around potential abuse of patients, with evidence of a closed culture. In addition to this, there was further evidence of a closed culture during a significant incident within the hospital, on a ward, in the secure division prior to this inspection, which identified abuse of a patient by numerous staff. There were 17 staff involved in this incident, due to a response received from across the hospital, via a group alert. This included staff who worked in the neuropsychiatry division. None of the staff who attended and were involved in, or observed this incident, raised any concerns.

This service demonstrated a closed culture. Well known risk factors were evident on the wards we visited. These included patients being unable to leave the service of their own accord and one to one care being delivered. Many patients were highly dependent upon staff for their basic care needs. Many patients had communication difficulties and / or some levels of cognitive impairment. However, the leaders in the service had failed to identify and act on the potential risks of a closed culture developing.

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.

The evidence showed significant shortfalls. Not all people felt they could speak up and that their voice would be heard.

Most staff we spoke with told us they felt they could speak up and raise concerns about colleagues and / or deficits in patient care. Staff we spoke with knew there was a process in place but could not always explain what this was. Many staff referred to recent information about raising concerns which had been displayed on the wards, so they knew where to locate this information if needed.

We reviewed the most recent available staff survey results for all the wards in the division, from June 2024. On all 3 wards we visited, staff had not collectively agreed with the statement ‘would feel safe to speak up / raise concerns’ (Scores ranged between 41% to 59%). This response was indicative also for the acquired brain injury wards in the division not visited. We were aware that staff speaking up had been a continued area of focus for leaders.

During this inspection period, CQC did not receive any concerns raised anonymously by staff at this hospital which related to the 3 wards visited across the neuropsychiatry division. CQC did receive hospital wide concerns raised by staff around medicines management, and generic failure of the alarm system. CQC had sought assurances from the provider relating to these issues and were satisfied that appropriate actions had been taken to maximise patient safety in these areas.

During this inspection period CQC were contacted by 2 separate staff members, raising concerns that many staff did not feel they could raise concerns anonymously – via the external process if they related to members of the executive team. This was because staff were aware that all concerns raised were escalated to the executive team for review. The provider’s Freedom to Speak Up policy stated that this external process provided a full, comprehensive written report for each call they received. This was then sent to the HR Director. This could potentially deter staff from speaking up. Staff who contacted CQC were afraid of potential consequences should they be identified. Furthermore, concerns were raised regarding a lack of access to the chairman of the organisation. The provider told us the chairman has a dedicated email address. However, these staff did not feel happy or secure with this process.

We asked what the freedom to speak up themes had been across the neuropsychiatry division over the 3 months prior to our inspection. Themes of concerns raised had been around staffing levels, communication (management), and fair treatment of staff including flexibility with planning shifts. The provider told us that no staff had raised any concerns with the external whistleblowing process which related specifically to the acquired brain injury wards.

Of the 16 staff we spoke with, 2 had raised concerns to senior staff. One was in relation to a patient, and one was in relation to the need for additional staffing. Both staff members felt listened too, with appropriate actions subsequently taken.

The evidence showed some shortfalls. The service placed some value around diversity in their workforce. They worked 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 prided itself on being an equal opportunities employer, welcoming a diverse workforce. The hospital had employee networks and forums for staff which enabled ongoing dialogue, learning opportunities and support. Examples included a disability and wellbeing network, and a PRIDE network.

Some staff we spoke with were unhappy with the recent changes in shifts. Set shift patterns which had been used to schedule shifts previously had ceased. Staff were expected to work more flexibly. This change was made as part of the wider, closed culture work taking place across the hospital. 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. Managers we spoke with anticipated this new change might be met with some resistance, but said they aimed to offer flexibility where possible.

The business language across the hospital was English. Staff had been reminded of this in the past, as speaking in languages patients do not understand is not conducive to their recovery and is not respectful. During this inspection, we heard one reference about staff speaking in languages other than English (from a patient).

Staff we spoke with gave positive feedback about the diverse workforce and available opportunities open to all. We reviewed the most recent available staff survey results for all wards in the division, from June 2024. On all 3 wards visited, a high number of staff reported their line manager valued their work (between 83 – 88%). This positive response was also received for the acquired brain injury wards not visited.

The evidence showed significant shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The neuropsychiatry division had a risk register, which had completion dates for actions identified, along with who was responsible for undertaking these. Some high risks which contributed to this inspection were present as expected. This included but was not limited to unreliable alarm system in some areas of the hospital, lack of leadership visibility and oversight, inconsistent delivery of enhanced observation practice, risk of a closed culture and inconsistent reporting of incidents and detail of incidents. However, we found sufficient actions had not been taken in order to deliver the required improvements.

Clinical governance meetings at ward and divisional level had a consistent agenda. This covered safety, compliance, physical health, effectiveness, overall governance and risk, patient / carer experience, people, culture, operations and estate / environment.

At ward level, we saw some wards held more discussion around incidents and risk than others. Walton and Elgar wards provided an overview of incidents over the previous month and had a breakdown of incident themes, restraints, seclusions, falls and safeguarding concerns reported. However, there was a lack of discussion around any learning from these. On Tallis ward, of 3 meeting minutes we reviewed, a brief incident analysis was provided in just 1 month out of the 3. There were no recorded discussions of learning.

We reviewed 9 ward meeting minutes between May and August 2025, and identified in 7 of these, there were incident forms pending managers review, which were overdue. If incidents are not reviewed in a timely way after occurring, there is a risk that required actions might be delayed.

At the divisional clinical governance meeting, each ward presented the relevant information under each agenda item. There was a lack of evidence regarding lessons learnt from incidents, complaints and feedback at these meetings. However, as referred to under the quality statement of learning culture, under the safe key question, systems were in place to share learning across the hospital.

The provider had a central audit timetable which was completed over the course of each year hospital wide. The audits covered several areas such as clinical documentation, physical healthcare, clinical supervision and patient community meetings. However, we found these audits had not led to the improvements required to ensure patients were kept safe.

All wards had their own clinical audit timetable, the frequency of which varied between monthly, three monthly and annually. Areas included infection prevention and control, medicines management, health and safety, care plans and enhanced support. Despite this, we found significant issues in relation to health and safety, care planning and enhanced support.

There were a number of quality improvement initiatives across the neuropsychiatry division at time of inspection. This included but was not limited to work around staff culture and leadership, inconsistent application of models of care, skill mix of staff, inconsistent reporting of incidents and quality of the detail, enhanced support care and blanket restrictions. Most of these concerns had been highlighted by CQC during previous inspections.

Each ward visited had an action log, some of which had been generated following audits. For example, environmental issues identified, medicine management issues and infection prevention and control. It was evident that some clinical audits identified shortfalls which meant action could be taken. However, not all audits undertaken resulted in an action plan. As the report refers to under the safe key question, audits of enhanced observations did not produce an action plan nor identified who would be responsible for addressing. This showed that shortfalls identified in audits had not always been actioned to make and sustain improvements. This did not give assurance that there was clear oversight and responsibility for monitoring and following up.

Of the 3 wards visited, Walton ward had received no complaints. Elgar ward had received 2, both from patients’ relatives. One regarding physical healthcare / personal care, which had been investigated and closed, and one around delayed discharge, which was ongoing. There were no recorded lessons learnt within the complaints log for the completed complaint.

On Tallis ward, there had been 2 complaints, one from a patient and one from an external professional. Both were about physical healthcare / personal care. One of these had been closed and one was ongoing. The lessons learnt provided within the complaints log for the closed complaint was “the care team to continue to work with patient’s”. More details could have been provided to guide staff in how to work with this specific patient.

The provider had plans in place to respond to and recover from a range of unforeseen incidents or emergencies (Incident response plan and a business continuity management system strategic framework). Examples of such incidents include a major fire, extreme weather conditions, or an outbreak of an infectious disease. The plan ensured all relevant people are informed, activation of relevant incident management teams, appropriate escalation, response, management, monitoring and resolution.

Staff had access to the equipment and information technology needed to do their work. There had been recognised concerns with connectivity of Wi-Fi, which on occasions, had resulted in a failure of the alarm system, and some delays with accessing electronic medicines records. This was something we were told the provider was continuing to address and monitor but had not seen sufficient improvements at the time of this inspection.

Information governance systems included confidentiality of patient records. Staff understood the importance of patient confidentiality. However, on one ward we visited, we saw an incident form had been completed, after a patient had clearly overheard staff talking amongst themselves about another patient and had proceeded to ask further questions, highlighting a confidentiality breach.

Managers had access to information to support them in their management role, such as training compliance, sickness and absence data, supervision compliance and any performance related concerns relating to team members.

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.