Archived: 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

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 as Requires Improvement.

At this inspection the rating has changed to Inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls

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 treat people with kindness, empathy, and compassion, or respect their privacy and dignity.

The provider did not ensure staff had sufficient time and support to always offer kind and compassionate care, treatment and support. During our visit staff were very busy and not always able to spend time with people. We carried out a short observational framework inspection (SOFI) to assess the quality of life experienced by people. We saw non-permanent staff supporting a patient. They did not engage with the patient who appeared uncomfortable and tense. We saw the patient’s mood improve when a permanent staff member took over and was able to engage with the patient, resulting in the patient smiling and laughing. Some patients received limited or no staff engagement within the SOFI timeframe.

We also saw one patient was distressed and trying to get staff members attention, but staff were busy supporting other patients. Nurses told us they did not have a good oversight of the ward day to day because they were busy administering medicines. Staff told us they only had time to provide basic care treatment and support. Redwood ward team meeting minutes in June 2025 recorded there was a “sense of moral injury with staff believing that they could/should be doing more for the patients”.

We reviewed CCTV footage for an incident on Redwood ward and saw a staff member did not offer comfort or compassion when a patient fell. We reviewed CCTV footage for an incident on Aspen ward and saw a staff member appeared frustrated and did not offer kindness or compassion in their interaction with a patient.

Whilst we were extremely concerned to see how some members of staff treated patients, other staff we spoke with were kind and compassionate in their approach and were motivated to improve outcomes for patients. On one occasion, we observed some very positive interactions between a patient receiving one to one enhanced support. The staff member knew the patient well and was able to engage them and provide reassurance and support which upheld the patients sense of wellbeing. However, it is not acceptable that this was not the consistent experience of all patients on wards for older people with mental health problems.

When asked if staff were kind and respectful, a patient said, “as much as they can be”.

The evidence showed significant shortfalls. The service did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The service did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff did not have enough time to provide care, treatment and support that met patients’ preferences. The service was aware their chosen treatment model the ‘enriched model of dementia care’ was not always followed and this was acknowledged within team meeting minutes and in the provider’s risk register. In response to concerns raised at our last inspection in March and April 2025, additional training about dementia and Huntington’s disease was planned for ward staff, but this was not planned to take place until September 2025.

Meaningful activity (activities based on individual preferences and interests) were not always delivered. This was because staff did not have enough time and there was not enough occupational therapy staff available to support the wards.

Each patient had an ‘all about me document’ and a ‘positive behaviour support plan’ (PBS) developed by the division’s psychology team. These plans provided information about significant social and cultural history and needs, and set out the patients likes and dislikes. However, information was limited and did not provide enough detail or translate to care and treatment plans designed to promote quality of life experiences based on preferences and abilities. For example, a patient’s likes and dislikes were recorded as “building blocks, yoghurt, TV, being read to and going outside”. Records showed they did have access to blocks and occasionally were supported to go out into the courtyard. There were no records seen of them being read to or what type of literature they would prefer.

The PBS plans utilised a psychology model Reinforce Appropriate, Implode Disruptive (RAID). The model is based on the reinforcement of behaviours viewed as positive (known as green behaviours) and described behaviours which would indicate distress. However, this model did not align with or support the ‘enriched model of dementia care’ which required staff to view distressed behaviours as the communication of unmet needs. It is difficult to understand how patients with dementia would benefit from this positive behaviour approach when they may not have the cognitive ability to recall appropriate responses or reflect and learn and implement changes themselves. PBS plans did not provide enough detail about what may have triggered the distressed behaviour or about what action staff should take to resolve it.

Since our previous inspection, action had been taken to personalise patient’s rooms to reflect their individuality with meaningful decoration such as photographs and items significant to their preferences and interests. This work was ongoing with plans to develop communal areas within Redwood ward to be more ‘dementia friendly’ such as decorating and furnishing the quiet room to resemble a living room to create a comfortable and familiar environment. However, there were no clear timescales for when this action would be completed.

The evidence showed significant shortfalls. The service did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment, and wellbeing.

We were concerned patients were not actively supported to enhance their autonomy or have as much control over their lives as possible. Patients were not supported to live fulfilled lives.

Staff told us and records showed a patient resistant to receiving personal care was restrained by staff to receive personal care. Care plans did not provide enough detail about how the restraint should be implemented in the least restrictive, person centered and safest way.

The patient’s ‘my daily living needs’ care plan recorded that “staff should respect the patient’s choice if they declined personal care”. However, in the section ‘wake up routine’ the care plan stated, “due to unexpected retaliation, 3 staff members will be required to facilitate personal care, 1 staff member will be either side of you, while the third staff member will carry out the personal care”. The use of the word ”retaliation” is punitive and demonstrates a lack of understanding of the patient’s behavior as distress. The care plans did not instruct staff to use an approach the patient may have found acceptable or reduce their distress. Records showed the patient had displayed frequent episodes of distress during personal care, including the patient having been injured and/or the patient hitting out at staff. There was no clear therapeutic plan to fully understand the distress experienced or to reduce or resolve it.

Community meetings were held each month where patients were asked a series of questions about their experience of the ward. Many patients had advanced dementia and were unable to participate in these meetings. Meeting records showed not all patients were included. Community meetings were not an effective method for many patients on the wards because this format did not meet their communication needs. We identified this concern at our previous inspection in March and April 2025.

Some patients were able to provide short responses, but many patients did not provide any response to the questions asked of them because of their cognitive difficulties. There was no action plan recorded where negative responses were provided. For example, when patients said they did not like it on the ward, did not like the food or did not feel safe, there was no record of any action or further exploration. Negative responses patients had provided were not included in the ward action logs or discussed within team meetings.

Staff told us and records we reviewed showed many patients had limited access to leave or to participate in activities that were meaningful to them.

Since our previous inspection the provider’s arrangements for accessing advocacy services changed. We were concerned patients would have reduced access to these services. The clinical governance meeting in May 2025 recorded there were ongoing issues with access to advocacy and social work support for patients on Redwood ward because of capacity issues in the wider Northamptonshire area.

The visiting room on Redwood ward was also the staff room. This did not support patients to have private and uninterrupted time with their friends and families or provide an appropriate space to do so. The provider had identified this as a concern and had identified an alternative room to re purpose for visiting. However, there were no timescales in place for when this action would be complete.

Records showed staff communicated with patients’ relatives and updated them of any changes. Staff told us they valued family involvement. An initiative known as ‘John’s campaign’ was being implemented to promote and support relatives’ involvement. ‘John’s campaign’ core principle is that family members and carers should be welcome and supported to assist with care, decision making.

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

Patients, needs and comfort were not always a priority and staff were not always able to respond to patients in a timely way because staff were so busy.

Staff told us they did not have time to provide anything other than basic care, treatment and support. Team meeting minutes for Redwood ward in May and June 2025 identified staff were finding it challenging to provide personal care in a timely way or to safely manage falls risks.

Since our previous inspection, 2 incidents had taken place where there was delay in escalation in an emergency situation. One incident where staff involved did not follow the provider’s procedure in response to a patient having a seizure and another patient falling and sustaining a head injury

We observed a patient in some distress and at risk of falling but staff were too busy to support them.

Systems and processes were not always effective in identifying the views and wishes of patients who could not articulate their experiences. There were no mechanisms in place to assess the patients experience where they could not verbally provide feedback. There was a lack of oversight or response where patients were frequently distressed or upset.

However, we did observe some positive interactions where staff were able to offer reassurance and comfort to a patient who had been distressed.

The evidence showed significant shortfalls. The service did not care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care.

Some staff we spoke with told us they felt like they were failing, as they could not always provide care, treatment and support in the way they wanted to. However, staff on Redwood ward said they were proud of the ward team and worked together well and were supported by the ward team manager. The ward team manager was motivated to improve staff wellbeing and to make changes to improve and provide person centred care. They had escalated concerns raised by staff and had developed action plans to bring about improvements.

Team meeting minutes recorded several ongoing staff concerns and low morale amongst the staff group. Staff concerns included staff feeling unsupported and experiencing a sense of “moral injury” because they felt they should be doing more for patients. Staff were concerned about a “blame culture” and worried about doing the wrong thing.

The provider’s risk register recorded a decline in staff morale following ward consolidation. Plans were in place to commence a monthly nomination forum to recognise staff member’s good work. However, staff had been raising similar concerns for some time. The most recent staff survey results for Redwood ward (June 2024) scored low (9%) for the statement; “satisfied with extent St Andrew's values my work” and “communication between senior management and staff is effective”. The statement “senior managers act on staff feedback” also scored low (18%).