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 previous 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 service was in continued breach of legal Regulation 17 in relation to good governance. 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 did have a clear vision, strategy and purpose which was to inspire “hope” for those living with complex mental health needs. However, they did not always understand the challenges patients experienced, or the barriers staff faced providing care, treatment and support to patients in a person-centred way. This concern was identified at our previous inspection in March and April 2025 and these concerns remained at the time of this inspection.

There was a continued lack of effective team working despite staff member’s best efforts because of insufficient staffing numbers resulting in extreme time pressures for staff to manage.

The provider was planning to introduce listening forums for staff to take place every 4 weeks to commence in October 2025.

Staff 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 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 we spoke with told us they would raise concerns with their line manager. On Redwood ward staff members we spoke with said that the culture was open and positive and they could express themselves. Staff were aware of freedom to speak up guardians and knew how to contact them. However, some staff were less confident about speaking up or being listened to by senior leaders. This concern was identified at our previous inspection in March and April 2025 and remained a concern at this inspection. Staff survey results from June 2024 were low (27%) for the statement, “would feel safe to speak up about anything thing that concerns me at St Andrews”. The provider sent us data about freedom to speak up themes in the previous 3 months and these included; staffing levels, management communication and fair treatment of staff including flexibility with planning shifts.

We were also made aware of staff coming forward to report abusive practice by a staff member, but there was considerable delay in this staff member reporting their concerns. Following the action taken by CQC, the provider had taken some significant action during the time of this inspection to inform and encourage staff to speak up if they had any concerns or had witnessed unsafe or poor care.

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 they had concerns regarding members of the executive team. The provider has told us that 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.

Staff understood their responsibilities regarding duty of candour to apologise when things went wrong. We saw evidence in records that staff had taken this action. However, we were not assured enough action was taken to prevent the same thing happening again.

The evidence showed a good standard. The service valued diversity in their workforce.

The provider had a policy in place to support equality and inclusion across the hospital. A diversity and inclusion report had been published which included diversity data of staff employed, support networks available to staff and priorities for the following year.

The provider employed a diverse workforce. Staff told us they were treated fairly regarding their equality and diversity needs and had not experienced discrimination.

Staff survey results from June 2024 scored high (91%) for the question “St Andrew's acts fairly with regard to career progression/promotion”. The question, “Not experienced discrimination from manager/team leader or other colleagues” scored 81%.

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.

There was an ongoing lack of oversight and quality monitoring. Many of the concerns we identified at our previous inspection, we found during this inspection. Concerns included a lack of available staffing, a lack of meaningful activities and a poor quality of life for some patients. Despite staff members best efforts and raising similar concerns for some time, not enough action had been taken by leaders to resolve these issues or to improve quality of life and safety for patients.

The provider had a risk register that included action plans with timescales for later in the year. However, patients were still not protected from harm. There was a lack of specialised training for staff and application of the provider’s chosen treatment model. While the use of agency staff had reduced, agency staff did not always have dysphagia (swallowing difficulty and risk of choking) training, and this did not support staff to keep patients safe. Most staff were motivated to improve outcomes for patients but remained frustrated with the lack of resources and support to achieve this.

There was a continued lack of effective communication methods for patients experiencing communication difficulties, so their experience and feedback was not assessed or taken into account. Restrictive practices regarding the use of plastic cutlery had still not been resolved. Some action had been taken to improve the ward environment and to make it more dementia friendly. However, further improvements were required.

The provider had an ongoing programme of audits to check compliance with their policies and procedures. Some of this work had been put on hold because the provider was addressing other priorities. This included taking action to address the closed culture concerns we found during this inspection.

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.

The provider had an ‘incident response plan’ and a Business Continuity Management System Strategic Framework which set out charity wide, roles and responsibilities in response to any incident or any unplanned disruptive event.

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.