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 last inspections of forensic inpatient or secure wards, we rated this key question inadequate. At this inspection the rating has remained inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

The inspection found shortfalls in how the service treated people with kindness, empathy, and respect for dignity. Staff interactions were not always discreet, respectful, or responsive, and emotional support was not consistently provided when needed. CCTV reviews raised concerns in over half of the incidents examined, including poor incident management, delays in removing a ligature, inappropriate restraint, and two cases of staff assaulting patients.

While permanent staff generally understood patients’ individual needs, reliance on bank and overtime staff affected continuity of care. Although the service had encouraged staff to “speak up”, some staff still feared repercussions for raising concerns.

Patient feedback reflected dissatisfaction, with complaints highlighting staff attitudes, communication failures, restrictive practices, physical healthcare delays, medication errors, and equality issues. Between August and September 2025, there were 68 complaints across all wards, with staff behaviour being the most frequent theme.

The service was previously in breach of the legal Regulations in relation to (Regulation 10) dignity and respect. Improvements were not found at this inspection, and the service remained in breach of these Regulations.

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 service did not treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not treat colleagues from other organisations with kindness and respect.

Staff attitudes and behaviours when interacting with patients had not always been discreet, respectful and responsive. Staff had not always provided patients with help, emotional support and advice at the time they needed it. During our inspection we reviewed incidents via CCTV and identified concerns in 9 out of the 16 incidents reviewed (56%). Review of CCTV identified concerns relating to poor management of incidents, a lack of dignity, a delay in removal of ligature, 2 staff assaults on patients, a staff member pulling a patient and an inappropriate restraint. The provider had reviewed the incidents and CCTV prior to our inspection, and had taken the appropriate actions in relation to inappropriate staff behaviour and performance.

Most staff supported patients to understand and manage their care, treatment or condition. However, one patient felt that “staff don’t understand autism” adding that they had received better treatment when in a previous hospital.

Staff directed patients to other services when appropriate and, if required, supported them to access those services.

Permanent ward staff generally understood the individual needs of patients, including their personal, cultural, social and religious needs. However, whilst there had been a reduction in the use of agency staff, wards were still reliant on overtime and bank staff, not all who knew the ward and patients.

Not all patients said staff treated them well and behaved appropriately towards them. Review of complaint data by ward (between August and September 2025), revealed that over the two-month period, there had been 36 complaints across the medium secure wards. Robinson ward recorded the highest number with seven complaints (19%), while Pritchard ward had the lowest with two complaints (6%).

During the same timeframe, 32 complaints were reported across the LDA wards. Sunley ward accounted for the highest proportion with six complaints (17%), whereas Berry and Marsh wards recorded the lowest, with 2 complaints each (6%).

The key themes from complaints centred on several recurring issues, which included staff attitude and behaviours (the most frequent theme, including reports of rudeness and lack of empathy), communication failures (lack of updates, exclusion from meetings, and unclear care plans), restrictive practices (concerns about leave restrictions and limited activities), physical healthcare (delays in treatment and missed appointments), medication management (errors and lack of consultation) and equality and accessibility.

The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. However, we found improvements in this quality statement since our last inspection.

The service had made adjustments for disabled patients by ensuring disabled people’s access to premises. However, staff were not always able to respond to the specific communication needs of deaf patients. Managers had not ensured that staff and patients always had easy access to interpreters and/or signers. On Fairbairn ward, staff told us that on average interpreters were only available on average 50% of the time. Patients told us of the need to ensure qualified interpreters were ward-based, and to recruit and train more deaf staff to both model deaf culture and ensure effective communication with patients. However there had been an increase in the number of staff attending BSL training.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and advocacy services. The information was available in formats suited to specific patient groups, such as easy-read versions on LDA wards.

Patients were offered a choice of food that accommodated dietary requirements, including food options related to religious and ethnic needs, as well as allergies and intolerances. However, feedback from patients indicated significant dissatisfaction with food quality, with comparisons made to prison meals. One patient described the food as “disgusting”, another referred to it as “atrocious”. One patient when talking about the small food portions, told us that they had been served with “just one fishcake and a tablespoon of baked beans as a meal”.

Staff took account of most people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. This was evident in people’s PBS plans. Staff ensured that patients had access to appropriate spiritual support.

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

Staff told us they tried to give people as much independence, choice and control over their lives as possible, while balancing this with individual risks. However, we did not find this to be the case. We found that several restrictions remained in place which were blanket restrictions. These included all patients not having access to hot water to make a hot drink, not freely able to access to cold drinks and snacks.

The service did not offer a variety of good quality food. Six patients raised concerns about the food.

Staff made sure patients could access information on their rights and how to complain. Information about the Mental Health Act and making complaints was displayed on a notice board.

People using the service confirmed that they were generally supported to spend time with people who were important to them. Staff did not restrict patients’ access to their mobile telephones unless there was a clinical reason to do so. They were able to have regular telephone contact, make video calls, and where possible, arranged to meet up in person. The service had arrangements in place for child visiting off the wards.

The service did not listen to or 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.

Staff where possible identified and responded to changing risks to, or posed by, patients. Patient risk assessments and care plans were discussed at the multidisciplinary meeting with the patients. Care plans were reviewed and adapted dependant on the patient’s presentation. However, due to staffing levels on the wards, staff were not always available in main ward areas or able to spend 1 to 1 time with patients.

Staff told us they used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened. The figures for patient restraint had slightly decreased across medium secure wards remained at or just below the average number (below 15 per month). However, the numbers of patient restraints across LDA wards had increased from June 2025 (under 120) to over 140 in September 2025.

During our inspection, we found that the treatment of deaf patients had slightly improved. Managers were taking steps to address staff skills, experience and competence to communicate effectively with deaf service users using BSL to meet their needs. There had been an increase in the number of staff who had commenced BSL training. In addition, a new ward manager was in post who could use BSL and had a good understanding of deaf culture. However patients continued to express concerns in relation to a lack of deaf culture on the ward, and difficulties in staff communicating with patients.

Some people told us staff could not always attend to their immediate needs, particularly if there was a person on the ward who required support from several staff members. Some patients told us that they had to wait for staff to be available to access a hot or cold drink. On occasions, patients had to wait for a considerable time. Examples given were being able to access leave and activities when they wanted.

Patients could give feedback on the service and staff supported them to do this. All wards held community meetings for patients. Information on how to contact the independent mental health advocacy service was displayed on a notice board. However, the advocacy service had recently changed. As a result, patients did not have the same level of access to advocacy with the new service, as they had with the previous service.

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.

Not all staff felt respected, supported and valued or felt positive and proud about working for the service and their team. Some staff had told us that incidents of inappropriate restraints and staff assaults on patients had adversely affected staff morale. Some staff spoke about recent improvements in patient care. One staff member told us that “patient care has improved since March”, however other staff members spoke about ongoing concerns regarding staffing levels. One staff member spoke to us about the need for staff to be trained in trauma informed care. Another staff member told us that “HCA training needs to be improved”, adding that staff were not using all the resources which were available for patients.

Staff had access to support for their own physical and emotional health needs through an occupational health service. The hospital offers an employee assistance scheme, where support is available via telephone, online or face to face. For staff who experience a traumatic event at work, there is a trauma response service available, in addition to the general occupational health team who offer advice and guidance with returning to work.

Patients and staff reported that staff often experienced verbal, racial, or physical abuse from people using the service. Most staff we spoke with said they reported these incidents in line with hospital guidance. However, one patient commented that “staff get racially abused, it’s not always taken seriously”, indicating concerns about how such incidents are addressed.

Numerous staff members spoke about staff burn out. Staff described the adverse effects of ongoing staffing challenges, which resulted in some staff having to undertake back to back observations. Other staff spoke to us about their frustrations that the good care being delivered to patients wasn’t being recognised, and how the emphasis was placed on learning from concerns relating to patient care delivery, rather than learning from good practice.

Staff told us that it was difficult planning and facilitating staff breaks. Wards frequently had to request support from members of the multi-disciplinary team to help support the ward when staff were on their breaks. Staff told us that the time of staff having to take their breaks were getting earlier in the day. This had then left some staff having to work several hours without a break for the rest of their shift. The hospital did have staff room facilities as well as on site cafes which staff were able to use.

The service recognised staff success within the service via staff awards. Staff appraisals included conversations about career development and how it could be supported.