Archived: 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 last assessment we rated this key question inadequate. At this assessment 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.

Despite some improvements found since the last review, the inspection identified weaknesses in leadership, governance, and organisational culture. Most staff were unaware of the strategic direction or how it related to daily care delivery, highlighting a disconnect between senior leadership and frontline teams.

Governance arrangements were weak. While frameworks for sharing learning were in place, improvements were inconsistent and not sustained. Risk registers identified high-risk areas but failed to capture critical operational issues, such as staff assaults on patients. Cost-saving measures (such as closing the swimming pool and plans to shut Workbridge), were perceived as compromising patient care and recovery opportunities.

Systems for data collection and performance monitoring were in place, but findings indicated that learning from incidents and safeguarding alerts were not fully embedded. Restrictions on patients were often blanket restrictions which were not clinically justified. Safeguarding concerns remained significant, with 38 allegations of staff-to-patient abuse reported between August and October 2025. Assaults on staff were also high, with over 500 incidents recorded during the same period.

Leadership capability remained a significant concern. Staff reported a lack of visibility and approachability from managers, with frustration over the layers of management. Staff expressed concerns about decision-making processes, citing lack of involvement and transparency. Morale was low, driven by staffing shortages and organisational changes. However, the culture of openness had improved, supported by visible Freedom to Speak Up guardians and promotional materials. Staff and patients had multiple ways to raise concerns, and patient feedback through the “My Voice” survey shows mixed experiences. Despite progress, staff remained cautious about speaking up, and cultural barriers persisted.

The service was in breach of regulation of the legal Regulations in relation to good governance Regulation (17). Improvements were not found at this inspection, and the service remained in breach of this Regulation.

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 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 fully understand the challenges and the needs of staff, people and their communities.

The service had a strategy and values in place. The purpose was ‘to relieve suffering, give hope and promote recovery’. The service aimed to achieve this by ‘focusing on 6 core areas.’ The core areas outlined within the strategy, focused on the quality of care, delivering value, buildings and information, people, new partnerships and innovation and research.

The service also had 4 core values. These were compassion, accountability, respect and excellence. However, most staff we spoke with did not understand the strategic direction of the hospital and how these related to the delivery of care. This concern has been identified during recent inspections of the hospital.

The service’s senior leadership team had not successfully communicated the service’s vision and values to the frontline staff in this service. Most staff were not aware of the service’s vision and values and how they were applied in the work of their team.

Staff were unable to explain how they were working to deliver high quality care within the budgets available. Most staff told us that there were inadequate staffing levels on the wards. Therefore, staff were not fully able to maintain patient safety, whilst ensuring that patients’ activities and leave were facilitated.

During our inspection, several staff told us that there had been improvements since our last inspection. However, staff still felt that leaders did not fully appreciate and understand the challenges that staff were facing. Numerous staff members told us that leaders should spend more time on the wards.

The service did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

Most leaders understood the services they managed. However, they could not explain clearly how the teams were working to provide high quality care. Leaders did not appear to accept the limitations associated with staffing level on the wards.

During our last inspections of forensic wards (March and July 2025), unsafe staffing levels were identified. Whilst there had been some changes in staffing (for example a reduction in agency staff usage), the findings of this inspection did not provide us with assurance that staffing levels fully met the needs of the service. Staff and patients told us that there were either enough staff to undertake duties (including having a nurse presence in key ward areas for observations), or staff had to be taken off these duties to support patient activities and patients’ leave off the wards.

Not all leaders had skills, knowledge and experience to perform their roles. Many staff members raised issues in relation to leaders. Staff raised concerns about the lack of continuity of leaders, ‘that managers were moved around a lot’. One staff member told us that “staff above ward managers are the issue”, another told us that the “culture of management doesn’t feel good” adding “it’s us versus them”. Staff expressed concern about the numbers of managers within the organisation. One staff member told us that “there are so many leaders”, another said that staff had “to go through hoops to get anything agreed”.

Staff told us that leaders were always not visible in the service and approachable for patients and staff. Staff told us that “we do not see managers on the ward”, “we are not supported by managers”, and “managers do not listen”. Additional staff views about leaders included the view that “staff are not valued by managers who are in posts above ward managers”, One of the biggest concerns expressed by staff, related to a lack of senior clinical input on the wards. Staff told us that “matrons do not work on the wards”. One staff member told us that they did not know who their matron was. However numerous staff members spoke highly about the chief executive officer (CEO), who was visible on the wards to both staff and patients.

Leadership development opportunities were available, including opportunities for staff. During our inspection we spoke to staff who had the opportunity to attend leadership development courses.

There had been no staff survey completed between August and September 2025.

People did not always feel they could speak up and that their voice would be heard. However, we found improvements in this quality statement since our last inspection.

Patients had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Managers and staff had access to the feedback from patients, carers and staff. In the medium secure division, patients were able to provide feedback to staff during their 1:1 meetings, community meetings, via complaints and compliments and ‘my voice’ survey.

During the period 1 August to end October 2025, 42 patients completed my voice patient survey in October. From the 42 responses, 50% (21) were recorded as positive responses and 29% (12) were recorded as negative responses. The remaining 21% (9) were recorded as neither negative nor positive responses. The highest number of positive feedback was from patients on Maple ward (5). The highest number of negative responses (3) were from patients on Mackaness Areas identified as ‘what we do well included helping, sessions, communication, and activities including psychology, treatment, and occupational therapy. Areas identified as ‘what we can do better’, included care, treatment, more staffing, restrictions, more appointments, more understanding of conditions, communication, listening, consistency, leadership and starting a LGBT (lesbian, gay, bisexual and transgender) group.

All patients within the LDA Division were offered the opportunity to take part in a “my voice” survey every quarter (3 months). This was facilitated by a member of the psychology team. During the period of July to September 2025, 49 patients completed the My Voice Survey. From the 49 responses, 63% (31) were recorded as positive responses and 18% (9) were recorded as negative responses. Areas identified as ‘what we do well included helping, sessions, communication, and activities including psychology, treatment, and occupational therapy. Areas identified as ‘what we can do better’, included care, treatment, more staffing, restrictive, more appointments, more understanding of conditions, communication, listening, consistency, leadership and starting a LGBT group.

Between 1 September and October 2025, the medium secure division received 2 concerns via Safecall, which was an internal freedom to speak up process (F2SU), where staff could call and raise any concerns. The LDA service received no Safecalls.

Staff across all wards told us that there had been an increased focus on speaking up and an increase in the number of ‘freedom to speak up’ guardians within the service. During our inspection we saw posters and life size cardboard cutouts of the freedom to speak up guardians, with guidance on how to raise concerns. Most staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences. Staff told us that there had been an increased focus on the importance of ‘speaking up’, and posters were visible across the service. However, whilst several actions had been taken by the provided to promote 'freedom to speak up, more work was required in terms of embedding the process and obtaining staff trust. Elements of the closed culture identified during our last inspection remained. Some staff who had previously experienced a negative response when raising concerns, told us that they remained concerned about the possible risks associate with speaking up. This included 'getting a reputation as a trouble maker' and possible actions being taken against them.

Between August and September 2025, 30 concerns were raised through the Freedom to Speak Up Guardian (F2SUG) process across both the medium secure and LDA wards. These concerns covered a range of issues, including safety, quality, wellbeing, bullying, harassment, attitude, behaviour, and instances of demeaning treatment. Concerns escalated via the freedom to speak up process, was escalated through directorate meetings.

Across the medium secure wards, Robinson ward recorded the highest number of concerns, with 5 reports. Cranford and Fairbairn wards followed with 4 and 3 concerns respectively, while Bracken and the other medium secure wards each reported 2 concerns. Amongst the LDA wards, Oak Ward had the most concerns, with 5 concerns raised, followed by Fern Ward with 4. Brook Ward recorded 3 concerns, and Sycamore and Lower Harlestone each reported one. The most common theme of concerns raised across all wards related to staff attitude and behaviour (particularly on Robinson, Oak, Fern, and Cranford wards). Safety and quality issues were raised on nearly every ward. Wellbeing was another recurring concern, especially on Fern and Oak wards. Reports of bullying, harassment, and demeaning treatment were less frequent but still present, notably in Robinson Ward and, to a lesser extent, in other areas.

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.

Governance arrangements across the hospital required external oversight, with weekly strategic and monthly meetings with external stakeholders to maintain patient safety and drive continuous improvements. The provider had engaged with this process and had employed additional senior staff to respond to our concerns relating to the standards of patient care and culture within the service.

Persistent issues across this service had included lack of specialised training for staff, ineffective staffing, lack of learning from incidents and some concerns around staff culture. At the time of our inspection, improvement work was ongoing and as reflected within this report, some improvements had been made across the 2 divisions visited. However any improvements were in the early stages of development, and most of the concerns raised from our July 2025 inspection remained.

Despite recent ward closures, staffing levels across the wards remained a significant concern. While there had been a reduction in the reliance on agency staff, the number of staff available per shift did not consistently meet the required minimum levels. Furthermore, the staffing model currently in place did not adequately reflect the complexity of patient needs, or the operational demands placed on staff. As a result of these shortfalls, essential duties such as facilitating patient leave and therapeutic activities were not always completed. This compromised the quality of patient care and limited opportunities for patient engagement, both of which are critical to recovery and wellbeing.

The limited availability of nurses in key ward areas increased the likelihood of missing early warning signs of potential incidents. This reactive approach meant that staff often had to intervene during or after an incident rather than implementing preventative measures. Such delays can escalate risks to patient safety and staff wellbeing and may lead to avoidable harm.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. However, gaps in communication remained and staff told us that a lot of information was ‘hearsay’ and communicated by rumours between staff. Frontline staff felt that senior leaders and service directors needed to be more open and timely with information.

Staff told us that staff morale was low. This was attributed to the outcome of the previous CQC report, organisational changes, ward reconfiguration, and voluntary redundancies.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. However, not all recommendations had resulted in positive changes across the hospital or had been sustained.

Patients were not always protected from harm and were not receiving person centred care, treatment and support. Unnecessary restrictions were in place for patients affecting quality of life, these were not clearly justified and did not meet the required principle of the `least restrictive' option as set out in the Mental Capacity Act 2025.

Staff understood the arrangements for working with other teams, both within the service and external, to meet the needs of the patients. Staff maintained and had access to the risk register at ward or directorate level. Staff at ward level could escalate concerns when required. The medium secure risk register included 11 risks of which 1 was identified as a major risk (restriction on admission and the consequences of this), 9 rated high risk and 1 rated a moderate risk.

The LDA risk register included 11 risks of which 9 were rate as high and 2 rated as moderate risks. Risks included general fire risk, number of patients in long term segregation (LTS) within the division, culture improvement, sickness absence, emergency lighting, supporting wards with improvement process, wards operating below occupancies target, restrictions for admission. Concerns which had been identified on the risk register for each division, did not fully match those on the risk register. For example, neither risk register contained reference to the reported issues of staff assaults on patients.

The service had plans for emergencies – for example, adverse weather or a flu outbreak.

The current cost improvements taking place, were compromising patient care. For example, the service had closed the swimming pool and gym at William Wake House. In addition, the service had informed local patient and carers of their intent to close Workbridge at the end of December 2025. Workbridge offers vocational opportunities and training for people with mental health needs.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, which helped to improve the quality of care. However, we were told there were occasional outages relating to Wi-Fi. This had caused a delay in staff recordings of patient observations.

The service used systems to collect data from wards and directorates. Team managers had access to information to support them with their management role. Managers discussed performance data at ward and service clinical governance meetings. This included information on the performance of the service, staffing and patient care. Each service had identified key performance indicators in place. Ward managers could access the compliance data for their specific ward.

Information was in an accessible format, and was timely, accurate and identified areas for improvement. However, concerns relating to key performance indicators remained. For example, the number of hours meaningful activity was below the 25 hours per week standard.

Information governance systems included confidentiality of patient records.

Staff described the organisation as being ‘top heavy with managers. One staff member when talking about leaders (above ward manager), told us that “senior managers are the problem”. Describing the high number of managers, one staff member told us that “it feels like there are multiple layers of management before reaching the board.” One staff told us that we are ‘just told’, another staff member described feelings of being micromanaged.

Not all staff felt that they were listened to by senior managers. Staff felt that senior managers should be more visible, one staff member told us that “you only see senior management, if something bad happens”. However several staff spoke about the visibility of the Chief Executive Officer, who had been visible on the wards, including patient’s community meetings.

Some staff on the medium secure wards told us that senior managers ‘had their favourites and if your face fits, then you are alright.’ One staff member said that “some staff are valued by managers and not others”.

Leaders had not always effectively communicated with staff. Some staff told us that there had been a lack of communication from senior leaders, and this had led to rumours in relation to changes within the hospital. Staff also spoke about a lack of involvement in recent changes. Staff told us how (in medium secure services) managers had undertaken a task to rank ward managers (based on ability, skills and experience). Staff told us that ward managers were not involved in this process and not all managers undertaking this piece of work knew the ward managers involved.

There were systems and processes in place to monitor and review the quality of the service. Different senior staff had responsibility for overseeing certain areas of the service. However, there were ongoing concerns in relation to the quality of patient care. For example, people using the service had not been adequately protected from harm. Between August and October 2025 there were 21 reported incidents involving allegations of staff to patient abuse across the medium secure wards, and 17 across LD/A wards. On LDA wards, there were also 2 incidents of inappropriate language from staff toward patients.

There was a high number of assaults against staff from patients. Between August and October 2025 there had been 120 incidents across medium secure wards, of which 781 were rated as level 1 (no harm), 39 rated level 2 (low harm) and 2 rated level 3 (moderate harm). 17 across LD/A wards which involved. During the same period, there were 526 patient assaults on staff, of which 362 were rated level 1 (no harm), 2 level 2 (low harm) and 1 level 3 (moderate harm).

We found that some restrictions placed upon people had caused frustrations, were not robustly clinically justified to use as a blanket approach, nor were they always the least restrictive option.

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.