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

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 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 provider’s chosen dementia care model was not consistently applied, and recommendations from a recent culture review for specialist training were not implemented because of the impending closure.

Ward managers had the skills and experience to lead their teams and were visible and supportive. However, not all leaders demonstrated a full understanding of the context in which care was delivered. Staff told us concerns about staffing had not always been acted upon, which affected their ability to provide person-centred care.

The service did not always foster a culture where staff felt confident their voice would be heard. Governance arrangements required external oversight to maintain safety and drive improvement. Persistent issues had included staffing challenges, lack of specialist training, and inconsistent learning from incidents.

Systems to share learning from incidents were in place but not consistently applied. Staff were directed to lesson-learned files and alerts, but some were unaware of recent incidents. Reflective practice was offered but attendance was affected by staffing pressures.

Staff described a supportive team culture within the 2 older people’s wards and were motivated to provide good care despite uncertainty about the planned closure.

The service was in breach of regulation of the legal Regulations in relation to good governance Regulation (17). The provider 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 service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

The service did not always have a clear shared vision, strategy and culture. Staff on the 2 wards visited described a supportive team culture and said there was a willingness to share concerns with one another across the two older people’s wards. Staff were aware there had been significant concerns with the overall hospital culture, which had resulted in the provider commissioning an independent review, the draft report of which, being produced in August 2025. The culture review specifically recommended specialist training in dementia, older adult care, and Huntington’s Disease. As the service was planned for closure, these recommendations would not be acted upon. It was evident during observations that there continued to be a lack of application and knowledge around the providers chosen treatment model (Enriched model) of dementia care.

Senior staff were trying to reassure colleagues who felt anxious about their future roles due to the impending closure of the service. Although staff knew the wards would be closed and patient numbers were decreasing, staff we spoke with were motivated to offer the best care they could.

Not all leaders understood the context in which the service delivered care, treatment, and support. They did not always embody the culture and values of their workforce and organisation.

The service had a senior leadership team who were overseeing the day-to-day running of the ward and the quality of the service. Staff we spoke with knew who these were and had seen some of them on occasions in the wards. Ward managers had the necessary skills, knowledge, and experience to perform their roles and were supported adequately.

Not all staff felt that staffing concerns over recent months had been listened to and acted upon to ensure staff could safely meet patients’ needs in a person centred way.

People did not always feel they could speak up and that their voice would be heard.

We were aware the hospital had been promoting the use of Freedom to Speak Up, with messages being sent from the Chief Executive Officer. Freedom to speak up themes reported in the last 3 months included staffing levels, management communication with staff, and fair treatment of staff.

Staff we spoke with said they knew how to raise concerns and would speak up if needed. One staff member told us they had raised concerns previously and senior staff had acted upon these. One staff member told us they felt continuous staffing concerns had not been listened to or taken seriously. One staff member said they would not be afraid to speak up but were not confident that any actions would be taken in response to this.

It had been difficult to continually receive feedback from patients about any concerns due to the nature and impact of their illnesses. Senior staff were aware of this and were looking into what strategies they could trial to improve this and get an improved view of patient experiences.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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.

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. 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.

Culture work was ongoing. We identified there continued to be a lack of specialist training for staff, impacting upon patient care. The providers chosen model of enhanced dementia care was not being delivered effectively. There continued to be shortfalls in how some staff interacted with and cared for patients. Some effort had been put into recognising individual patients interests and preferences, but more work needed to be done to ensure truly person-centred care was being offered, in a sensitive, dignified and consistent way. Care plans required improvement, with a lack of detail to fully reflect individual needs, strengths and preferences. The monitoring of the care delivered needed to be strengthened to ensure any shortfalls were actioned and continuous improvements were made and sustained.

Embedding learning was an ongoing piece of work; shortfalls remained evident. While there were systems and processes in place to cascade learning, this had not always been effective in ensuring staff on the wards were up to date and aware of previous incidents, and actions advised to take to improve patient experience. Staff recorded they had completed most patient observations on time and in line with policy, yet there continued to be unexplained injuries to patients who were on enhanced observations.

There continued to be a heavy reliance upon bank staff, despite patient numbers having been steadily reducing. Staff had continued to report staffing levels made it difficult to meet all patients’ needs in a timely way. This was primarily due to many patients requiring a minimum of 2 staff to support with personal care needs.

At the time of our inspection, improvement work was ongoing and as reflected within this report, some improvements had been made across the 2 wards visited.

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.