The Care Quality Commission
  • Mental Health
  • Independent mental health service

St Andrew's Healthcare - Birmingham

Overall: Requires improvement read more about inspection ratings

70 Dogpool Lane, Birmingham, West Midlands, B30 2XR (0121) 432 2100

Provided and run by:
St Andrew's Healthcare

All Inspections

During an assessment of Forensic inpatient or secure wards

The service had made a number of improvements since the last inspection and was no longer in breach of some regulations. However, we found 2 breaches of the regulations in relation to safe care and treatment and good governance. The service mostly provided safe care but some aspects of the service needed further improvement.

Medicine management was not always optimised and governance systems were not always effective in identifying or addressing areas for improvement, such as the poor WiFi connection in some areas of the wards, which hindered staff in carrying out some of their duties in a timely manner.

The ward environments were spacious, comfortable, safe and generally clean. The wards had enough staff and ward teams had access to the full range of specialists to meet the needs of patients. Staff minimised the use of restrictive practices and followed good practice with respect to safeguarding. Staff completed thorough risk assessments of wards and individualised risk assessments with patients, which they updated regularly including when people's risk presentation changed. Managers ensured that staff received training, supervision and appraisal and had listened to staff concerns by increasing

During an assessment of the hospital overall

St Andrew’s Healthcare Birmingham is a purpose-built facility operated by St Andrew’s Healthcare, a national registered charity. St Andrew’s Healthcare Birmingham was registered with CQC in December 2011 to deliver the regulated activities of:

Assessment or medical treatment for persons detained under the Mental Health Act 1983; and

Treatment of disease, disorder or injury.

We carried out a mix of onsite and offsite inspection and assessment activity from 15 July to 1 August 2025. This was an unannounced assessment, which means the provider was not told in advance that an assessment was going to be starting. We began with a nighttime inspection visit.

We assessed the service to review the progress made against the warning notice that was served on the provider following the inspection in November 2024. We found that the service had made improvements and had met the actions of the warning notice.

The service had a controlled drugs accountable officer and a Registered Manager.

We visited the following wards as part of the assessment:

Edgbaston ward, a medium secure ward for men with 15 beds

Hawkesley ward, a medium secure ward for men with 15 beds

Hazelwell ward, a low secure ward for men with16 beds

Hurst ward, a low secure ward for men with 16 beds

Lifford ward, a low secure ward for older men 16 beds

Northfield ward, a low secure ward for men 16 beds

Moor Green ward, a low secure ward for women with16 beds

Speedwell ward, a low secure ward for men with16 beds.

At this assessment we assessed the 1 assessment service group at the hospital; Forensic inpatient or secure wards. We assessed all quality statements across the five key questions: safe, effective, caring, responsive, and well-led.

During this assessment we spoke with 16 patients and 67 members of staff, including hospital managers, nurses, healthcare assistants and members of the multidisciplinary team. We inspected the ward environments and clinic rooms at the hospital. We observed staff and patient interactions on the wards including 4 community meetings. We reviewed 35 patient care records including 3 seclusion reviews, 5 electronic prescribing records and we tracked 6 safeguarding incident reports. We reviewed minutes of various meetings, policies and procedures, data and documents relevant to the running of the service.

The team that inspected this service comprised 4 CQC inspectors, 3 CQC bank inspectors , 1 CQC senior specialist, 1 CQC clinical fellow, 1 CQC medicines inspector and 5 Specialist Advisors, experienced in the field of forensic mental health.

At this assessment we identified breaches of regulations in: regulation 12 - Safe Care and Treatment and regulation 17 - Good Governance. We found 2 breaches of regulations in relation to: medicines management and in leadership impact and implementation of policies and procedures. At our last assessment we rated this service as Requires Improvement. At this assessment we found improvements had been made but the rating has remained Requires Improvement.

We have asked the provider for an action plan in response to the concerns found at this assessment.

During an assessment of Forensic inpatient or secure wards

Background: Onsite assessment: 12 to 14 November 2024

We found the service required improvement and identified 5 breaches of the regulations in relation to person centred care, dignity and respect, safe care and treatment, good governance and staffing.

Staff were not always clear about how they learnt from incidents and what was done to improve.

People were not cared for in a well-maintained environment that respected their dignity. Equipment and technology did not consistently support staff to deliver safe and effective care.

The electronic medicines system was slow at times. However, people's medicines were appropriately prescribed and supplied.

People had mixed feedback about involvement in their care plans and risk assessments. Some people said they were, but others told us they were not involved. Records were not always updated to ensure that staff knew how to safely support people.

Governance systems were not effective in assessing and identifying risk to the people who used the service.

However, staff were supported and received training to respond to people in an emergency.

There were examples of quality improvement initiatives. Restraint was rarely used in the hospital.

People could contact their family and friends, and most people thought permanent staff treated them with kindness and compassion.

During an assessment of the hospital overall

We found the service required improvement and identified 5 breaches of the regulations in relation to person centred care, dignity and respect, safe care and treatment, good governance and staffing.

Staff were not always clear about how they learnt from incidents and what was done to improve

People were not cared for in a well-maintained environment that respected their dignity. Equipment and technology did not consistently support staff to deliver safe and effective care.

Staff were supported and received training to respond to people in an emergency.

People had mixed feedback about involvement in their care plans and risk assessments. Some people said they were, but others told us they were not involved. Records were not always updated to ensure that staff knew how to safely support people.

Governance systems were not effective in assessing and identifying risk to the people who used the service.

There were examples of quality improvement initiatives.

Restraint was rarely used in the hospital. People could contact their family and friends, and most people thought permanent staff treated them with kindness and compassion.

24 January 2024, 25 January 2024

During a routine inspection

We rated St Andrew’s Healthcare Birmingham as requires improvement because:

  • The service did not always have systems and processes to safely administer, record and store medicines.

  • Managers did not ensure that sufficient staff received updated training in basic life support.

  • The service had enough staff, but they were not always deployed effectively to support patients on each ward and staff reported feeling burnt out.

  • Staff did not always discharge their roles and responsibilities under the Mental Capacity Act 2005 as patients' decisions made about resuscitation were not regularly reviewed and updated where needed. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were not regularly reviewed or updated.

  • The service had some blanket restrictions in place on some wards regarding accessing the courtyard and use of vapes. The provider gave an explanation that these restrictions were necessary and proportionate for managing risk. They were frequently under review through governance processes. However, there were not individual patient care plans for these.

  • Care plans were generic and did not show the patient was involved. They did not all include discharge plans.

  • Patients were not regularly engaged in therapeutic activities.

  • The governance processes were not fully embedded to ensure that ward procedures ran smoothly.

However:

  • The ward environments were safe, clean and well maintained.

  • Staff followed good practice with respect to safeguarding.

  • Staff engaged in clinical audit to evaluate the quality of care they provided.

  • Managers ensured staff received supervision and appraisal.

  • The ward staff worked well together as a multidisciplinary team.

  • The ward teams had access to the full range of specialists required to meet the needs of patients.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood their individual needs.

  • Staff planned patient discharge and liaised with services that would provide aftercare, however not all patients had a discharge plan in their records.

26, 27 & 28 June 2018

During a routine inspection

We rated St Andrew’s Healthcare Birmingham as good because:

  • Staff treated patients well, taking the time to listen to their concerns and were sensitive to patient issues. Patients said they felt staff understood their individual needs. Patients told us they were actively involved in care planning and risk assessment and this was evident in care plans.
  • Staff ensured that the admission process informed and orientated patients to the ward and the service. Staff displayed posters in communal areas alerting patients to the daily activities and meetings for the ward.
  • Staff completed comprehensive care plans which demonstrated good practice. We saw evidence that staff followed National Institute for Health and Care Excellence guidance when providing therapy and prescribing medication.
  • A dedicated physical healthcare team provided effective and timely physical healthcare to patients. The team provider tailored services to meet the needs of individual people and services were delivered in a way to ensure flexibility, choice and continuity of care.
  • Managers ensured that staff received mandatory training. Staff were appraised annually and supervised monthly.
  • Managers ensured shifts were covered by enough staff of the right grades and experience, and that staff maximised shift-time on direct care activities.
  • The provider demonstrated a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that met these needs and promoted equality. The provider used interpreters to ensure that patients could communicate if they did not speak or understand English. The provider also worked with catering so that the food provided met patients’ cultural needs with respect to diet. The provider had a RACE (Race, Culture and Ethnicity) group which looked at ways that patients from different ethnic backgrounds could be supported. The chaplaincy department ran an awareness session on Ramadan and worked with catering on what foods to serve post fasting.
  • Staff provided information in other languages and there were some examples of wards buying in newspapers, CDs and books in different languages to enable patients to keep connected to their cultural identity. The chaplaincy department carried out an exercise to establish patient feedback on how the provider met their spiritual needs.
  • Managers planned the services to integrate with other organisations and the local community and ensured that services meet people’s needs. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.

However:

  • The provider had not mitigated all risks posed to the quality of stored medication by broken air conditioning. On Hurst ward, and in the separate physical healthcare clinic room, the ambient room temperature was 29.8 degrees centigrade. In the months of May and June 2018, the provider had recorded temperatures above the maximum 25 degrees centigrade on each day between 5 May 2018 and the day of the inspection, yet had continued to dispense medication from these rooms. There was a risk that medication may become less effective if stored at the incorrect temperature.
  • The seclusion room on Speedwell ward had been damaged on 8 June 2018 and therefore was not in use. Hurst seclusion room was not in use due to the air conditioning not working. This meant that, if staff decided that a patient should be secluded, they would have to use the facility on another ward.
  • Managers had not ensured a safe environment on Speedwell. The lock to the staff office door had been damaged on 1 June 2018. This meant that staff had to use a key to lock the door rather than it locking automatically on closing. There was a risk that staff may forget to lock the door as they entered or left the office. This could allow patients to access confidential information. Also, it would take staff longer to respond to incidents because staff had to lock themselves in the office and so would have to unlock the door to get out to attend an incident.
  • On Lifford and Edgbaston wards there was a delay in referrals to urology for two patients who had markers indicating they could have prostate cancer. This meant that there was a risk of a delay in diagnosing a potentially treatable cancer.
  • Staff had not completed appropriate care plans for one patient on Speedwell ward, with complex needs and behavioural issues. We found there was no positive behavioural support plan for staff to follow and an inconsistent approach to assessment and care planning for this patient. Staff demonstrated a lack of understanding of the patient’s needs.

6 October 2015

During an inspection looking at part of the service

We rated St Andrew's Healthcare - Birmingham as good because:

There were a range of measures in place throughout the hospital to ensure patient safety.  There were policies in place to make sure patients and staff were safe.  The hospital were committed to learning lessons from identified areas of risk and they had procedures in place to capture risk issues and made changes when needed. 

Staff in all wards, at all levels, were caring and compassionate. We saw that there were a really good skills mix in all the wards to support the patients and staff.  We saw that staff worked positively with patients and supported them well. 

Staff said that they were supported by managers and senior managers, which helped them to feel valued. The hospital had a clear vision and this was understood by staff.  The hospital also invested in their staff to ensure they were skilled to provide the best possible care to patients.  

9-11 September 2014

During a routine inspection

St Andrew’s Healthcare Birmingham is an independent hospital which provides medium and low secure support for people with mental health needs and or autistic spectrum conditions.

The hospital is registered to accommodate up to 128 people and is made up of eight wards.

There is one ward, Moor Green, which is for women only.

Staff in all wards were caring and compassionate. We saw that they worked positively with people and supported them well.

There were policies in place to make sure that patients were safe. We found that staff worked well together to meet people’s needs and that they were able to respond to individual needs and preferences.

Staff said that they were supported by managers and senior managers, which helped them to feel valued.

7, 14 June 2013

During a routine inspection

Our visit to the hospital was supported by a specialist advisor and expert by experience. We visited three wards Speedwell, Hawkesley and Moor Green. We also inspected with a Mental Health Act Commissioner who visited Northfield ward.

We spoke with fourteen people who used the service, ten members of staff and two senior managers and shared information with the Mental Health Act Commissioner. The people we spoke with told us that they felt safe and were mostly satisfied with the care they received at the hospital. People had opportunities to be involved in decisions about their care and support. There was also a range of planned activities available for people who wanted to participate. Comments we received from people who used the service included: 'I really feel staff are catering for my needs' and 'This hospital is quite good.'

Staffing needs were regularly monitored and adjusted to ensure there were sufficient staff available on the wards. There were also a wide range of staff, including psychiatrists, psychologists, nurses, occupational therapists and nurses available to ensure people were supported by appropriately skilled staff. However, some people felt there were not always enough staff to support their section 17 leave, which is used to assist in preparing people for discharge from hospital into the community.

Systems were in place to monitor how the service was run and ensure people received a quality service. This was supported by good quality records that enabled the service to identify and act upon issues raised about the service.

10 April 2012

During a routine inspection

During our inspection, we spoke with fourteen patients and spent some time on four of the wards, Moor Green, Edgbaston, Speedwell and Northfield.

Patients we spoke with told us 'everything is fine' and 'feel safe'. They were satisfied with the care and support they received from staff. Patients were being supported by skilled staff that had undertaken a range of relevant training.

Patients were able to access other health care professionals when needed, for example, doctors, dentists, psychiatrists, social workers and occupational therapists.

We found that patients were involved in making decisions about their care and their daily lives on an ongoing basis. There was a range of activities available for patients to choose from.

Patients were encouraged to be involved in the every day tasks on the wards while they were using the hospital service. They spoke with us about keeping their rooms clean and tidy, doing their own laundry and cooking for themselves. Patients told us they been made fully aware of any restrictions in their movements around the hospital or in the community and why these were in place.

Patients that we spoke with had mixed views about the range and quality of food available to them from the menus on the wards.

The hospital was making sure that patients had opportunities to give their views about the service. This happened in one to one conversations with staff and hospital wide meetings and ward meetings.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.