St Andrew's Healthcare - Birmingham

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• 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 assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

Good: This meant people were supported and treated with dignity and respect; and involved as partners in their care.

At our last assessment we rated caring as requires improvement and issued the provider with a warning notice. The last assessment showed that patients experienced significant delays getting repairs done so they could access basic facilities, such running water in their ensuite bedrooms. Patients and staff told us they did not feel heard by managers when they raised concerns about their wellbeing. At this assessment the rating has changed to good. Staff and patients reported improvements. Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition. Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. Staff informed and involved families and carers appropriately.

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 always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Staff attitudes and behaviours when interacting with patients showed that they were discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it.

Patients were mostly positive about how staff treated them and told us staff showed compassion and dignity. However, some patients told us that temporary staff might not know them very well, so might not know how to engage with them in a way that made patients feel valued and heard.

Staff supported patients to understand and manage their care, treatment or condition.

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

Patients said staff treated them well and behaved appropriately towards them.

Staff understood the individual needs of patients, including their personal, cultural, social and religious needs.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences.

Staff maintained the confidentiality of information about patients.

The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The service made adjustments for disabled patients – for example, by ensuring disabled patients’ access to premises and by meeting patients’ specific communication needs. The service installed bariatric equipment for a patient and made sure patients could get equipment such as walking aids if they needed them to maintain their independence with mobility.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and how to use the Recovery College.

The information provided was in a form accessible to the particular patient group (for example, in easy-read form for patients who needed it).

Staff made information leaflets available in languages spoken by patients.

Managers ensured that staff and patients had easy access to interpreters and/or signers when they needed it.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances.

Staff ensured that patients had access to appropriate spiritual support to meet their individually identified needs.

The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Patients were encouraged and supported to maintain the relationships that were important to them. Patients told us they could keep in touch with their families in person, by phone or online video call. Patients who wanted to improve their reading and writing could get help from staff, so they could correspond with friends and family by post.

Patients told us their family could come to visit them and could be invited to important ward meetings. If they could not attend in person, staff made sure they could take in the meetings using video calls.

The hospital ran a regular carers’ group for families and had recently reintroduced a patient focused newsletter, engaging patients across the hospital with each other.

Some patients told us they did not have enough things to do but most patients told us there were always lots of activity options for them to join in with if they wanted to. We looked at the activity plans for the wards and there were a lot of varied options for patients ranging from quiet one to one things (such as adult colouring books) to small group sessions (such as shared cooking) and larger group activities (such as day trips to places of interest and the coast). The provider provided spending money for patients to use to buy ingredients for cooking sessions and for patients to spend when out on the organised trips.

Patients said they were encouraged to be as independent as possible and encouraged to clean their own bedrooms. During our visit, one group of patients wanted to tell us how proud they were of the meal they had cooked for each other and how much they had enjoyed the activity.

We saw that patients were offered opportunities to have choice and control over their own care. In the community meetings we observed, patients took active roles in chairing the meetings. There was a set format to the agenda that staff agreed with patients in advance. Staff encouraged everyone to join in and share their views. The meetings were ordered but open to discussion and the sharing of opinions. Most patients were enthusiastic participants and staff gently supported patients to take turns. Staff used appropriate levels of humour to engage patients.

We saw examples of staff gently encouraging patients to allow housekeeping to enter their bedrooms so they could be cleaned. This was a major block to independence for some patients, but staff managed it sensitively.

Staff were aware of and dealt with patients’ specific risk issues, such as continence, falls or pressure ulcers and care planned for these accordingly. We saw examples of staff using specialist services such as tissue viability and physiotherapy to keep patients safe, comfortable and to maximise their independence.

Staff identified and responded to changing risks to, or posed by, patients for example changes associated with aging bodies.

Staff used de-escalation techniques to reduce the need for physical interventions when patients showed distress or their behaviours became heightened.

The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

We observed staff responding to patients when they asked for information or help, regardless of how busy the wards were. Staff saw patients as their priority and did not keep them waiting any longer than necessary.

Staff showed that they knew their patients well and understood when they needed to intervene and offer support before being asked to. We observed staff quietly monitoring group and individual interactions on the ward and intervening before patients got upset with themselves or each other. These timely interventions descaled situations and reduced incidents of distress for patients.

Patients had mixed views about the comfort of the temperature in some bedrooms – some found them too warm and others found them too cold. We saw that staff listened to patients’ experiences and offered solutions.

Staff encouraged patients to self soothe using distraction techniques they were familiar with and comfortable with if they were becoming agitated.

The provider trained and supported staff in basic life support and immediate life support so they could respond to patients in an emergency.

Staff had been trained in how to administer Naloxone, an emergency medicine used to reverse or reduce the effects of opioids, potentially saving a life until emergency services can attend.

The service cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care.

Staff felt respected, supported and valued by their immediate managers but not always by the provider as a whole. Several staff told us they felt a real disconnect with the charity head office and other hospital sites.

Staff felt positive and proud about working for the provider and particularly about being part of a team that supported patients to move on from the hospital.

Staff told us they now felt heard by senior provider managers. Specifically, in relation to the recent increase in staffing establishments on the wards. They explained that previously, the provider had reduced the number of staff working on each shift and this had led to a lot of staff experiencing “burn out”. We were told that it had been particularly hard for night nurses. Until the recent improvements they had not always been able to take their break when they were the only qualified member of staff in charge at night. Staff told us they felt much better now there were more of them to support patients, and they were now able to provide better care. They told us that having more than one night nurse on duty also meant they were able to look after themselves better.

Staff told us the social work team had experienced a similar “top down” decision for staffing. That decision had also been reviewed recently, but by the time of our onsite inspection, half of the social workers had left or were planning to leave. However, the service had found locum replacements and were in the process of recruiting permanent staff into the vacant posts.

Staff had access to support for their own physical and emotional health needs through an occupational health service. Almost all staff told us their line managers had been very supportive of their needs, particularly when they had been away from work on sick leave. They told us their manager made regular calls to check on their wellbeing, which they found kind and supportive.

The service recognised and celebrated staff success with nominations for staff awards.

Staff appraisals included conversations about career development and how the service could support staff to take up additional training, learn new skills and gain qualifications which could

enhance their development. Some told us they had been encouraged to apply for apprenticeship programmes, which would lead to professional nursing qualifications.

Several staff told us they were given conflicting information about what they could wear in extremely hot weather. They explained they wanted to feel comfortable in the heat when supporting patients on community leave and had been told they could wear tailored knee length shorts but the decision was reversed by managers with little warning or explanation.

The provider had a Freedom to Speak Up system in place. Staff were aware they could raise issues using the Freedom to Speak Up process.