The Care Quality Commission (CQC), has published reports on three services at St Andrews Healthcare Northampton, an independent mental health hospital, and taken action to protect people following an inspection in July and August.
St Andrew's Healthcare is a registered charity specialising in the assessment, treatment and rehabilitation of people with psychiatric disorders, autistic people and people with a learning disability.
CQC carried out this inspection of its Northampton hospital site in response to an incident reported by St Andrew’s Healthcare involving an alleged assault by a staff member on a person, that was being investigated at the time of the inspection.
CQC identified 14 breaches of regulation related to person centred care, safe care and treatment, safeguarding, dignity and respect, good management and staffing. CQC told the service to submit an action plan showing what immediate and widespread action it is taking in response to these concerns.
Due to the level of concern found during the inspection, CQC imposed an urgent condition on St Andrews Northampton’s registration to restrict new admissions to the hospital. Since the inspection, CQC has imposed further conditions on the service to ensure improvements are made and monitored
CQC has again rated forensic inpatient or secure wards, and wards for older people with mental health problems, as inadequate. It has downgraded the rating of services for people with acquired brain injury from good to requires improvement. The overall rating for St Andrews Healthcare Northampton remains inadequate.
CQC has kept the service in special measures which involves close monitoring to ensure people are safe while they make improvements. Special measures also provides a structured timeframe so services understand when they need to make improvements by, and what action CQC will take if this doesn’t happen.
Craig Howarth, CQC deputy director of mental health, said:
“During our visit to St Andrew’s Northampton, it was concerning that improvements hadn’t been made since our previous inspections and people were still at risk of receiving unsafe care. This is despite us providing detailed information in our previous reports of the areas that leaders needed to improve.
“This inspection took place due to a serious incident on a ward involving an alleged assault by a member of staff. In addition to this incident, we saw evidence of closed cultures on wards and several other incidents which were improper, abusive, inappropriate and unsafe.
“In forensic inpatient or secure ward services, people were concerned about how staff communicated with them, and some described feeling unheard and isolated.
“During our visit to services for people with acquired brain injury, we also found a lack of evidence to show that learning opportunities had been used to improve services. Only a quarter of the staff we spoke to could tell us an example of some recent learning, which highlighted that leaders needed to do more to make sure this was effective.
“At our previous inspection of wards for older people with mental health problems, we raised concerns about staffing levels, and this was still an issue at this inspection. The minutes of ward meetings showed staff continually raised concerns about staffing, including that people’s safety was being compromised and it was making staff tense and stressed.
“People accessing mental health services should be kept safe while receiving care that meets their needs. St Andrew’s have failed to deliver this and must make urgent improvements. We have told senior leaders at St Andrews where further improvements are needed, and we’ll continue to monitor the service closely to make sure this happens.
“We have already taken action to restrict new admissions to the service to ensure St Andrew’s can focus on ensuring immediate improvements are made to people already receiving services. We have now imposed further conditions on the service to ensure those required improvements are made and we can monitor the delivery of them, and we won’t hesitate to take further enforcement action if improvements aren’t made or sustained.
"We have undertaken extensive work with stakeholders to ensure oversight of the safety and quality of services at St Andrew’s Healthcare Northampton since our inspection and will continue to do so until those improvements have been made and sustained.”
Inspectors found in forensic inpatient and secure wards:
- Staff told inspectors about a closed culture on the ward, and the negative impact that the organisation’s cost saving programme was having on services and staff morale.
- The service didn’t have a proactive culture of safety based on openness and honesty. Although leaders had some processes in place for sharing learning opportunities, there was no evidence to show how effective this was, and inspectors were concerned about how this reached temporary staff.
- Inspectors identified several incidents of inappropriate use of restraint by staff which had led to harm to people.
- Inspectors saw records showed staff were restraining people in positions that contradicted national advice.
- Staff didn’t always treat people with kindness, empathy and compassion. Although inspectors saw staff have some positive interactions with people, they also found several examples of unprofessional and abusive behaviour.
Inspectors found in services for people with acquired brain injury:
- Staff didn’t consistently protect people from identified and known risks.
- Leaders didn’t have effective systems and audit processes in place to identify or address areas for improvement.
- Most people told inspectors they felt safe and spoke positively about staff. However, some reported staff didn’t listen to concerns or interact with them during advanced observations.
- Staff made sure people had choice and control in their treatment and provided regular opportunities for them to give feedback on their care.
- Staff told inspectors they were happy working in the service and felt well supported by leaders.
Inspectors found in wards for older people with mental health problems:
- Staff had mixed interactions with people on the ward, with some having positive interactions while others received little attention. Inspectors saw one person in distress, but no staff were available to support or reassure them.
- The low number of staff was having a negative impact on people’s outcomes. It was also preventing staff from providing person-centred care, as workload pressures meant they didn’t have time to understand people’s needs and preferences.
- Leaders still weren’t monitoring the wards closely enough to review the quality of care being provided. They didn’t have the processes in place to get feedback from people and understand their experiences.
- People had limited access to meaningful activities or leave outside the ward. Some people had poor quality of life and had been on the wards for several months.
- While leaders could provide some examples where learning had been shared, inspectors were concerned that similar incidents had continued to happen across the hospital and weren’t reassured about the action being taken.