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

The provider had developed a robust strategy which included 7 strategic ambitions; however, these had not filtered down to, or understood by ward staff. The provider had a ward manager development programme in place which supports leaders to embody the culture and values of their workforce and organisation. Leaders had taken action to review and improve the culture of the organisation in the context of equality, diversity and inclusion. The provider had in place a diversity and inclusion manager, an inclusion strategy and steering committee. However, during our assessment we were advised that despite staff having been racially abused by patients and carers, no action had been taken. In addition, 2 staff members spoke to us about feeling marginalised on the wards due to their protected characteristics. There were regular ward and divisional governance meetings for safety, audit, quality and governance. These discussed and addressed key areas of performance, risk, audit, culture and workforce. Minutes showed areas of concern were identified, however actions had not always been taken to learn and improve. For example, not all staff working on the ward had attended dysphagia training, despite this being raised as a concern within a clinical governance meeting and identified as a risk on the divisional risk register.. There were processes to ensure that learning happens when things go wrong, and from examples of good practice. Whilst some staff felt supported and guided by their leadership team, some staff members felt that leaders above matron level were not visible. The provider had a good range of accurate and timely data and information available to understand performance and quality and improvements were made as needed. This included access to staffing in real time. However, some staff felt that this did not fully reflect the full picture and that leaders did not understand the impact of current staffing on their role.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff could not articulate the vision of the hospital. The senior leadership team had a vision and strategy, but this had not filtered down to ward staff we spoke with, who were not aware of the new strategy. Leaders acknowledged that some key messages were not currently understood at ward level. Equality and diversity were actively promoted, however the causes of any workforce inequality action taken to address these had not always taken place. During our assessment we found examples or racial abuse which had not been actioned on. This was escalated to leaders during our assessment.

The provider has 7 strategic ambitions; however, the process in place, did not ensure that staff these were fully understood at ward level. In addition, the neuropsychiatry service has an agreed purpose and vision which had been communicated to all staff. The mission is to provide a safe and therapeutic environment for patients via multi-disciplinary individualised person-centred care based on the needs of each patient. The aim of the service was to improve the quality of life of our patients and promote social inclusion. The vision of the service was to continually improve specialist service by providing personalised patient care contributing to a better quality of life.

Some staff felt supported and guided by their leadership team. However, three staff members told us that leaders above matron level were not visible. Staff felt that leaders were mostly knowledgeable about issues and priorities for the quality of services, however staff felt that leaders did not understand the impact of current staffing on their role. Leaders once alerted to any examples of poor culture that may affect the quality of people’s care and have a detrimental impact on staff, had not always addressed this quickly.

The provider had a ward manager development programme in place which supported leaders to embody the culture and values of their workforce and organisation. The programme aimed to ensure that leaders had the skills, knowledge, experience and to lead effectively.

Staff we spoke with told us they knew how to speak up if they had concerns and would do this if it would benefit patient care. Staff knew how to raise concerns and felt confident to do so. However some staff told us that they had raised concerns and that these had not been listened to.

The provider had systems and processes in place to support staff to speak up, and reviewed issues of concern. Staff were aware of these systems and were happy to use them.

Leaders had not always taken action to improve where there were any disparities in the experience of individual staff members with protected equality characteristics, or those from excluded and marginalised groups. On inspection we were advised that staff had been racially abused by patients and carers, however no action had been taken. This was brought to the attention of managers. In addition, 2 staff members spoke to us about feeling marginalised on the wards due to protected characteristics. However, the provider has a number of Charity networks to promote inclusivity such as WiSH, BAME, DAWN, PRIDE and Unity. The provider has told us that at the time of the inspection, there were no reported incidents of racial abuse. Staff are encouraged to speak up and are aware of their right to report to the Police, and the support we have within the Charity.

Leaders had taken action to review and improve the culture of the organisation in the context of equality, diversity and inclusion. The provider has in place a diversity and inclusion manager, inclusion strategy and steering committee, and a process to respond to concerns about racist or other discriminatory abuse. The provider had produced a comprehensive diversity and inclusion report (2022-2023), which outlined the diversity within the organisation including patient and employee demographics.

The provider had a good range of accurate and timely data and information available to understand whether performance and quality and improvements were made as needed. This included access to staffing in real time. Governance was used to learn, improve and innovate. However, staff at ward level did not always have the time and resources to undertake effective governance and manage risk. Information held about patients was secure and protected.

There were regular ward and divisional governance meetings for safety, audit, quality and governance. These discussed and addressed key areas of performance, risk, audit, culture and workforce. Minutes showed areas of concern were identified and actions were taken to learn and improve. However, changes had not always been made when needed to improve the service. For example, not all staff working on the ward had attended dysphagia training, despite this being identified as a need at a clinical governance meeting and identified as a risk on the divisional risk register. Data or notifications were submitted to external organisations as required.

Patients provided a limited response to this quality statement; however relevant external agencies were invited to patients’ care programme and approach meetings and were provided with regular updates regarding the patient’s progress.

Staff and leaders collaborated with all relevant external stakeholders and agencies, including commissioners, host local authorities and care teams.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care.

Staff were supported to prioritise time to develop their skills around improvement and innovation. There is a clear strategy for how to develop these capabilities and staff were consistently encouraged to contribute to improvement initiatives. However, staff told us that due to staffing levels, they did not always have capacity for improvement initiatives.

There were processes to ensure that learning happens when things go wrong, and from examples of good practice. However, learning had not always taken place following incidents of low staffing levels. Leaders encourage reflection and collective problem-solving. Some staff were supported to prioritise time to develop their skills around improvement and innovation. There is a clear strategy for how to develop these capabilities and staff were consistently encouraged to contribute to improvement initiatives. The service has strong external relationships that support improvement and innovation. Staff and leaders engage with external work, including research, and embed evidence-based practice in the organisation.