- Independent mental health service
St Andrews Healthcare Northampton
We have taken urgent enforcement action by imposing a condition on St Andrew's Healthcare's registration on 14 July 2025 to keep service users safe by restricting new admissions at St Andrew's Healthcare Northampton. We have also imposed a number of conditions on St Andrew's Healthcare registration on 10 November 2025 to require the provider to make improvements in the safety and quality of care provided relating to; staffing, ward environments, blanket restrictions, risk management, observations, incident management, governance and systems and processes.
Report from 21 September 2025 assessment
Contents
Ratings - Wards for older people with mental health problems
Our view of the service
This inspection of services for people older people with mental health problems at St Andrew’s Healthcare Northampton took place in October and November 2025. This inspection was undertaken as a follow up to the previous inspections in July and August 2025, with the wards for older people with mental health problems being one of 3 assessment service groups reviewed. The CQC had placed restrictions upon new admissions to the service. We needed to assess if these restrictions remained fair and proportionate, and whether all were still needed to keep patients safe.
St Andrew’s Healthcare Northampton is part of St Andrew’s Healthcare, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs.
In the neuropsychiatry division of the location, there were 2 wards open for older adults with mental health problems at the time of our assessment. One ward (Aspen ward) had been closed shortly after our last inspection. During this inspection, we visited both wards, Cherry and Redwood:
- Cherry ward - a specialist older adult service for females with complex dementia and / or progressive neurological conditions, including Huntington's disease, who present with cognitive deficits (12 beds).
- Redwood ward – a specialist older adult service for males with complex dementia and / or progressive neurological conditions, who present with cognitive deficits (12 beds).
The service was registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983.
There was no registered manager in post at the time of this inspection.
This assessment service group was most recently inspected in July and August 2025 and rated as Inadequate. At the time of this inspection, CQC were aware that the provider had plans in place to close the older peoples service in the future. CQC were not aware of any definitive dates for this planned closure at that time. As the assessment progressed, the provider confirmed closure of the 2 remaining wards would be at the end of November 2025.
During this inspection we reviewed 13 quality statements under 3 key questions (safe, caring and well led). We found ongoing breaches in Person centred care (Regulation 9); Safe care and treatment (Regulation 12); Safeguarding (Regulation 13); Governance (Regulation 17) and Staffing (Regulation 18). We rated the service Requires Improvement.
Systems to learn from incidents and embed lessons were not consistently applied, and governance arrangements required external oversight to maintain safety and drive improvement. Risk assessments were in place, but care plans often lacked sufficient detail. Daily progress notes were mostly task-oriented, which could compromise continuity of care.
Staffing continued to be a challenge, with a continued reliance upon bank staff, and occasional delays in meeting patients personal care needs. Raised concerns from staff about staffing were not always acted upon, and the service did not consistently foster a culture where staff felt confident their voice would be heard.
The provider’s chosen dementia care model was not consistently applied. Opportunities to promote independence and choice were sometimes missed, and dignity had not always been maintained.
However, some improvements had been made since the last inspection. We observed examples of compassionate care and staff spending quality time with patients. Staff tried to personalise care and engage people in activities they enjoyed. Documentation of injuries had improved across both wards. There had been some improvements with restrictive practices, with individual risk assessments replacing blanket restrictions, for example around the use of metal cutlery. Ward managers were visible and supportive, and staff described a positive team culture despite uncertainty about planned ward closures.
Mental Health Act and Mental Capacity Act Compliance
Patients on the 2 wards were detained for treatment under the Mental Health Act 1983.
Staff received training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Online training on the Mental Health Act was mandatory for all staff. Compliance was over 90% at time of inspection.
Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff could access support from the providers’ Mental Health Act administration department.
The service had the relevant policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice.
Staff explained to each patient their rights under the Mental Health Act. Rights were repeated to patients as required and this was recorded in patient records. Many patients had cognitive impairments which meant they had difficulties processing this information. Where possible, staff had involved and consulted relatives who were involved in their care.
Patients had access to an Independent Mental Health Advocate (IMHA). Posters were displayed on noticeboards on the wards with contact details to reach this service. Access to advocacy was through the Local Authority. Due to cognitive impairment of some patients, emphasis was on the staff to refer patients to the advocacy service if the patients themselves were unable to. Prior to the Local Authority arrangement, advocates would spend time on wards with patients. Advocacy was available, but at a reduced level to previously.
Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to, requested by the patient’s responsible clinician.
Staff stored copies of patients’ detention papers and associated records correctly and could access them when needed.
Managers and staff made sure the service applied the Mental Health Act 1983 correctly by completing audits and discussing the findings. The implementation of the policy was overseen by the Mental Health Act Steering Group comprising of the Mental Health Act lead, a clinical director, a solicitor, responsible clinicians, nurses and social workers.
Mental Capacity Act
Staff received training about the Mental Capacity Act and understood the key principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law. Compliance was over 90% at time of inspection.
Individuals’ capacity to make decisions was monitored and recorded at multidisciplinary team meetings.
Initial findings from a recent culture review (August 2025) highlighted a need for enhanced MCA /DoLS training for staff beyond e-learning, with focus upon practical application in a ward setting.
People's experience of this service
At the time of our assessment, we visited Cherry and Redwood wards. During our visit, there were only 9 patients present on the wards. We spoke with 4 of these. It was not possible to gleam much feedback about their experiences due to the nature of their illness which had impacted upon cognition and communication. However, we did undertake some observations on each ward to see how staff cared for the patients. Further details can be found later in this report.
We received feedback from 3 relatives of people who were using the service. All the feedback was positive. Staff were described as treating people with compassion and understanding. Two out of three relatives expressed sadness about the upcoming closure of the service, telling us they had no concerns about the care and treatment their relatives had received.
One relative told us bank staff were often used on the wards, although they had not observed this causing any concerns. One relative said they had shared a lot of information with the staff about the patient, which they believed had been used to formulate care plans.