The Care Quality Commission (CQC) has raised several concerns surrounding St Andrew’s Healthcare Adolescents, based in Northampton.
St Andrew’s Healthcare has almost 860 inpatient beds across its services, which include hospital wards for people with mental health issues, learning disabilities and autism in the Midlands and Essex. It receives 90 per cent of referrals from the NHS.
The St Andrew’s Healthcare Adolescents service registered with the CQC on 11 April 2011. It is registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the 1983 Act.
A report said senior leaders had not fully accepted the serious nature of concerns raised by the CQC in previous inspections, causing a two-year backlog to address patient safety issues.
The Charity Commission said it has an ongoing regulatory compliance case about the charity's safeguarding practices and governance.
Inspection: ‘Staff did not always treat patients with kindness’
An inspection was undertaken because failings – including for governance, “which underpins the provider’s ability to provide safe and effective care and treatment” – were previously identified at seven St Andrew’s locations.
During a routine inspection carried out on 19-21 March and 18 April 2019, the CQC rated St Andrew’s Healthcare Adolescents service as “inadequate”. This was partially because it found that “staff did not always treat patients with kindness, dignity, compassion and respect”.
For example, 11 of the 15 seclusion rooms did not include furnishings such as a bed, pillow, mattress or blanket. Moreover, on one occasion, staff did not respect a patient’s privacy and dignity when changing the patient’s clothing and did not ensure that female staff assisted with this for female patients. “It was the inspection team’s view that this practice was uncaring, undignified and disrespectful.”
The inspection also found that staff did not follow best practice when using seclusion and long-term segregation. Staff secluded three patients for longer than necessary and in some instances applied blanket restrictions without justification.
‘Failings hindered the provider’s ability to provide safe and effective care’
Kevin Cleary, CQC deputy chief inspector for mental health and community services, said that there were “repeated and systemic failings relating to procedures and clinical governance”.
He added: “These failings hindered the provider’s ability to provide safe and effective care and treatment.”
The inspection report identified some areas of improvement. Cleary said: “Leaders had comprehensive knowledge of challenges faced, but many of their plans were in their infancy. Although leaders were visible and approachable, we were not assured that staff were always confident to raise concerns without fear of reprisals, with one employee not being afforded appropriate legal protection when making a disclosure.
“Concerns raised by CQC were not always timely addressed or fully accepted; there was a two-year backlog to address some issues. Processes for reporting to the board meant some issues were not covered by routine reports”.
Cleary added that although there was a plan to reduce physical restraint, its actual use had increased.
CQC has told St Andrew’s Healthcare it must make several improvements, including timely actioning and completion of all regulatory breaches and concerns identified by Mental Health Act reviews and ensuring restrictive practices – including physical restraint – continue to be reviewed across all its services, reducing these in line with guidance.
St Andrew’s: 'Cultural change can take time'
Katie Fisher, the charity's chief executive, joined in June 2018 and earned £223,000 for the rest of that financial year, according to the charity’s accounts for the year to 31 March 2019. Her salary for a full year would have been £275,000.
A St Andrew’s Healthcare spokesperson said: “We are pleased the CQC has recognised areas of good practice within St Andrew's Healthcare, but we recognise that we need to make further improvements in order to provide outstanding patient care.
“We have a new leadership team in place who are committed to making improvements and creating a culture of complete openness, honesty and transparency to make sure that we are always doing the right thing by our patients and staff. But as the CQC highlighted, such plans are in their infancy and cultural change can take time, especially in a complex mental healthcare setting.
“A charity-wide review of our restraint, seclusion, and long-term segregation process has just been completed and we are implementing changes under the leadership of senior clinicians across the charity. This will ensure that, when safety concerns make it necessary to restrain, seclude or segregate a patient, the facilities provided and monitoring undertaken are consistently safe and robust.”
“We appreciate the CQC's feedback, and we will continue to work to improve our processes, reporting and governance, as well as ensuring our facilities are as safe and effective as they can be.”
A spokesperson for the Charity Commission said: “We have an ongoing regulatory compliance case into St Andrew’s Healthcare to assess the charity’s governance, management and oversight of their safeguarding arrangements in light of the previous report by CQC into the charity. Our case will include consideration of CQC’s recent findings.”