St Andrews Healthcare Northampton

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified some concerns around staffing which had impacted upon the care of young people which will require an action plan. We identified that there was not always enough staff to meet the individual needs of young people. A high number of non-substantive staff were being used to staff the ward, some of which were unfamiliar with the young people and specific needs. Staff told us that there was not always enough staff on the ward to safely manage incidents, and at times when they had requested additional support from across the hospital via an alarm call, there had been delays with staff attending. The hospital had a procedure in place regarding learning from incidents. There were different forums where incidents were discussed. We saw that there had been a learning alert following an incident whereby a young person had engaged in deliberate self-harm. The alert was available to staff on the ward. Registered staff were able to clearly discuss some learning from incidents. However, some unregistered staff we spoke with could not give recent examples, although some had taken some learning points away following discussions during handovers. The hospital has a procedure in place for the clinical management of referrals and admissions as required. Staff aimed to regularly review individual care plans and positive behavioural support plans with young people.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most young people we spoke with expressed no concerns around staff being open and honest. All were aware that incidents were reported and investigated. Two patients referred to a young person on the ward who had been recently distressed and who had been involved in numerous incidents. One patient told us that “staff had handled this really well”. One patient told us that not all staff completed 5-minute observations on time, due to being busy with other things. They said that on one occasion they had been left for 15 minutes unchecked. This was reported to senior staff at the time and the young person said this had been addressed, with no harm reported.

We spoke with 8 staff members who were on shift on the day of assessment. Registered staff told us that the hospital had a procedure in place regarding learning from incidents. Alerts were sent out from other divisions (other parts of the hospital). Information was shared through a ‘red top folder’ available on the wards. Registered staff were able to give examples of learning which had been shared by managers. Three unregistered staff were unable to give specific examples of any recent learning, but did explain there were regular discussions during handovers. Two further staff members relayed learning that they had personally taken away from incidents on the ward during discussions at handover following incidents of deliberate self-harm.

During the ward shift hand-over, incidents were discussed. Discussions included what had happened, any actions required and any learning to minimalize the risk of this occurring again. Additionally, the division had a wider meeting every weekday morning, during which incidents were reported and any immediate learning shared with attendees, for them to relay to the other staff on the wards. We saw a recent learning alert which managers had distributed to staff on the ward, following an incident which had led to harm of a young person.

Registered staff explained that there is an admission process which they followed, to ensure all relevant information relating to any new young people is relayed to the receiving ward. This applied for any internal or external transfers of young people. All new admissions or transfers of young people consisted of an initial assessment for suitability, which is conducted by two senior multidisciplinary (MDT) members who have different clinical backgrounds. Diagnosis, current presentation, risks, and historical information are carefully considered. The MDT aim to accept young people who they can help through various therapies which they can offer. All staff who are on shift when a young person arrives to the ward are given a handover of immediate risks, proposed care and treatment, together with a discussion of what support they will need, such as enhanced observations. Additionally, the ward had a more detailed folder, which offers photographs of all the young people on the ward, along with likes / dislikes, levels of any enhanced observations, and how to help them during times of distress, which was in line with their positive behavioural support plans.

Feedback received from the Integrated Care Board and the Local Authority has not identified specific concerns within the systems, pathways, and transitions of young people at this hospital. There are appropriate policies and procedures in place for staff to enable a safe and effective transition, using a multi-disciplinary team approach.

The hospital has a procedure for the clinical management of referrals and admission to inpatient services. This details guidance and key requirements relating to the initial referral and pre-admission assessment, to include what actions should be taken if the assessment has defined the hospital are unable to meet the needs of the patient. The procedure is not specific to children and young people but is applicable to all patient groups. We reviewed one young person’s admission notes and identified that staff had followed the admission process. The hospital holds a regular bed management meeting, whereby the current beds in use are reviewed, along with upcoming transfers and discharges, as well as reviewing patients who are awaiting admission. This is to ensure that relevant external parties are kept updated of any planned patient movement.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Four of the 6 young people we spoke with felt involved in their care. One patient chose not to be, and one patient declined to speak about this. Young people were able to discuss their care regularly in their multi-disciplinary meeting and were able to make requests around their care and treatment during these meetings. Young people told us that they did have regular sessions with their key nurses during which they discussed goals and future plans. Young people were involved in their care planning and in updating their positive behavioural plans. All the young people we spoke with understood what levels of observations they were on and the rationale for this.

All staff we spoke with knew it was important to work collaboratively with the young people on the ward to help them progress, which in turn would enable them to do things that mattered to them. Staff aimed to regularly review individual care plans and positive behavioural support plans with young people. This was reflected in documentation reviewed. When a young person had declined to discuss their care and treatment, staff usually recorded this in their clinical notes. Staff openly discussed risks during the regular multi-disciplinary meeting with young people, when levels of observations were reviewed, along with any temporary restrictions, to keep them safe.

The hospital has a policy around the use of enhanced observations which staff were expected to follow to keep young people safe. Three of the 6 young people we spoke with relayed some concerns around some staff not undertaking enhanced observations correctly. Three young people told us that some staff had been reported because they were supposed to check them every 5 minutes, but they had failed to do so on occasions. We saw a patient safety action notice which had been produced in November 2024. This had been circulated due to an identification that staff had not undertaken observations in line with policy, to ensure a young person was safe. We identified that during November, staff had recorded 2 incidents for missed patient observations. Senior staff informed us that regular observation audits were being undertaken and appropriate actions taken with individual staff members.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We spoke with 6 young people. Five of the 6 told us there was not enough staff on the ward to meet their individual needs. One patient said, “there are not enough free people, staff keep us safe, but there is never enough to do extra things like leave.” We were told that on some shifts the number of regular staff who knew the patients well could be as little as 2. The provider acknowledged the regular use of non substantive staff, and strived to ensure staff used were familiar with the ward and patients. Patients said that not having enough staff had led to occasions where they had to wait for a drink, wait to use the toilet ( an example given was if they required female supervision in the bathroom and no female staff were available) and one patient told us of delays in making telephone calls to their family as they needed staff supervision, and staff would not always be available when they wanted to make the call. Of the 6 patients we spoke with, 3 said staff knew them well, and one said the regular staff did.

We spoke with 8 staff who were working on the ward throughout the day, which included registered and unregistered staff. Some were substantive staff; some bank and some working via an agency. One substantive staff member said they had enough staff on the ward, but it was the skill mix which could be problematic. They talked about non-substantive staff not always being as familiar with individual young people due to not always working consistently on the ward. Another substantive staff member told us there was not always enough staff to meet the young people’s needs effectively and said that they seem to be using more bank and agency than previously. Registered nurses we spoke with confirmed that swapping male staff for female staff to accommodate bathroom needs could be difficult and confirmed that fitting in all staff breaks could be challenging. However, they strived to ensure every staff member had their entitled break. Senior staff explained they had over recruited and had no current vacancies on the ward at the time of assessment. However, we were also told that as of 05 December 2024, there were 8 substantive staff members not currently working, due to sickness and authorised leave. One staff member who worked across the hospital chose to work on Seacole ward as they enjoyed working with young people and told us there were occasions when they had worked shifts with above minimum numbers. We were made aware by some registered staff members, that on occasions, a hospital wide “group alert” had been activated, to seek additional assistance during incidents, as the usual assistance call had resulted in little or no attendance. The hospital policy regarding group alerts was requested. The hospital did not have a specific policy around this. However they were able to provide several information documents to support staffs understanding of the Group Alert process.

When we arrived on the ward, we saw that all staff were busy. The weekly multi-disciplinary meeting was due to commence. There were 8 young people on the ward in total. Four of these were being cared for under 2:1 enhanced supportive observations throughout the 24-hour period, so 8 staff were needed to always cover these. Four young people were on general observations (visual check at least every hour), with 2 of these increasing to intermittent observations when in less visible ward areas. The total number of staff for the day shift was 15.5. Three of which were registered nurses (one on a phased return / non-patient facing role) and 13 unregistered staff (healthcare assistants). Of the staff, 7 were substantive; 5 were regular bank staff, 1 regular agency, 2 from an agency and one bank staff who had not worked many shifts on the ward previously. Therefore, most staff on shift were familiar with the young people on the ward.

Senior staff completed the staffing rota in advance which enabled them to see any shortfalls and organise appropriate cover, taking into consideration planned absence or leave. Short term sickness absence was managed through covering shifts with substantive staff where possible, or bank or agency staff, preferably those who had worked on the ward previously and were familiar of the young people’s needs. The hospital had a staffing co-ordinator on each shift throughout the 24-hour period, who reviewed staffing across the division, enabling them to re-deploy or source additional staff where required. Senior staff use the Mental Health Optimal staffing tool (MOHOST) to ascertain staffing requirements. This tool reviews patient acuity and dependency to help inform decisions around required, safe staffing. We reviewed staffing from 01 November – 01 December 2024. Of the shifts covered on Seacole ward, 41% were sourced from agency, 36% were substantive staff, 17% were bank staff and 6% staff who did overtime. Agency use was high but had been needed to cover absence and enhanced observations. Of 31 shifts examined. Eleven of these shifts were staffed at 100% or over (35%). Twenty shifts were under 100% staffed (65%) Eight shifts were staffed at 90% or under; twelve were staffed between 91 and 98%. This supports what young people and staff told us about staffing numbers and the use of agency staff on this ward.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.