Chief Inspector of Hospitals publishes report on the quality of care provided by St Andrew’s Healthcare rating the service as ‘Requires Improvement’

England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has published his first report on the quality of care provided by St Andrew’s Healthcare.

St Andrew’s Healthcare is one England’s largest charities providing specialist mental health care and facilities for children, young adults, women, men and older people. The charity also provides private therapy services for GP referred patients. It has eight registered locations serving mental health and learning disability needs, including four hospital sites in Northampton, Birmingham, Nottingham and Essex.

Under its new inspection model, CQC has given individual ratings to each of the core services. CQC rated St Andrew’s Healthcare as Requires Improvement overall, following its inspection on 9 September 2014. CQC’s inspection team informed the service of its concerns immediately after the inspection so that it could take steps to improve.

The team included CQC inspectors and a variety of specialists: behaviour nurse therapists, a consultant eating disorders psychiatrist, consultant forensic psychiatrists, a consultant learning disability psychiatrist, a consultant psychologist, a learning disability consultant psychologist, experts by experience, family carer experts, a forensic psychologist, a hospital manager, learning disability nurses, Mental Health Act reviewers, mental health nurses, pharmacists, a quality manager, social workers and a student nurse.

The service was rated as Good with regard to whether services were effective, caring and responsive and Requires Improvement with regard to whether services were safe and well-led.

Full reports for the service will be published on CQC’s website today at the following link: www.cqc.org.uk/provider/1-102643363.

The service has been told that it must take action to improve in the following areas:

• The provider must ensure that care in the adolescent service is planned in accordance with children’s rights.
• Care and risk must be assessed, planned and managed based on individual needs.
• All care and treatment options must be discussed and explained in a way the patient understands, particularly in the learning disability and children and adolescent mental health services.
• Patients and their family or carers should always be involved in their care planning and risk assessments. The provider must ensure that the Code of Practice for the Mental Health Act 1983 is always adhered to when necessary.
• The provider must ensure that all accommodation is in line with best practice guidance for same sex accommodation. There were no clear arrangements for ensuring same sex accommodation in the older adult’s service adhered to guidance from the Department of Health and the MHA Code of Practice, to protect the safety and dignity of patients.
• The provider must ensure that patients who are deaf or have hearing loss are cared for by staff able to communicate with them effectively.

Across the service, the inspection team found areas of good practice. These included:

• Inspectors spoke with patients in the children and adolescent’s mental health service who spoke of the support provided to them and how staff had continued to work with them when other people had let them down.
• Practice in the older person’s service incorporated the latest research and evidenced-based guidance to ensure the most effective care was being provided.
• A strong model for future plans in the neuropsychiatry service meant that at a strategic level it was clear how developments were to be implemented.
• People in Northfield Ward at the Birmingham location were supported to access community based college courses and work placements.
• Each ward at the Birmingham location had at least one ‘buddy’. This was an existing patient at the service who showed new people around the ward on admission to help them feel safe and welcome.

Dr Paul Lelliott, CQC’s Deputy Chief Inspector of Hospitals (lead for mental health), said:

“Overall we rated St Andrew’s Healthcare as Requires Improvement.

“Many of the children and young people admitted to St Andrew’s Healthcare have severe mental health problems and have a history of behaviour that has put themselves or others at risk. Despite that, we were surprised at the number of occasions when staff had resorted to physical restraint. The staff at St Andrew’s Healthcare must ensure that when restraint is used it is by the safest means to minimise the possibility of harm to the patient.

“St Andrew’s Healthcare has had difficulty recruiting nursing staff and many posts were vacant. It has been relying heavily on the on the use of agency and bank nurses “The service has given us assurances that it is making the necessary improvements and we have already witnessed some of these in action.

“People deserve to be treated in services which are safe, caring, effective, well-led, and responsive to their needs and this is what we look at when we carry out our inspections. We will continue to monitor this service closely and this will include further inspections.”

The report which CQC publishes today is based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations. CQC inspectors will return to the service in due course to check that the required improvements have been made.

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