St Andrew's Hospital chief admits 'we have failed staff'

Katie Fisher, chief executive of St Andrew's Healthcare
Katie Fisher, chief executive of St Andrew's Healthcare

The chief executive of St Andrew's Hospital says she feels they have let down their hardworking staff.

Yesterday the mental health hospital's adolescents ward was rated inadequate by the Care Quality Commission (CQC) and placed in special measures.

And Katie Fisher, chief executive of St Andrew's Healthcare - the charitable company which runs the hospital - has acknowledged how her employees are feeling about the blow.

She said: "I've been with staff most of this morning and they are devastated by the report.

"We have failed them in terms of not creating the best conditions for them to succeed every single day."

The specialist Child and Adolescent Mental Health Services (CAMHS) inpatient hospital is located in FitzRoy House. It cares for up to 100 young people with mental illness, autism and learning difficulties.

One of the inspectors' many criticisms of the unit was that the wards are often understaffed.

About 13 per cent of shifts were unfilled in March, but Mrs Fisher said this was to do with an ongoing national skills shortage - which she has been working to rectify during her 11 months in the job - rather than through lack of investment.

The charity has been criticised in the past for the amount of money that goes unspent on patient care and employees. Last year, bonuses which staff said were promised for hitting targets were withdrawn after the charity failed to make enough money.

Latest accounts show St Andrew's Healthcare has around £240 million in the bank. The 2018 accounts show its six directors received more than £1.7 million between them in salaries / fees and other benefits.

Mrs Fisher has accepted a wage lower than her predecessor, Gil Baldwin, but is still earning £275,000 a year. The chief executive said she did not set her own wage - an independent panel decided on the figure, with other charity chiefs' pay taken into account.

She said: "I am earning substantially less than [Gil Baldwin] did. The board decided they wanted a different type of chief executive.

"We've also taken the decision to remove bonuses because we felt it didn't really have a place in a charitable organisation."

In response to the report, the hospital issued the following statement from Mrs Fisher:

“We deeply regret that we have fallen below the standards we aim to uphold, and those expected by the CQC.

“The CQC’s report highlights our key challenge as one of variability in care. There are examples, as identified by the CQC, where we are getting care right, so the patient experience is good, our service is effective and we respond well to patient needs. Patients also reported feeling safe on the wards and we had some positive feedback from carers about the care provided by our staff.

“However our process, reporting and governance need to improve. Wherever possible we have taken immediate steps to address issues raised by the CQC, and have temporarily closed our Child and Adolescent Mental Health Service to new admissions.

“With particular reference to process surrounding seclusion and long-term segregation, we accept that we should have done better by our patients. We need a bigger rethink of our seclusion and long-term segregation process, so have begun a charity-wide review. This will ensure that, when safety concerns make it necessary to seclude or segregate a patient, the facilities provided and monitoring undertaken are consistently safe and robust. We are seeking independent advice from another CAMHS provider, whose services are rated ‘outstanding’ by the CQC, to help us improve.

“We are also appointing a new Improvement Director, who will work across our organisation to implement consistent changes that will benefit our patients. The Improvement Director will oversee implementation of our seclusion and long-term segregation review.
“We are confident that when the CQC returns to inspect the St Andrew’s Healthcare Child and Adolescent Mental Health Service in the next six months, they will see significant improvement that will be reflected in an improved rating.”

ACTION TAKEN FOLLOWING INSPECTION
We accept that there were a number of instances where actions fell short of the high standards we strive for. As soon as issues were raised we acted swiftly and decisively:
 On receipt of the CQC’s draft report we took immediate steps to address the specific issues raised by the CCQ; such as reconfiguring CCTV to remove blind spots, altering our process on the provision of furniture in seclusion rooms, and reiterating to staff the critical importance of accurate reporting and following process.
 We have temporarily closed our Child and Adolescent Mental Health Service to new
admissions.
 We have launched a charity-wide review into our seclusion and long-term segregation
process. This will ensure that when safety concerns make it necessary to seclude or
segregate a patient the facilities provided and monitoring undertaken are consistently the
safest and most robust they can be.
 We are appointing a new Improvement Director, who will work with the Charity Executive
Committee to embed our agreed changes across the entire Charity, making sure that our
processes are followed consistently for the benefit of our patients in all services. The
Improvement Director will oversee implementation of our seclusion review. In the
immediate term, with patient safety our priority, we have re-inspected all seclusion suites
and any sharp edges on doorframes have been addressed.

POSITIVE FINDINGS OF THE REPORT
The CQC rated our CAMHS service as ‘Good’ in relation to effectiveness and responsiveness to patient needs, and also identified many other positive aspects of the care we provide:

 Patients reported feeling safe on the wards and that permanent staff were friendly,
supportive, kind and respectful.
 All patients and carers spoken to by CQC inspectors reported that the environment
and facilities at St Andrew’s were very good. Carers told inspectors that staff were
‘kind’, ‘brilliant’, ‘amazing’, and ‘the hospital is the best my child had been in’.
 Staff were recognised as having the experience, skills and knowledge to meet the
needs of our patients.
 Patients have access to an extensive range of rooms and equipment. All patients and
carers reported that the environment and facilities were good.
 All CAMHS patients have access to St Andrew’s College – rated as ‘Outstanding by
Ofsted - to help meet their educational needs while in our care.
 Patients have access to spiritual support and opportunities for work experience
within the hospital.
 Risk assessments had been completed for each patient, with comprehensive mental
health assessments and individualised care plans in place for each patient.
 We proactively advocate for patients who have been inappropriately placed with us,
to ensure they move on to more suitable care at a time that is right for them.
 Leaders within the service are visible and approachable, and that staff feel
respected, supported and valued.