'Oppressive culture' and repeat failures in patient safety earn St Andrew's men's healthcare 'inadequate' rating, says CQC

A CQC report into St Andrew's Hospital quality of care was published on August 7.
A CQC report into St Andrew's Hospital quality of care was published on August 7.

Inspectors have branded a Northampton mental health hospital's adult male care as unsafe and poorly led.

St Andrew's Hospital's men's service was rated "inadequate" in a report published yesterday (August 7) by the CQC, who found failings in cleanliness, patient safety, and pointed to an "oppressive culture" that dissuaded staff from speaking up over concerns.

The service had also failed to address issues around ligature anchors in wards, bedrooms and toilets - points where patients intent on self-harm might tie something to strangle themselves.

It came as part of a wider inspection of the hospital, in Billing Road, carried out in May and June, which rated the hospital's women's and neuropsychiatry service as "good".

But it also rated adolescent care at the £45million Fitzroy House, which opened in January, as "requires improvement".

However, the report consistently praised the hospital's staff for providing a "caring and responsible" service.

The report into St Andrew's men's care said: "The standards of cleanliness were poor on three wards. Some of the wards were not clean or safe. Ferguson Ward was dirty and had plaster falling off the walls.

"Staffing levels were poor. Shifts often had one qualified member of nursing staff, especially at night, which meant staff could not take breaks.

"The standard of record keeping was poor in forensic and rehabilitation services. Record entries in the learning disabilities service were sometimes punitive in nature.

Inspectors criticised St Andrew's men's care for its safety and leadership, and rated both as "inadequate."

In particular, they pointed to a failure to address issues raised in an inspection in June 2016, when they found staff were trained in two different ways of managing aggressions and restraint, which posed a risk to both staff and patients in a potential incident.

The report said: "We formed the view there was an oppressive culture in these services. Different staff groups, including nursing staff, medical staff, psychologists, and social workers, reported a fear of speaking up in case of reprisals.

"We were given examples of when a clinician’s decision had been overridden by non-clinicians. This posed a risk of inappropriate admissions."

St Andrew's Hospital featured on the Channel 4 show Dispatches in March and was heavily criticised for their use of restraints and seclusion.

The report noted a "continued move to reduce the use of restraint". But the men's care's long-term segregation policy did not meet the code of practice set out by the law. Staff were "confused" about the policy, and described patients in seclusion or long-term segregation as being in "extra care".

Inspectors did however praise the hospital's provision for older patients and dementia care, and said that St Andrew's had taken action to address the shortage in staff.

The men's service was consistently rated as "good" for being caring and responsive across the report, and that staff involved patients, families and carers in care plans.

The CQC has directed St Andrews to make improvements across the board in cleanliness, patient records and infection control, and must also work to address the shortage of staff.

A spokeswoman for St Andrew's Hospital said: "We regret the rating we have been given for six wards within our men’s service. It is important to note that this is not reflective of our overall performance across our varied and complex services.

“We are determined to put this right. We are pleased that the CQC noted that even before their inspection, a newly appointed service director for our men’s services was already in place and understood the improvements that are required. Since then, we have taken action in all the areas identified in the CQC report in relation to men’s service and will work with our patients and their relatives to make sure that these changes are sustained. This includes making the decision to close one ward singled out by the CQC for having a number of environment issues. Patients from this ward will move to a newly refurbished ward in early August.

“We will work tirelessly to bring all of our men’s wards up to the high standards seen elsewhere in our hospitals and to regain our “good” rating in child and adolescent services. We look forward to continuing to work with the CQC and to welcoming them back in December to show them the improvements we’ve made.

“St Andrew’s is unique in being a charity providing care to NHS patients who could not, in many cases, be treated elsewhere. Half are in the criminal justice system and are some of the most vulnerable patients treated anywhere in the health service."