ACCOUNTS 2018/19these outcomes improve is highly motivational for our teams. We have expanded our portfolio and invested in Broom Cottage, a ive-bed residential home in Nottinghamshire

QUALITYACCOUNTS

2018/19

St Andrew’s Healthcare Quality Accounts 2018/19

Page 2 of 44

Section 1: Introductions “Progress and Plans”A welcome from Katie Fisher, our CEO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Dr Sanjith Kamath, Executive Medical Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Statement of Directors Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Section 2: Quality PrioritiesQuality Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Statements of Assurance from the Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Review of Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Never Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

National Core Indicators of Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Mortality Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Learning from Mortality Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

NHS Number and General Medical Practice Code Validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Clinical Coding Error Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

NHSE Specialised Services Quality Dashboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

NHSE Specialised Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Duty of Candour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Participation in Local Clinical Audits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Learning from Clinical Audits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Goals Agreed with Commissioners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

What others say about St Andrew’s Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

CQC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Data Security and Protection Toolkit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Staff Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Involvement and Feedback from Key Stakeholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Northamptonshire County Council Overview & Scrutiny Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

NHS England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Healthwatch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Section 3: Review of Quality Services1 . Empowering carers and patients to make a difference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

2 . Gain parity of esteem between Physical Healthcare and Mental Health . . . . . . 32

3 . Further reductions in restrictive practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

4 . Right Staff, Right Place, Right Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

5 . Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Section 4: St Andrew’s Healthcare ShowcaseDiversity and Inclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

REDS Academy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

ASPIRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Section 5: What our patients and carers are sayingPatient and carer quotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Contents

Section 1Introductions

“Progress and Plans”


Page 3 of 44

A welcome from Katie Fisher, our CEO

Having joined St Andrew’s Healthcare in

June 2018, my first months in this role have

been enormously inspiring.

St Andrew’s Healthcare has much to be proud of,

and there have been many important achievements

in the past year. We have continued to embed our

Value Based Healthcare model, within which we

measure outcomes for every individual to ensure

we are personalising how we care for them. Seeing

these outcomes improve is highly motivational for our

teams.

We have expanded our portfolio and invested in

Broom Cottage, a five-bed residential home in

Nottinghamshire. Broom Cottage is home to five

people with Learning Disabilities and Autistic

Spectrum Disorder, and provides residents with the

right support to successfully live in the community.

Building on the success of our innovative provision at

Winslow, this addition to our new Community Services

Division forms part of our plan to partner with other

organisations in delivering local services.

We have also opened a new Carers Centre; a

welcoming environment for carers, family and friends

of the people in our care in Northampton. Designed in

collaboration with our carers, the centre is open seven

days a week, offering both face to face support and

telephone advice.

The Charity continues to be committed to education.

We offer various educational and vocational

opportunities for the people in our care to learn and

develop work and life skills in a fully supportive

environment. All patients, whatever their skills or

level of leave, can get involved with activities including

craft, textiles and woodwork.

Some take this a stage further. Over the past year,

patients have taken up 46 work placements, many

gaining a qualification in the process. In the last 12

months, 1,471 people have been discharged from

our care – equipped with the skills and knowledge to

move forward with their lives.

Our staff too are always developing their skills, which

both creates rewarding careers and helps us retain

exceptional people. Over the past year our staff have

completed 23,000 days of learning – that’s 5.7 days

of learning per staff member – and we have invested

more than £3.5m on staff education and career

development.

These are exciting times for St Andrew’s Healthcare.

Our progress is the result of the indefatigable passion

and commitment of everyone who works for the

Charity, and I thank them for their ongoing dedication

to providing exceptional care.


Page 4 of 44

Section 1

Introductions “Progress and Plans”

Dr Sanjith Kamath, Executive Medical Director

Following on from a major transformation

programme in 2017/18, our care is now

being successfully provided within 16

Integrated Practice Units (IPUs).

Each IPU supports people with a similar or related

set of health conditions or needs, enabling our care

teams to focus their efforts on more bespoke care.

Each IPU measures a set of outcomes for each patient

to help monitor and measure their progress in mental

wellbeing, their physical health and in personalised

care. The outcomes data is shaping how we care for

our patients in each IPU and is helping us deliver the

best value in aiding their progress.

One of our core priorities for the year has been to

increase our investment in physical healthcare and

to roll out an integrated model of physical healthcare

delivery in the IPUs. This is helping us ensure that

our patients have timely access to great physical

healthcare as well as support for their mental health

needs, while allowing the IPUs to further focus on the

preventative aspects of physical health problems.

Reducing restrictive practices remains high on the

agenda for St Andrew’s Healthcare and we continue

to make progress in this area while recognising that

there is still a considerable amount of work that is

needed. This will form a large part of the quality

improvement we want to progress over the coming

year. In particular we are seeking to minimise the use

of seclusion and to use de-escalation more effectively

before restrictions are needed.

The importance of effective clinical leadership in

ensuring a high quality health care system that

consistently provides safe and efficient care is well

known and therefore a further area of priority for

the Charity has been embedding clinical leadership

at all levels in the organisation. We have taken some

important steps towards this through the appointment

of more clinicians in senior leadership roles and

developing our leaders.

We recognise that we still have much more to

do, but it is important to recognise and celebrate

our achievements. Even more importantly, I must

express my thanks and appreciation for all our staff,

volunteers and partners who help enrich the lives of

everyone at St Andrew’s Healthcare.


Page 5 of 44

Section 1


Statement of Directors Responsibilities The Department of Health has issued guidance on the form

and content of the annual Quality Account. In preparing

the Quality Account, Directors should take steps to satisfy

themselves that:

The Quality Account presents a balanced picture of the

Charity’s performance over the period covered

The performance information reported in the Quality

Account is reliable and accurate

There are proper internal controls over the collection

and reporting of the measures of performance

included in the Quality Account, and these controls

are subject to review to confirm that they are working

effectively in practice

The data underpinning the measures of performance

reported in the Quality Account is:

Robust and reliable

Conforms to specified data quality standards and

prescribed definitions

Subject to appropriate scrutiny and review

Has been prepared in accordance with Department

of Health guidance.

The Directors confirm to the best of their knowledge and

belief that they have complied with the above requirements

in preparing the Quality Account for 2018/19.


Page 6 of 44

Section 1


Section 2Quality Priorities


Page 7 of 44

To support our vision of Transforming Lives with C.A.R.E. (Compassion, Accountability,

Respect and Excellence) we have identified Quality Priorities aligned to our strategic

priorities. We want to continue the great work already achieved and have identified the

quality priorities in our 2018 strategy. Value based outcomes underpin the model of care,

we are fully committed to patient and carer involvement and co-production of outcomes

and we aim for mental health and physical health to be equally valued.

We will do this in the following ways:

1. All aspects of care are co-produced in partnership with our patients and carers

Co-production means delivering services in an equal and reciprocal relationship between professionals,

patients and their families. It happens when professionals and patients design, plan and deliver care and

support together, recognising that both partners have vital contributions to make in order to improve quality

of life for patients who use services. We recognise that co-production goes beyond consultation and is

an important element of improving the quality of the care that we provide. Over the next year we will be

reviewing how we involve our patients and their carers in care planning and care delivery, with a view to

increasing our abilities to deliver truly co-produced care. This will support better patient focused care, a

better experience of care while at St Andrew’s Healthcare and improved patient outcomes.

2. Clinical Effectiveness will be embedded in the Charity

Clinical effectiveness is defined as the application of the best knowledge, derived from research, clinical

experience and patient preferences to achieve optimum processes and outcomes of care for patients.

It involves a framework of informing, changing and monitoring practice. We have launched a Clinical

Effectiveness strategy that will ensure that we are delivering effective care across the Charity and that we

have systems and process to monitor the effectiveness of treatments. The domains of the strategy

include a programme of benchmarking our care against NICE and other national guidelines, the use

of data, technology and innovation to improve care delivery, as well as the ongoing measuring and

monitoring of mental and physical health outcomes. This will help us drive forward evidence

based care across the Charity.

3. To further reduce the use of unnecessary restrictive practices

While we have made progress in reducing unnecessary restrictions for our patients, we

recognise that there is still much work to be done in this area. The programme of work

over the next years will focus not only on areas of restriction described in the Mental

Health Act Code of Practice such as seclusion and Long Term Segregation, but also

on areas identified by our patients as being unnecessarily restrictive. We will aim to

monitor these at ward and IPU level and work with patients and carers to ensure that

the care we deliver in our services is not unnecessarily restrictive.

Compassion Respect ExcellenceAccountability


Page 8 of 44

Section 2

Quality Priorities

Review of Services

From 1 April 2018 to 31 March 2019 St Andrew’s Healthcare provided services in the field of mental health,

learning disability and brain injury to 1440 patients, commissioned by 184 different bodies, of which 92% were

NHS services or organisations. The remaining 8% of patients are funded by non-UK organisations, private

funders or individuals. St Andrew’s Healthcare has reviewed all the data available on the quality of care in

respect of the services for which it provides clinical NHS care.

Never Events

St Andrew’s Healthcare is pleased to confirm that there have been no never events during the reporting period.

National Core Indicators of Quality

The core set of indicators are defined in the quality accounts regulations. All providers are required to report

against these indicators using standardised statements as set out in the table below. Providers are only required

to include indicators in their Quality Accounts that are relevant to the services they provide. The table below

includes all of the core indicators that are applicable to St Andrew’s Healthcare.

Statements of Assurance from the Board

1 . The percentage of patients aged:

I. 0-15 years and

II. 16 years or over

Readmitted to a hospital which forms part of the charity within 28 days of being discharged from a hospital

which forms part of the charity during the reporting period.

INDICATOR MEASURE 2017/18 2018/19

The percentage of patients aged: (i) 0-15 Percentage 0% 0%

(ii) 16 or over Percentage 4.70% 2.52%

Readmitted to a hospital which forms part of the charity

within 28 days of being discharged from a hospital which

forms part of the charity during the reporting period.

Patient safety incidents Number 20708 22949

Patient safety incidents that resulted in severe harm or death Number (%) 14 (0.07%) 17 (0.07%)

2017/18 2018/19

Percentage of patients 0-15 years 0% 0%

Percentage of patients 16 years or over 4.70% (18) 2.52% (10)


Page 9 of 44

Section 2

Quality Priorities

St Andrew’s Healthcare considers that this data is as described for the following reason: The readmission

rate has decreased for the 16 years or over age group – 9 of these readmissions were from our PICU

wards. We now have four PICU wards in total (2 in Northampton and 2 in Essex). Our PICU services provide

tailored treatment programmes that are developed to recognise individual need. All of our PICUs are

members of the National Association of Psychiatric Intensive Care and low secure Units (NAPICU) and

comply with their standards and admission criteria.

St Andrew’s Healthcare has taken actions to improve this percentage and so the quality of its services by

moving to a value based healthcare approach centred on patient outcomes.

2 . Number of patient safety incidents and patient safety incidents resulting in severe harm or death

2017/18 2018/19

Patient safety incidents 20708 22949

Patient safety incidents that resulted in severe harm or death 14 17

St Andrew’s Healthcare considers that this data is as described for the following reason: All patient

safety incidents are reported on our Datix incident reporting system. Data quality checks are routinely

undertaken. Data from this system is used to provide the charity and key external stakeholders with

detailed analysis of reported incidents.

St Andrew’s Healthcare has taken the following actions to improve this and so the quality of its services by

active monitoring, investigation and learning from incidents.

The incident reporting policy and procedures have been reviewed and updated with guidance for staff on

reporting incidents and classifying what is a serious incident as per the NHS serious incident framework.

We have held training sessions and intend to roll out this training further in 2019/20. A monthly report on

serious incidents is submitted on a monthly basis to the Charity Executive Committee. We have started using

a Statistical Process Control approach to presenting data, which provides a more accurate position over time

and enables action to be taken, when necessary if data shows numbers outside of the expected norm.

The charity operates a serious incident review group which meets twice weekly and sets the terms of

reference for serious incident investigations; the membership of this group is made up of clinicians from

across the organisation and leads for key services such as pharmacy, safeguarding and investigations. The

charity utilises a red top alert system through which any learning from incidents can be cascaded charity

wide with immediate effect and there is also a learning lessons newsletter which is distributed to all

services. The Quality and Safety Assurance Committee meets quarterly, with standing agenda items that

include a report on serious incidents and learning.

Mortality Review

During the reporting period Q1-Q4 (April 2018 - March 2019) 15 patients who were in the care of St Andrew’s

Healthcare died.

One patient, who was recently discharged, died in Q3 - this is not included in any of the figures below, but it

should be noted that this death is subject to external investigation. This comprised the following number of

deaths which occurred in each quarter of that reporting period:

Four in the first quarter; three in the second quarter; six in the third quarter and two in the fourth quarter.

Mortality reviews (case record reviews), using the St Andrew’s Healthcare mortality framework tool, are carried

out into all expected deaths. For unexpected deaths a Serious Incident (SI) investigation is commissioned.


Page 10 of 44

Section 2

Quality Priorities

Of the 15 deaths during the year, two were subject to an investigation and 13 to mortality reviews.

The number of deaths in each quarter for which a case record review or an investigation was carried out was:

Four in the first quarter;

Three in the second quarter;

Six in the third quarter;

Two in the fourth quarter.

Two, representing 15.5% of the patient deaths during the reporting period, are judged to be

more likely than not to have been due to problems in the care provided to the patient. In

relation to each quarter, this consisted of:

Unexpected death of an inpatient (Q1). Subject to full external Root Cause Analysis

investigation

Unexpected death of a patient who was on exit S17 placement (Q4). Death due to

physical healthcare problems. Joint investigation between St Andrew’s Healthcare and

placement.

One death, representing 25% for the first quarter;

No deaths representing 0% for the second quarter;

No deaths, representing 0% the third quarter;

One death, representing 50% for the fourth quarter.

These numbers have been estimated using the St Andrew’s

Healthcare standard mortality review tool.

Learning from Mortality Reviews

In January 2019 the Board of Directors was presented

with the Annual Report on Mortality, detailing the work

undertaken by the Mortality Surveillance Group. It was

noted that to further the interests of transparency and

external scrutiny we have secured the attendance of

an expert Consultant in Palliative Care to improve the

robustness of our mortality reviews and processes. The

report also provided for thematic learning drawn from the

standardised review of 14 deaths occurring in the Charity

between 1 January and 27 November 2018.

The findings from the mortality reviews included improvements in

holistic End of Life care plans with clear and detailed documentation, evidence

of personalisation of care and examples of outstanding care with care teams reporting increased

confidence in practice, learning and positive coping. There was evidence of integrated care and

active relationships with the local palliative care team and supportive relationships with families, with

positive feedback. Areas which would benefit from further focus and improvement included better advanced

care planning around End of Life care for patients who have capacity to make decisions, and also ensuring the

consistent consideration of spiritual care for all patients receiving end of life care. The standardised mortality

review framework was updated to provide more robustness following our participation in the Royal College of

Psychiatrists’ pilot of the review tool in November 2018.


Page 11 of 44

Section 2

Quality Priorities

Data Quality

Good quality information underpins the effective delivery of patient care and is essential if improvements in the

quality of care are to be made. Improving data quality, which includes the quality of ethnicity and other equality

data, will thus improve patient care and improve value for money. St Andrew’s Healthcare is taking the following

actions to improve data quality:

Implementing a Data Governance Strategy to ensure data is treated as an asset and also drive data quality

improvements;

Creating a Data Warehouse where all data is put through strict quality measures;

Profiling, assessing and cleansing data to increase the accuracy of information used to drive decisions;

Defining communication protocols to improve the alignment of all stakeholders involved in the data

lifecycle;

Adopting a structured approach to managing data, deriving insight and driving action.

NHS Number and General Medical Practice Code Validity

St Andrew’s Healthcare is submitting the MHSDS dataset in line with national requirements. Codes are checked

and validated on a regular basis against national lists.

Clinical Coding Error Rate

SNOMED CT is the fundamental standard for healthcare terminology. SNOMED CT provides the vocabulary for

recording structured data in relation to the health and care of an individual in electronic records; as such its use

in systems is wide ranging. SNOMED CT also provides features that enable powerful analytics and a high level of

expressivity of information about the health and care of the individual. Implementation of SNOMED CT is part of

the national requirement for electronic patient records. St Andrew’s Healthcare is working towards implementing

the SNOMED coding change, in line with the national requirement for compliance by 2020.

NHSE Specialised Services Quality Dashboard

Specialised Services Quality Dashboards (SSQD) are designed to provide assurance on the quality of care by

collecting information about outcomes from healthcare providers. SSQDs are a key tool in monitoring the quality

of services enabling comparison between service providers and supporting improvements over time in the

outcomes of services commissioned by NHS England. St Andrew’s Healthcare submits data to Mental Health

SSQD on a quarterly basis.

NHSE Specialised Services

Specialised services are those provided in relatively few hospitals, accessed by comparatively small numbers

of patients but with catchment populations of usually more than one million. These services tend to be located

in specialised hospitals such as St Andrew’s Healthcare. As a part of the contractual arrangements with NHS

England, St Andrew’s Healthcare works to provide its services in accordance with the service specifications.

Staff from St Andrew’s Healthcare meet with colleagues from NHS England specialised services on a quarterly

basis to scrutinise contractual achievement. St Andrew’s Healthcare is also required to make an annual self-

declaration with the Quality Surveillance Team of its compliance levels with the service specification. This self-

declaration is made in June of each year, at last submission (June 2018) full compliance was declared.


Page 12 of 44

Section 2

Quality Priorities

Duty of Candour

We completed a review of the Duty of Candour processes in January 2019. Between April 2018 and

March 2019 three incidents were reported under the Duty of Candour requirement.

We reviewed the role of the Duty of Candour group which meets monthly to review any incidents which

have been identified as subject to Duty of Candour requirements. The policy has been reviewed and staff

have been provided with training as part of the revised incident reporting training.

Duty of Candour incidents are monitored as part of the report on serious incidents that is presented to the

Patient Safety Group and Quality and Safety Assurance Committee and Charity Executive Committee. Learning

from Duty of Candour incidents is shared via the charity processes for shared learning.

Participation in Local Clinical Audits

The Clinical Audit & Service Evaluation Proposal process continues to evolve and is regularly updated to improve

the effectiveness of clinician led audit activity within St Andrew’s Healthcare.

Changes this year have included a tailored proposal process for the IPUs to submit their NICE related assurance

audits and additional clinicians and subject matter experts from other fields have been added to the proposal

review panel. Therefore increasing the depth of challenges made to proposals in order to maximise the quality and

benefit of the audits or service evaluations. Furthermore all clinical audit proposals are now shared with the Charity

Effectiveness Group and the Quality and Safety Assurance Committee for further awareness and oversight.

In keeping with the creation and launch of the Charity’s new Clinical Effectiveness Strategy, the Clinical Audit

procedures were reviewed and relaunched. These included specific procedures for local clinical audits that

follow the Quality Improvement process of Plan, Do, Study and Act, with the intention of further enhancing the

quality, effectiveness and impact of clinical audit activity.

During 2018/19 11 local clinical audits were completed and 12 are in progress following approval via the St

Andrew’s Healthcare review process, these are detailed in the table below:

COMPLETED 2018-2019 (11) APPROVED 2018-2019 (12)

Case study in the use of Media Exploring Sensory Processing Difficulties

Change in Level of Functioning of Forensic Patients Vitamin D Monitoring

Contribution of functional ability to risk assessment

and intervention in forensic careUse of PBS to Work Effectively with Patients

Section 17 Leave and Therapeutic ActivitiesSecurity Level Predicted by Health Status, Forensic

Risk and Crime Committed

CBT for Psychosis DBT in CAMHS

Secondary Care Physical Health Access Evaluation of Nurse Manager’s Perspectives

Media Service Review Risk Management Training & Record Management

Arts @ St Andrew’s Healthcare Service ReviewChange of Quality of Life outcome measures and

Community Leave

Use of PRN Presence of Autism Specific Risk Factors

Evaluation of CL@S pilot initiative Art Case Study (as yet un-named)

Case Study of 1:1 music service provision Review of Psychology Supervision

Staff Training Survey


Page 13 of 44

Section 2

Quality Priorities

Clinical Audit and Assurance Team

A programme of Clinical Audit and Assurance assignments that incorporates audits and reviews against

specified categories/drivers is maintained by the Clinical Audit and Assurance Team. These audits and reviews

are in addition to the audits completed by Clinicians as part of the Clinical Audit proposal process and the audits

or compliance checks performed at an IPU and Ward level.

During 2018/19 17 audits were completed by the Clinical Audit Assurance & Internal Audit Teams and 9 are

currently underway at various stages of completion.

A further 4 were completed by clinicians with support from the Clinical Audit and Assurance Team, these are

detailed in the following table:

COMPLETED & PUBLISHED AUDITS BY THE CLINICAL AUDIT AND ASSURANCE & INTERNAL AUDIT TEAMS

Care Plan Quality – Patient Care Plan Reviews quarterly report and trend analysis

Consent (to share and to treatment)

Seclusion Reviews – Nottingham ASD & LD

Handover process

Seclusion Reviews – Medical, Nursing and MDT – Birmingham

Meaningful Activity

Seclusion Documentation and Environment – Nottingham IPU

Clinical Records review

Section 17 Patient Leave – Follow-up

Section 132 Patient’s Rights – Follow-up

Complaints Management

Patient Carer Information management – Follow-up

Medical Equipment

Serious Incident Management

Outcome Measures – quality of data

Safeguarding – Follow-up Assurance Review

Infection Prevention & Control – Follow-up Assurance Review

PROVIDED ASSISTANCE TO OTHER CLINICIANS AND MEDICAL STAFF IN SUPPORTING WITH THEIR AUDITS

Acuity / Complexity ASD & LD

MCA Capacity assessments

Falls Outcomes (re-audit)

NICE assurance review – Decision Making and MCA (NG108) – stages 1 & 2

continued over the page


Page 14 of 44

Section 2

Quality Priorities

IPU NICE Assurance Audits

Guidance and quality statements from the National Institute of Health and Care Excellence (NICE) are recognised

as important quality standards, drawn from the wider evidence base that can improve clinical outcomes if

implemented.

In line with our vision to provide ‘world class care’, we needed a robust capability to identify and prioritise

relevant NICE Guidance, Quality Standards and Technology Appraisals, and complete the full audit cycle to

implement and sustain improvements. To embed this we have produced a procedure for implementing NICE

guidance that sits within our Clinical Effectiveness Policy.

As part of the programme of providing assurance against NICE, we established a schedule of regular Charity-

wide deep dive reviews and specific IPU led NICE assurance audits, as selected in consultation with the IPU

leadership, Effectiveness Group and Clinical Audit & Assurance Team.

The final reports for all NICE audits and reviews will be published and shared to promote learning, with

periodic re-audits and reviews taking place to provide on-going assurance that actions have been taken and

practices maintained. Action plans for these audits are owned by the IPU, with progress tracked via the Charity

Effectiveness Group and IPU Quality Meeting.

The table below details work currently planned or underway:

ONGOING AUDITS AND REVIEWS AT VARIOUS STAGES OF COMPLETION

NICE assurance review – Personality Disorder related (CG78)

NICE assurance review – Dementia related (NG97)

NICE assurance review – Decision Making and MCA (NG108) – stage 3

Seclusion Environment – Follow-up

Seclusion Documentation

Consent – Follow-up

Anti-Microbial Stewardship Review

Care Plan Quality – Patient Care Plan Reviews

NHS Wales Required Care Outcomes

ONGOING IPU NICE ASSURANCE AUDITS AT VARIOUS STAGES OF COMPLETION

NG10 Violence and aggression

NG53 Transition between in-patient mental health settings and community care or care home settings

PH53 Overweight and Obese adults

NG108 Decision making and mental capacity

NG11 Challenging behaviour and learning disabilities

NG54 Mental health problems in people with learning disabilities

CG142 ASD in adults

QS14 Service user experience in adult mental health services

continued over the page


Page 15 of 44

Section 2

Quality Priorities

Learning from Clinical Audits

The Clinical Effectiveness Strategy and supporting procedures ensure clarity in the use of auditing and embed

clinical quality at all levels of the Charity. This helps to create a culture that is committed to learning and

continuous organisational development. It also helps to deliver demonstrable improvements in patient care

through the development and measurement of evidence based practice.

Four audits undertaken this year have been detailed below as examples of our learning:

Patient Care Plan Reviews – update

NHS contracts and applicable regulations identify the need for the review of individual Personalised Care Plans

and the ability to evidence accurate and complete record keeping on an on-going basis.

Reviews, using a specific and continuous audit programme are completed on a monthly basis ensuring a sample

of care plans for patients from all IPUs is reviewed on at least a quarterly basis. One of the key benefits of the

continuous approach is the ability to provide the Wards with an immediate action plan and an overall assurance

rating based on the level of compliance.

The review assists management in gaining assurance that the care and risk of each patient is assessed, planned

and managed based on individual needs and that patient views are documented in the care plans, and also that

patients’ and their carers’ are involved in care planning, wherever possible.

Identified actions are implemented by Ward personnel and are followed up on the return audit as well as through

periodic spot checks on progress. Updates can also be given at the appropriate meetings within the IPUs.

The outcome of all Patient Care Plan audits are collated and maintained on a trend analysis with a quarterly

summary provided to management (by IPU), highlighting areas of good practice as well as areas that require

improvement.

During 2018-19 we have completed 227 individual patient care plan reviews, with an overall compliance rate

of 80.5%. This continues the improvement seen in prior quarters, whereby the rate was 75% (quarter 1), 79%

NG97 Dementia: Assessment, management and support for people living with dementia and their carers

CG170 ASD in under 19s

NG116

(was CG26)PTSD

NG43 Transition from children’s to adult services for young people using health or social care services

CG178 Psychosis and Schizophrenia in adults

CG120 Coexisting severe mental illness (psychosis) and substance misuse

QS88 Personality Disorder - Borderline & Antisocial

CG77 Antisocial personality disorder

NG7 Preventing excess weight gain

NG10 Violence and aggression

PH53 Overweight and Obese adults

CG178 Psychosis and Schizophrenia in adults


Page 16 of 44

Section 2

Quality Priorities

(quarter 2), 80% (quarter 3). This compares to 2017-18 when the programme of reviews began where the overall

compliance rate was 73%, demonstrating a significant overall improvement in the completion and on-going

management of care plans since the introduction of the reviews.

Next year the programme is set to evolve further with devolution of the compliance checks carried out at ward

(IPU) level whilst the Clinical Audit & Assurance Team focusses on the quality of the care plans.

Patient Care Plan Reviews

2017-18 2018-19

82%

80%

78%

76%

74%

72%

70%

68%

Co

mp

lia

nce

Ra

te

173 Reviews

227 Reviews

Academic data for the Quality Account 1 April 2018 – 31 March 2019:

ARTICLES AND BOOK CHAPTERS

Published Articles Accepted for Publication Book Chapters

19 3 2

CONFERENCE ATTENDANCE

Oral Presentation Poster Presentation Symposium

3 7 3

PATIENT PARTICIPATION IN RESEARCH STUDIES

Men’s and Women’s NPS CAMHS LD/ASD

58 0 6 59

Affiliations

London South Bank University - MOU

Loughborough University - MOU

University of Birmingham

University of Buckingham

University of Kent - MOU

University of Northampton

University of Nottingham


Page 17 of 44

Section 2

Quality Priorities

Clinical Records

Patients should have confidence that their personal records are complete, accurate, appropriate, timely and

maintained in accordance with the law, and that they are protected against the risk of unsafe or inappropriate

care and treatment arising from a lack of proper information being held about them.

For the purpose of this review we defined Clinical Records “as any record or document collated over time that

evidences the care provided to a patient or is used to deliver the care”.

The review checked several areas of patient care for evidence that clinical record keeping is carried out to a good

standard, in accordance with local and national regulations and legislation, with core elements based on the

main requirements of the MHA Code of Practice and key Charity policies.

The review highlighted many positive findings, including: patients being informed of their rights on admission in

a timely manner; consent to treatment forms correctly in place; annual health-checks correctly carried out and

the required tests for patients on high dose antipsychotics were being completed correctly and within the right

timescales.

Areas for improvement were indicated for various aspects included in the scope of the review and on the whole

they related to the incompleteness of some clinical records. Many of the recommendations reflected actions

highlighted in more targeted and in-depth audits of the clinical record areas. All actions from Clinical Audits

are tracked and reviewed for progress by the Effectiveness Group and Quality Business Partners and followed

through to closure to ensure that the necessary changes are made and lessons learned.

Handover process review

Handover and continuity of information is vital to the safety of our patients. Good handover does not

happen by chance and is of little value unless action is taken as a result. Formal handovers should

become part of good professional practice and meet patient expectations that staff

caring for them share information to minimise repetition and maintain safety.

Handovers are carried out when there is a change of shift, from day to night

and vice versa. A handover may also be carried out for staff that are

working a half shift or alternate hours to the main shift. An optional

template is available as part of the policy that staff can use if they

wish. In summary, handovers should have adequate time allocated,

have clear leadership, ensure members of the team are adequately

briefed on concerns from previous shifts, include detail of tasks

not yet completed (which should be clearly understood by the

incoming team), the tasks should be prioritised, include plans for

further care put into place, and should ensure unstable patients

are reviewed.

An audit comprised of observing a selection of shift handovers and

a survey issued to staff to obtain their views was carried out, with

standards based on external guidelines and local policy. It included

attendance and timekeeping, the location used, role allocation and

documentation. A key element to the audit was the issuing of a survey to all

relevant personnel to gauge opinion on the effectiveness of current handover

processes, including how staff felt on various issues such as enough time given and

the quality of information given.

Positive findings were found with the majority of observed handovers starting on time, however most of these

were subject to staff joining late, which was seen in comments from the staff survey. All were led by a qualified


Page 18 of 44

Section 2

Quality Priorities

member of staff using written prompts, however the method and detail varied considerably, with a number of

negative staff comments towards the RiO tool. Where an additional Health & Safety induction was required this

was identified and carried out. There was differing findings on the length of handover, however the

need for flexibility became apparent due to the varying patient groups and length of past events

they covered.

As part of implementing the recommendations a solution is being investigated utilising

handheld tablets for displaying information that can be used wherever the handover is held.

A review of policy and the RiO electronic tool is also planned to make it more suitable and

user friendly.

Falls Outcomes

Clinical Audit carried out by a clinician to measure against NICE guidance on falls

assessment and prevention, and comparing with the National Audit of Inpatients

Falls completed in 2017.

A multifaceted approach was taken, including the review of incident

reports, risk assessments, care plans and post-fall review provision and

assessment. The audit focussed on the Dementia and HD IPU as the area

with the highest concentration of frequent fallers in the Charity.

The audit highlighted that multifactorial risk assessments were fully

evident, fracture risk assessments were present in the vast majority of

cases. Delirium risk assessments were completed in all cases however

there was no evidence of subsequent delirium prevention and management

care plans, or a supporting protocol within the Charity. Optician assessments

and BP recording were also poorly evidenced.

Falls Care Plans were found to be of a very good quality on some wards however

there are gaps in other wards where patients at risk do not have a care plan in

place. Many care plans also require improvement in quality to individually tailor them to

patient needs and to ensure they are reviewed and kept in date. The conclusion drawn from

this was that more serious fallers had a better quality of care plan.

A review of interventions showed significant improvement in practice, all frequent fallers and those who had

sustained injury had been reviewed by the Multi-Disciplinary Team on a frequent basis, along with further

analysis to identify patterns in frequent fallers.

A post fall assessment had been completed in all cases however the review didn’t include the quality of these.

Recommendations following the audit were made around improving the quality of the multifactorial risk

assessment and falls care plans, better evidencing of blood pressure recording.

Participation in Clinical Research

Since the launch of the Research Centre at St Andrew’s Healthcare, in April 2018,

we have focussed on establishing solid foundations upon which we will build and

integrate research as a ‘core’ activity across our hospitals. The first step was to

establish the infrastructure and governance that ensured the conduct and delivery of

high-quality, robust research. We have recruited an independent external Research

Committee, which draws on a broad range of knowledge, expertise and experience

to provide guidance, help and advice. Importantly, and for the first time, this includes

representation from patients and carers.


Page 19 of 44

Section 2

Quality Priorities

1. This slight reduction in percentage in Q3 was due to the Charity’s decision to delay

the roll out of the REDS Academy to one hospital site until Q4.

2. At the time of writing the results were still to be confirmed (tbc) for Q4

CQUIN TITLE Q1 Q2 Q3 Q4

Recovery Colleges for Medium and Low Secure Patients 100% 100% 87%1 tbc2

Reducing Restrictive Practices within Low and Medium

Adults Secure Services100% 100% 100% tbc2

Improving CAMHS Care Pathway Journeys by Enhancing the

Experience of the Family/Carer100% 100% 100% tbc2

Mental Health Discharge Planning and Care Planning 100% 100% 100% tbc2

We have developed a research strategy that sets a clear direction and priorities for the next 3-5 years. The

strategy focuses on three key themes:

1. Personalisation: building a patient-centred knowledge base to change individual care and outcomes

2. Mental and Physical Health: developing treatments for the whole person; exploring the interplay between

mental and physical conditions

3. Transition: improving the patient journey across and between mental and physical health systems

and settings

The strategy places patients at the centre of everything we do, in alignment with the wider-Charity’s approach,

and puts a focus on innovation and utilising technology, with translation into practice the goal for our research.

During the first few months, we conducted a review of the research portfolio, resulting in a 67% reduction to the

number of projects (down from some 107 to a focussed portfolio of approximately 33), which are now aligned to

our strategy. We have also initiated some new and exciting research programmes, which, although at an early

stage, have the potential to create a step change in the treatment of severe mental illness.

Building external relationships and partnerships across a range of mental health institutions and organisations

will be critical to our success, and we now have collaborations with 14 UK universities and a number of mental

health charities. We aim to promote a positive, research active culture across our care teams. Being research

active will not only bring benefits to our patients, it will encourage and support the best clinical staff and enhance

the reputation of the Charity.

This year 807 staff members participated in research projects that took place across the charity. This included

completing questionnaires as well as face to face interviews.

The number of NHS patients receiving care provided by St Andrew’s Healthcare in the 2018/19 reporting period

that were recruited to take part in approved research studies was 123.

Goals Agreed with Commissioners

The Commissioning for Quality and Innovation (CQUIN) programme provides a national framework for improving

quality and innovation within NHS funded care to realise better patient outcomes. First launched in 2009/10 the

scheme sets annual quality improvement goals.

The current CQUINs are relevant to the specialist care provided by the Charity and are summarised below along

with our achievement scores:


Page 20 of 44

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Quality Priorities

CQC

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. All

providers of regulated activities must be registered with the CQC under the Health and Social Care Act 2008. As

from 1 April 2015 all providers are expected to meet the fundamental standards as laid down by the CQC.

St Andrew’s Healthcare is required to register with the CQC. We are registered to carry out the following

regulated activities:

Assessment or medical treatment for persons detained under the Mental Health Act 1983;

Treatment of disease, disorder or injury;

Accommodation for persons who require nursing or personal care.

Conditions of registration require that all regulated activities are managed by a Registered Manager in respect of

that activity and that each activity must be carried out at the locations detailed within the Certificate of Registration.

During the year the CQC carried out five inspections with regard to the fundamental standards. The first of these

was a focused inspection in Birmingham in June 2018. The second of these visits was to our Northampton site

Women’s services in July 2018. Our Nottinghamshire site was inspected in October 2018, the CQC visited our CAMHS

service at the end of October 2018 to carry out a focused inspection into seclusion and long term segregation.

The current ratings across the charity are detailed in the tables below:

What others say about St Andrew’s Healthcare

Forensic inpatient/

secure wards

Requires

ImprovementGood Good Outstanding Good Good

Wards for people

with learning disabilities

or autism

Requires


OverallRequires


Birmingham

OVERALLSAFE EFFECTIVE CARING RESPONSIVE WELL-LED

CAMHS GoodRequires

ImprovementGood Good

Requires

Improvement

Requires

Improvement

Overall GoodRequires


Requires

Improvement

Requires

Improvement

CAMHS



Page 21 of 44

Section 2

Quality Priorities

Acute Wards for Adults of

working age and psychiatric

intensive care units

Requires

ImprovementGood Good Good Good Good

Forensic inpatient/

secure wards

Requires


OverallRequires


Essex


Acute wards for adults of

working age and psychiatric

intensive care units

Good Good Good Good Good Good

Forensic inpatient/

secure wards

Requires

ImprovementGood Good Good

Requires

Improvement

Requires

Improvement

Long stay/rehabilitation

mental health wards for

working age adults

Good Good Good Good Good Good

Wards for older people with

mental health problems

Requires


Requires

Improvement

Requires

Improvement

Requires

Improvement

Wards for people


or autism

Requires

Improvement

Requires

ImprovementGood

Requires

Improvement

Requires

Improvement

Requires

Improvement

OverallRequires


Requires

Improvement

Requires

Improvement

Requires

Improvement

Men’s Services



mental health problemsGood Good Good Good Good Good

Overall Good Good Good Good Good Good

Neuropsychiatry



Page 22 of 44

Section 2

Quality Priorities

Forensic inpatient/

secure wardsInadequate

Requires

ImprovementInadequate Good Inadequate Inadequate

Overall InadequateRequires

ImprovementInadequate Good Inadequate Inadequate

Nottinghamshire



mental health problems

Requires


Requires

Improvement

Requires

Improvement

OverallRequires


Requires

Improvement

Requires

Improvement

Winslow


Forensic inpatient/

secure wards

Requires


Long stay/rehabilitation

mental health wards for

working age adults

N/A Good Good Good Good Good

Wards for people


or autism

Requires


OverallRequires


Women’s Services


We were very pleased to receive an overall rating of good for Birmingham, with the responsive key question

being rated as outstanding and safe being rated as requires improvement. Staff were praised for their admission

process and helping patients settle in their ward, provision of physical healthcare, responding to individual

patients’ needs, care planning and working with other agencies. Improvements were required in relation to

environment and these have been completed. Staff at Birmingham work hard to provide high quality care and are

constantly seeking to improve where they can.

The inspection of Women’s services in July 2018 was a focused inspection and did not affect the previous ratings

which were good overall, with safe being rated as requires improvement.


Page 23 of 44

Section 2

Quality Priorities

The CQC identified actions we needed to take to improve which included work on the environment, staffing and

adherence with the Mental Health Act Code of Practice. All actions have been identified and are subject to regular

monitoring. Areas of good practice were identified in relation to physical healthcare, management of safety and

support to staff following serious incidents.

We are sorry that the visit to Mansfield in October 2018 resulted in the service being rated as

inadequate overall with effective rated as requires improvement and responsive rated as good.

As a consequence of these ratings the services were placed in special measures and will be

re-inspected within six months of the publication of the report (6 February 2019). We deeply

regret that in a small number of instances, care provided to patients at Mansfield fell below

our expected standards. As soon as the CQC raised concerns we acted decisively, closing

the facility to new admissions and completed a clinical and operational review

under new interim management. We identified the actions we needed to

take to improve the standard of care and these actions were robustly

monitored both within the charity and via meetings with the CQC and

commissioners.

The CQC’s main concerns related to the care and monitoring of

those in seclusion – a measure that we very much consider to be a

last resort. We regret that in a few individual cases, care of those

in seclusion fell short of the high standards we strive for. Any

instance where we have let patients down is one too many and

is unacceptable.

We were pleased that the CQC praised the involvement of

patients in the care planning and rated Mansfield as ‘Good’ with

regards to responsiveness to patients’ needs.

We will continue to work with staff and patients, patients’

families and carers, as well as the CQC, to promptly address these

concerns. We will welcome the CQC back to Mansfield to review

improvements within the next six months and are confident this will

result in an improved rating for the facility.

Actions arising from all CQC inspections are monitored via the Patient Safety

Group, Quality and Safety Assurance Committee and the Charity Executive

Committee.

In addition to the fundamental standards inspections described above, the CQC

undertook 34 unannounced inspections under the Mental Health Act across the

Charity during this year. Overall our position with regard to findings in these reports

is very positive, where action plans have been required, 100% of these have been

returned to the CQC within the defined timescales.

Data Security and Protection Toolkit

In April 2018 the Data Security and Protection Toolkit replaced the Information Governance Toolkit. It forms part

of a new framework for assuring that organisations are complying with their statutory obligations on updated

data protection requirements and data security. It is an online self-assessment tool that allows organisations to

measure and publish their performance. All health and care services that have access to NHS patient information

are required to meet the standards of the Toolkit.


Page 24 of 44

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The Charity’s Data Protection Officer has led this work, with support from IT teams and senior

colleagues. This work has been being overseen by the Charity’s Information Governance Group.

A huge amount of work has been completed to ensure that we are complying with all of the

requirements:

Updating of data protection policy and procedures and an updated methodology and process for

conducting Data Protection Impact Assessments, a new breach reporting procedure, and a new procedure

for how we deal with subject access requests and other data protection rights.

We have introduced a layered approach to how we advise people how their personal information will be

used. An easy read version of the Patients and Service Users Privacy Notice has been created and we have

also created a patient leaflet which has been distributed by the IPUs.

We have carried out due diligence activities on our suppliers to ensure they are handling personal data in

line with our policies and standards.

We have created a personal data inventory which includes information about the personal data that

we hold. This includes the source of the information, the category of personal data, the legal basis for

processing the data, who the information is shared with, where the information is stored and how long for.

We have surveyed all of our IT software to ensure that we documented where we have not been able to

keep software up to date. This has involved carrying out data security risk assessments. We ensure that

the SIRO is kept up to date when security updates cannot be applied in order that they are informed and

can consider the risks properly.

We have developed our strategy for applying security updates and have worked with our IT partner to

ensure that they understand their responsibilities.

We have reviewed and updated the staff E learning module to ensure it includes updated data protection

requirements.

We have started to carry out spot check access audits on the patient record system to check that access is

legitimate.

The submission reflected a “Standards met” position, however, as part of the process to complete this work, we

have captured some areas for improvement to ensure we continually assess and audit our data security and

protection controls. This work will be overseen by the IGG, which is part of their remit.

Staff Survey

Our 2018 Your Voice Snapshot survey ran between 10 October and 2 November 2018 and contained six

engagement questions.

The engagement scores since 2015 have been steadily improving, as detailed below:

2015

59%

2016

64%

2017

64%

2018

66%


Page 25 of 44

Section 2

Quality Priorities

The full 2018 charity-wide results were as follows:

Our 2018 strategic target is 70% which is aligned with a High Performance Benchmark (HPB).

Whilst we still have work to do to achieve this target, when we compare our 2018 results with the HPB in the

three engagement categories, the results are as follows:

Energy – A score of 75%, the same as in 2017, means we are achieving the HPB target of 75%.

Pride – A score of 60% was an increase of 4 percentage points from 2017. The HPB target is 74%, which

means there is still room for improvement here.

Optimism – A score of 62% was an increase of 1 percentage point from 2017, and means that we have also

achieved the HPB target of 62%.

Whilst it’s encouraging to have achieved the High Performance Benchmark for Energy and Optimism, the

challenge throughout 2019 will be to maintain these scores, whilst making improvements to improve our Pride

score.

We’ve since collectively reviewed the action plans at both an IPU and charity-wide level, and have identified key

themes and priorities for us to implement throughout 2019/20 to ensure that more people feel like they’re part of

something great at St Andrew’s Healthcare.

Your Voice Snapshot Results - Charity

Energy

75%

Favourable Neutral Unfavourable

I am willing to give extra effort to help St Andrew’s Healthcare meet its goals

0% 20% 40% 60% 80% 100%

82% 14% 4%

I am excited about the way in which my work contributes to St Andrew’s Healthcare success

0% 20% 40% 60% 80% 100%

67% 24% 10%

Pride

60%

I feel like I am part of something great at St Andrew’s Healthcare

0% 20% 40% 60% 80% 100%

62% 25% 12%

I would recommend St Andrew’s Healthcare as a great place to work

0% 20% 40% 60% 80% 100%

57% 28% 15%

Engagement

66%

Optimism

62%

I am very confident in the future success of St Andrew’s Healthcare

0% 20% 40% 60% 80% 100%

54% 32% 14%

If you have your way, will you still be working at St Andrew’s Healthcare 12 months from now?

0% 20% 40% 60% 80% 100%

71% 19% 11%


Page 26 of 44

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Quality Priorities

Complaints

The total number of complaints received between April 2018 and March 2019 was 249,

25 were dealt with as Serious Incidents (SI’s) and 224 as complaints. By comparison,

328 complaints were received for the same period the previous year.

The complaints are broken down by IPU in the following table:

IPUNUMBER OF

COMPLAINTS% OF TOTAL

Brain Injury – Rehab & Care 14 6.3%

Dementia & HD Care 2 0.9%

LD & ASD Secure Care Notts 27 12.1%

LD Secure Care 12 5.4%

ASD Secure Care 7 3.1%

MMH Medium Secure 20 8.9%

MMH Low Secure/Locked 10 4.5%

Mental Health & ASD Secure Care Birmingham 17 7.6%

PICU 6 2.7%

WMH Medium Secure 21 9.4%

Women’s Low Secure & Locked 6 2.7%

Women’s DBT 9 4%

Mental Illness & Personality Disorder Essex 23 10.3%

CAMHS 28 12.5%

CAMHS Developmental Disorders 10 4.5%

Other Departments 12 5.4%

Over the year, 91% of complaints opened were closed within the 30 working day deadline and we continue to

focus on improving our response rate. The key themes for complaints in this period were Staff Attitude and

Behaviour and Communication/Information followed by Clinical Treatment. All complaints received give us

the opportunity to improve and are used to help us to identify when and how we can make changes. Our key

improvements following complaints during the year have included:

Further training for staff on safety framework and MDT to ensure its being used consistently

As part of nursing reviews, meals to be offered and a record made whether patient accepts or declines

Ensure procedures are communicated to patients in a way they understand to eliminate confusion.

Care coordinators to ensure weekly 1:1 sessions are completed and logged on RiO

Greater focus on individual patient needs when planning patients’ treatment


Page 27 of 44

Section 2

Quality Priorities

Harness the knowledge of carers and work in closer partnership with them

Plan for extra staff to cover on days when trips are booked

A number of staff have undergone additional supervision or training following complaints about their

attitude, competence or behaviour

A complaints audit was conducted and whilst the way in which complaints are handled has areas of good practice,

to enhance the process there is a need to provide clear procedural guidance and associated training to frontline

staff. We need to ensure that an appropriate threshold is in place for recording complaints, acknowledge and

investigate complaints on a timely basis, and use learning from complaints to drive improvements in patient care.

During 2019/20 our focus will be to implement the recommendations from the audit, drive awareness and

implementation of the updated complaints policy and ensure lessons learnt are captured and shared for all

complaints so that learning is embedded in practice.

Northamptonshire County Council Overview & Scrutiny Committee

As context for this response it should be noted that Northamptonshire County Council adopted a new model for

Overview & Scrutiny (O&S) in September 2018. The new model is based on a single O&S Committee, with a remit

that is strongly focused on the following areas:

Delivery of Northamptonshire County Council’s current budget and savings plans

Development of the Council’s future budget proposals

Major risks to the Council, the local community and the county

Engagement, alignment and support for the Council’s improvement plans

The O&S Committee’s remit includes the statutory function for scrutinising the planning and provision of health

services in Northamptonshire. However, the prioritisation of the focus areas set out above, as well as the need

to bring a newly-constituted Committee into operation, has necessarily minimised the amount of health scrutiny

work that the O&S Committee has been able to do in 2018/19.

The O&S Committee formed a working group to consider and respond to local healthcare providers’ draft Quality

Accounts / Reports for 2018/19. However, as this Quality Account was received after this working group met on

15th May 2019, it was sent to councillors by email for review and the following comments were provided:

Page 10: There seems to be quite a number of 2018/19 patient safety incidents resulting in severe harm or death

(17). A breakdown of this figure would be appreciated: Could it be split down into self-harm, patient- patient

interaction, carer-patient interaction for instance. Also these figures to be shown in comparison with another

similar institution?

Page 32: In respect of the priority relating to reductions in restrictive practices: This needs further clarification.

What is the target reduction aimed for in each of the measures, e.g. a 10% reduction or a 50% reduction? How

will the effect of this be measured? It would be useful to see these figures over a longer period and to have a

comparison with other similar institutions. Also, are there likely to be any other side effects of these reductions,

for instance an impact on the severe harm/death figures? Has a comparable reduction been achieved elsewhere

and what were the outcomes?

Involvement and Feedback from Key Stakeholders


Page 28 of 44

Section 2

Quality Priorities

NHS England

‘The St Andrews service has faced a number of challenges over the period and are committed to improve the

quality of their services. Specialised Commissioners continue to work in close collaboration with the team at

STAH . There have been a number of senior staff changes. The team are well engaged with partnership working

as part of the emerging collaborative commissioning projects in the West and East Midlands. There has been a

specific focus on restrictive practice; in particular long term segregation. The charity has established monitoring

arrangements and the opportunity for confirm and challenge. There has been a continued reduction in beds

commissioned in line with the transforming care agenda and some focussed work supporting the charity on

a number of patients whose discharge is delayed. The charity is establishing a new blended women’s secure

service as a pilot and there is a good level of service user engagement evident’

Healthwatch

Healthwatch Northamptonshire welcomes the appointment of Katie Fisher as the new CEO of St Andrew’s

Healthcare. Our meeting with her in January 2019 was very positive and Healthwatch is particularly pleased

to hear of her commitment to provide educational and vocational opportunities for people to develop work

and life skills whilst in their care. Additionally, supporting staff to develop their skills will also improve career

satisfaction, retention and the patient experience.

We support the 2019/20 quality priorities and the commitment to reducing restrictive practices and the use of

seclusion.

The involvement of patients in care planning is essential going forward if St Andrew’s Healthcare truly wants to

deliver coproduced, outcome focused patient care. It is also imperative that St Andrew’s Healthcare continues to

improve its response rates to complaints and sees them as a source of feedback for continuous improvement.

The involvement of families and carers is also essential for the wellbeing of patients and the patient experience

and outcomes. The new Carers Centre in Northampton demonstrates the commitment of the Charity to support

this.

We look forward to working with St Andrew’s Healthcare over the coming year to ensure that the voice of

patients, carers and families continues to be heard.


Page 29 of 44

Section 2

Quality Priorities

Section 3Review of Quality

Services


Page 30 of 44

1 . Empowering carers and patients to make a difference

Continue to improve on the immense work that has already commenced around patient and carer

engagement and involvement to ensure that both patients and carers are truly empowered to make a

difference.

The Patient Involvement Strategy outlines several key areas however our priorities are:

Listen and respond to feedback

Co-produce future plans and services

Demonstrate our impact, share good practice and shape national agendas

The Carers Strategy defines the Triangle of Care as a therapeutic alliance between service user, staff member

and carer that promotes safety, supports recovery and sustains wellbeing. The Strategy clearly identifies its

seven key priorities as:

Carers and their role are identified at first contact or as soon as possible;

Staff are trained on carer engagement;

Policy and practice protocols concerning confidentiality and sharing

information are in place;

Defined post(s) responsible for carers are in place;

Effectively communicating with carers including an

introduction to the service and staff;

Provide access to support and information;

Planning, delivery and evaluation of our services.

Why did we choose this priority?

These priorities were selected as the organisation has been

very much in its infancy in involving patients and carers. Whilst

progress had been made with patient involvement, there had

been very little focus on carers which resulted in a carers

engagement strategy being developed therefore a priority was to

focus on its implementation.

What did we achieve?

Within patient involvement, we increased our response rate to the patient

survey and some IPUs developed action plans to address issues together with

using feedback from care opinion to inform quality of care improvements.

Whilst we are not at true co-production stage, patients have been more involved in decision

making with representation on key committees such as Restrictive Practice Monitoring

Group, Research Committee and more recently, recruited for the Quality and Safety Assurance

Committee. Patient interview panels have been involved in the recruitment of all senior

positions and within some IPUs they have had input into ward staff recruitment. Patients

have been consulted on some policies and focus groups have been held to gain feedback

on different aspects of service development.


Page 31 of 44

Section 3

Review of Quality Services

External collaborations have significantly increased through several patient reviews of the Mental Health Act,

contributing to the Blended Model Pilot application and over a dozen sessions being held with

patients within LD and ASD on Transforming Care and the NHS 10 year plan – this has meant a

substantial contribution to the national agenda.

Progress has been made on the implementation of our carers strategy with a new Carers

Centre opened in Northampton that provides central support and information. A carers

survey has been conducted to establish the views and experience of carers together

with general feedback provided to carer centre staff. Guidance for staff on information

sharing with carers has been developed and carers had significant input into the Care

Plan Approach (CPA) policy and process. Staff training on carer engagement has been

piloted and is being reviewed following feedback and input from staff and carers.

Carers were also involved with the Mental Health Act review and in research with the

National Association of Psychiatric Intensive Care and Low Secure Units.

Carers have shared their experiences at Leadership and Board meetings in the last year.

2 . Gain parity of esteem between Physical Healthcare

and Mental Health

Implement the recommendations made by the Physical Healthcare Needs Analysis around the

patients’ physical health needs, overall governance of the Service; approaches to physical

healthcare and the Charity-wide operational delivery.


The physical health of our patients was rightly recognised as a key priority for the Charity.

The evidence suggests that individuals with serious mental health problems are at greater

risk of developing physical health illnesses such as diabetes, obesity and cardiovascular

problems.


We undertook a comprehensive review of the physical health needs of our patients and, based on this analysis,

we changed the model of physical healthcare delivery to an integrated model of care embedded in the IPUs. To

do this we doubled the number of physical healthcare practitioners and have implemented a rota to increase

our capabilities to provide out of hours physical healthcare. Through improvements in our data collection and

our upgraded electronic patient record, our clinicians have easier access to physical healthcare information and

we have refreshed the governance framework to ensure that we have the right systems to effectively monitor

physical healthcare delivery.

What are we doing next?

We will continue to improve our capabilities to deliver physical healthcare through specific training around

physical health conditions with a specific focus on preventative measures and earlier intervention in long term

conditions, aiming to improve patient physical healthcare outcomes.

3 . Further reductions in restrictive practices

Continue to reduce the use of Prone Restraints (unless it is patient choice, care planned and risk assessed);

Minimise the use of Seclusion as a therapeutic intervention;


Page 32 of 44

Section 3


Maximise the capability of data and analysis when evaluating quality and value within the patient outcome

measures;

Ensure staff are trained to deliver positive and safe care and reduce the use of enhanced support and

restraint;

To increase the opportunities for the therapeutic use of leave and other off ward activities for patients in

keeping with the principles of least restrictive practice and recovery focussed care.

This priority has been partially achieved.


Our quality priorities were designed to further enhance the recovery of our patients through ensuring the

reduction of the use of restrictive practices.

What have we achieved?

The Restrictive Practice Monitoring Group continues to meet monthly to monitor the use of restraint, including

prone restraint, restraints and seclusions. The seclusion policy, enhanced support policy, long term segregation

and seclusion policy have all been reviewed during this year to ensure they reflect the latest guidance and

learning. The IPUs also monitor this within their IPU quality and governance meetings. The graphs below show

data for the period May 2017 to March 2019.

We started to use the Statistical Process Control method to present data in January 2019. This is a key continuous

improvement tool recommended by NHS England. The upper (orange), lower (blue) and mean/average (black)

reference lines are produced using all the data points – the upper and lower lines are calculated based on the

data points within the graph, so will change every month. So, while the graph line may show spikes and troughs,

they may well be within expected limits and are nothing to be concerned about. When they are above the upper

or below the lower limit, then they become noteworthy.

In addition, an increasing run of 7 or more consecutive points indicates things are steadily getting worse,

while a decreasing run is an improvement (in a stable system). A run of 7 or more consecutive points above

the mean tends to indicate a period where incidents were consecutively high, while below the mean they were

consecutively good (also in a stable system).

This method allows us to identify trends more accurately. The graphs below show data per occupied bed days

and whilst there is some variation the graph for prone restraint shows an overall downward trend.

Prone Restraints

2

4

6

8

May

2017

Aug

2017

Nov

2017

Feb

2018

May

2018

Aug

2018

Nov

2018

Feb

2019

Pe

r 10

00

OB

D

Mar

2019


Page 33 of 44

Section 3


Next steps?

To further refine the data monitoring

To continue to re-inforce the least restictive practice approach with staff and provide training on skills and

methods of de-escalation and therapuetic enagement.

4

8

12

14

6

10

Seclusions

May

2017

Aug

2017

Nov

2017

Feb

2018

May

2018

Aug

2018

Nov

2018

Feb

2019

Pe

r 10

00

OB

D

2

6

10

4

8

Rapid Tranqs

May

2017

Aug

2017

Nov

2017

Feb

2018

May

2018

Aug

2018

Nov

2018

Feb

2019

Pe

r 10

00

OB

D

15

25

35

45

20

30

40

Restraints

May

2017

Aug

2017

Nov

2017

Feb

2018

May

2018

Aug

2018

Nov

2018

Feb

2019

Pe

r 10

00

OB

D

Mar

2019

Mar

2019

Mar

2019


Page 34 of 44

Section 3


4 . Right Staff, Right Place, Right Time

Implement the staffing models identified through

the Hurst Assessments and effectively manage the

workforce resource to achieve the best outcomes for

the patient;

Enhance care hours and the therapeutic time and

opportunities for patients including leave, therapy and

activity;

Ensure a stable, engaged and skilled workforce working

in teams to deliver the highest quality standards and

outcomes;

Appropriate reduction of agency staff use.

This priority has been partially achieved.


Our quality priorities were designed to further enhance the

recovery of our patients through ensuring the correct staffing

was in place.

What have we achieved?

The graph below shows that over the time period May 2018

to March 2019 the gap between required staffing levels

and the actual has reduced. Staffing is monitored within

IPUs and monthly Patient Safety Group and Charity Executive

Committee meetings, as well as the quarterly Quality and

Safety Assurance Committee meetings. Staffing is also

part of the safety framework which we have developed for

monitoring key safety elements of services.

Staffing Gap – Nursing

8%

12%

18%

10%

14%

Staffing Gap – Nursing

May

2018

Jun

2018

Jul

2018

Aug

2018

Sep

2018

Oct

2018

Nov

2018

Dec

2018

16%

Jan

2019

Feb

2019

Mar

2019


Page 35 of 44

Section 3


There has been a significant re-structure in the charity in quarter 4 of 2018/19. A key element of this change was

that the operations and nursing responsibilities were separated so that we had the appropriate focus on both of

these critical areas. The new roles of a Chief Nurse and a Chief Operating Officer were identified.

What next?

We will use the six months from January 2019 to June 2019 to make sure we have the right focus in each of the

two areas. As part of the new Chief Nurse role a further review of staffing has been undertaken to ensure the

Hurst model meets the ever changing requirements of the different IPUs.

New processes will be put in place to ensure that all areas are regularly reviewed in accordance with the Hurst

Tool, this will then in turn ensure that the right numbers of staff are allocated to wards at all times. A new safer

staffing dashboard will also be introduced that shows the number of staff on duty at any time within the charity

and will provide an escalation process from ward to board.

Further work will be done on capturing the use of therapeutic and meaningful activities to enhance the patient

experience.

5 . Outcomes

To embed outcome driven care throughout the organisation;

Work towards publishing our outcomes data.


Improving outcomes that matter to our patients is at the heart of what we do at St Andrew’s Healthcare and

to that end the Charity implemented Value Based Healthcare, founded on the principle of using resources as

effectively as possible to measure, monitor and maximise these outcomes. This allowed us to work with our

patients and carers to focus on those activities that improved outcomes.

MONTH COMMENCING

FILLED BY

1ST APR 2018

1ST MAY 2018

1ST JUN 2018

1ST JUL 2018

1ST AUG 2018

1ST SEP 2018

1ST OCT 2018

1ST NOV 2018

1ST DEC 2018

1ST JAN 2019

1ST FEB 2019

1ST MAR 2019

Staff 25405 26869 25489 25401 26348 25976 28200 27606 26834 28276 24362 26385

Overtime 3720 3879 3770 3869 3555 3305 3402 3317 3246 3547 3621 4472

WorkChoice 4875 5395 5382 5828 6706 6099 6122 6246 6489 6852 6410 7179

Agency 3577 3575 3695 3816 4372 3968 3863 3838 3738 4232 4072 4559

3288 2861 2744 3059 3328 3027 2801 2228 2777 2760 3123 3099

Fill Rate 92.0% 93.3% 93.3% 92.7% 92.5% 92.9% 93.7% 94.8% 93.6% 94.0% 92.5% 93.2%

Shift fulfilment by type of staff

Unfilled


Page 36 of 44

Section 3



As a first step towards true outcomes driven care, we co-produced an outcomes framework with our patients,

their carers and our staff. The resulting framework was then mapped across well-established, validated outcome

measurement tools. These tools were then embedded in our electronic patient record and systems were put

into place to ensure that these outcomes were recorded regularly, monitored and then used to support decision

making. All 16 of our IPUs are now measuring outcomes for their patients and these outcomes are being used to

improve the care we deliver.

What are we doing next?

The journey to deliver better care with each day continues and the work on outcomes continues to evolve with

new tools, specific to different patient groups, being identified and adopted. We are working to build on our

clinical dashboards so our clinicians have even better access to the data they need.


Page 37 of 44

Section 3


Section 4St Andrew’s Healthcare

Showcase


Page 38 of 44

Diversity and Inclusion

St Andrew’s Healthcare has a diverse workforce, where we employ more women than men, have a higher BAME

(Black, Asian and Minority Ethnic) population than the national average as well as more members of the LGBT+

community. We also have broad age distribution across our colleagues.

The Charity Executive Committee appreciates that a highly diverse organisation is a high-performing one, and we

are actively seeking ways to become more inclusive and cohesive.

The creation of our Inclusion Leadership Committee was an important part of this. In November 2018 we invited

people from across the Charity to help shape our future and make sure that everyone feels welcome and valued

here: whether they are a patient, a visitor or a member of staff.

It has been a very positive year for diversity and inclusion. Some important milestones include:

A visit from the Reverend Richard Coles as part of LGBT History month. Having been a patient at

St Andrew’s Healthcare at the age of 17, he said that our psychiatric care had ‘saved his life’.

Two women and a director of BAME origin were appointed to the Board over the course of the year.

The majority of our Clinical Directors have BAME heritage.

A BAME network was established to provide peer support for people of all ethnicities to facilitate feedback

and initiate change.

Training a team of people in Mental Health First Aid, to provide a listening ear and support for colleagues.

The launch of WiSH – Women in St Andrew’s Healthcare – a new network to drive gender equality at work.

REDS Academy

In June 2018 St Andrew’s Healthcare launched the Recovery and Every Day Skills (REDS) Academy.

REDS Academy is a uniquely inclusive offering open to patients, staff and carers alike. Its aim is to increase hope

and help all students better manage their mental health and prepare patients for life outside our care.

Each course is designed and delivered in partnership with professionals and people with personal experience of

mental health challenges.

Courses cover a wide range of topics from understanding mental health and recovery to meditation and drama.

They also give people support with managing money and healthy eating.

Since launch, 111 patients and 127 staff

across our four sites have taken part

in the full range of courses.

Quotes about REDS:

“Meditation teaches me about my mental health

and gives me coping strategies.”

– student

“As a Peer Trainer my role is to

help create and deliver courses using my lived experience of

mental health alongside my training skills. The aim, though, is to have

more St Andrew’s Healthcare patients involved in doing that.

The empowerment they’ll gain from co-designing and co-delivering

courses is massive.”

– Kyle, REDS Academy

Trainer

“It felt honest, engaging and

emotional at times, but well worth taking part in.”

– student on

‘Personality Disorder

and me’


Page 39 of 44

Section 4

St Andrew’s Healthcare Showcase

ASPIRE

ASPIRE is an initiative which provides both financial and on-going pastoral support (for a period of up to 2 years).

The programme enables St Andrew’s Healthcare staff to complete their Nursing degree and is available to

individuals who are either starting on their career journey in either mental health (MH) or learning disability (LD)

nursing, or for those who are already part way through their MH/LD nurse training. There are two cohorts per

year; applicants who meet the criteria can apply for this two year programme, where the Charity provides salary

support of up to £16,056 per year. In addition to financial assistance, students in the programme are supported

throughout their education with mentorship, pastoral care and regular contact events where they can meet

fellow students and peers from the Charity.

Each year we provide nurse bursaries under our ASPIRE programme, funding 25 staff members to undertake

their nursing degree, at a cost of over £15,000 per person.

There are currently 90 people at various stages of their academic journey.

Nina joined St Andrew’s Healthcare in 2004 as a Healthcare Assistant at Spring

Hill House, on a ward for patients with learning disabilities. Having always had

hopes to become a nurse, she was inspired ultimately by her children to begin

studying:

“My son had an accident and was being cared for in a high dependency unit.

Watching the nurses caring for him focused me on taking the next step. I wanted

to make my children proud, and able to say ‘my mummy’s a nurse.’”

Nina first needed to complete her GCSEs and level 4 training in order to start her

nursing degree. With a full time job, a five year old and three year old this was

no easy task. Having hated school, she was also nervous about studying. But

she was well supported by St Andrew’s Healthcare and given adapted hours to

complete her studies. She received her GCSE results in August 2016, and started

her nursing degree at the University of Northampton just two weeks later.

The course was enjoyable and Nina flew through practical exams, but found the

writing side a challenge: “I’d never written academically before, so I had a lot

to learn about the style and referencing. The 10,000 word dissertation nearly

broke me: I tried to put it off but realised I was spending just as much time

worrying about it as it would take just to do it!”

Nina graduated in February 2019 with a First. She says that the ASPIRE

programme has changed her as a person: “It’s given me such a sense of pride,

especially on coming back to work with my team. I owe a lot to St Andrew’s and

particularly the ASPIRE team – Ged, Emma and Karen. And while I love being

a Senior Staff Nurse, I want to carry on pursuing my career. My next goal is to

become Clinical Nurse Leader.”

CASE

STUDY

1

Nina


Page 40 of 44

Section 4


Phil’s ASPIRE journey

Phil joined St Andrew’s Healthcare in 2006 as a healthcare assistant. He

progressed to become an assistant practitioner, but wanted to become a fully

qualified mental health nurse, so he embarked upon the level 4 certificate of

higher education. “Before that, it was about 20 years since I was in school and I

had no real academic ability whatsoever,” he explained.

Once Phil had attained the certificate, he applied to the ASPIRE programme and,

after a successful interview, gained a spot on the programme.

“Being accepted into the ASPIRE programme and going through the interview

process gives you a bit of self-belief that they have seen something in you and are

prepared to put the time and investment into you to progress and develop,” he said.

Phil’s consistently high grades on the course allowed him to leave university two

years later with a first-class degree. “I couldn’t have done it without ASPIRE. The

financial support is a bonus; being a mature student and having commitments,

there was no way I could have taken any other route to university, let alone

have the confidence to do it.”

He is now back at St Andrew’s Healthcare, working as a staff nurse within our Child

and Adolescent Mental Health Service. “Working in St Andrew’s Healthcare as long

as I have makes it easier to come back and focus on being a nurse, as you’re not

coming in blind.

“There aren’t rules to learn and that sort of thing so you can focus on every

aspect of your nursing role when you come back to the

ward and build relationships with patients,” he said.

CASE

STUDY

2

Phil

The ASPIRE programme has

transformed my life. I am committed to spending my

professional life paying this tremendous ‘gift’ forward

to transform the lives of our patients and help educate

future ASPIRE students.

The ASPIRE programme has been

fantastic for me personally and I know for colleagues

it has been too, it prepares you both mentally and

academically for those who have been out of education for some time, the support

is endless from all areas.

The experience I have been gaining at St. Andrew’s has

allowed me to witness the commitment and dedication that the

charity invests in their patients and staff

alike.

Quotes from other

ASPIRE students:


Page 41 of 44

Section 4


The ASPIRE programme provides

a chance for people like me who are struggling

to return to education to become the exception and succeed in their

training.

I am deeply passionate about

nursing and hope that a degree in nursing will

be the development of my career to really

make a difference to the lives of others.

Section 5What our patients and

carers are saying


Page 42 of 44

“You are loved, you are cared

about and you are worthy of help.”

– a patient

“St Andrew’s Healthcare gives

great care for those they care for, and

gives care for those who care.”

– a carer

Thank you so much for all your wonderful care, we know she is

in safe and loving hands.Wonderful

staff

We received 224 compliments and 49 stories have been

captured on Care Opinion

What are our patients and carers saying?

“Came in a mess, was tended to by angels and now I’m better.”

– a patient


Page 43 of 44

Section 5

What our patients and carers are saying

“I’ve had so many ups and

downs, but thank you for putting me together.”

– a patient

“Sometimes it’s been quite tough, but with carers and health professionals working together we

can overcome the challenges.”

– a carer

“A service user once told me: “This is my home and

you are my family, it’s all I have and all I know.” This has resonated with me ever since, and is what motivates me on a

daily basis to give individuals in our care the best quality of life

and care possible.”

– staff member

I feel like the staff are

very supportive. I feel like they are handling

my care very well and I feel like I am

going to have a good and positive

future.

Really good

treatment

This is the best hospital

I have been in


Page 44 of 44

Section 5

What our patients and carers are saying

Documents

ACCOUNTS 2018/19these outcomes improve is highly motivational for our teams. We have expanded our portfolio and invested in Broom Cottage, a ive-bed residential home in Nottinghamshire