St Andrew’s Healthcare is a mental health charity that, for nearly 200 years, has provided care and support to some of the most vulnerable people in our society.

While society has come a long way in recognising mental health, people with the most complex needs are still too often overlooked. This is where St Andrew’s steps in. Working in partnership with the NHS and others, we provide specialist care to patients with the most complex needs, supporting them to find hope and meet their goals. But we face a very significant challenge.

Challenges we face

In recent times, we have failed to deliver the level of care that our patients rightly deserve. Every day, many of our staff do an outstanding job looking after patients and helping them lead a more independent life with hope, but this is not consistent across all wards in our hospitals.

In some wards, closed cultures have formed among staff - cliques that perpetuate poor practice and discourage colleagues from speaking up when something isn’t right.

There have been high-profile cases of UK hospitals failing patients where closed cultures exist, and the Care Quality Commission (CQC), in particular, has been leading the way in helping to identify closed cultures in healthcare. But as the CEO of a charity that exists to support the most vulnerable, it is hard to put into words how devastating it feels to know that we have let down some patients and their carers. I am determined to fix this.

Northampton inspection

The CQC will soon publish a report into its inspection of our Northampton hospital. It will conclude that our overall standard of patient care has not been good enough. We fully accept its conclusion, and we are sorry that we’ve let down patients. We recognise we have an issue. Working with the CQC and our NHS commissioners, we are taking swift and urgent action to address the problems and improve our care.

Urgent action

Having an open culture - Where all staff understand it is their duty to speak up - is central to this. And to fix the problem, we must first fully understand it.

We are taking expert advice from Helené Donnelly OBE, a former whistleblower who pioneered the Freedom to Speak Up Guardian role in the NHS. With Helené’s support, we’ve encouraged all staff to speak up if something is wrong, even if that means reporting colleagues for poor practice.

We’ve seen a strong response, with ‘speak up’ reports more than doubling. Each report is thoroughly investigated, and when a patient safety concern is identified, we share it with the CQC and, where appropriate, escalate it to other authorities such as the police - always maintaining the anonymity of the person who raised the issue. I’ve been deeply impressed by the way so many of our front-line staff have risen to the challenge, showing real determination to improve care and root out poor practice.

We’ve held one-to-one conversations with patients in our care, led by an independent clinician, to hear directly from them how we are doing. We’ve had similar conversations with patients’ carers and loved ones.

We’ve invested in training for front-line staff on best practice, care standards, reporting and culture.

We are reviewing our management structures from top to bottom to ensure we have the right leaders in the right places, with clear accountability for patient care and safety at all levels, who lead by example and promote open cultures.

And we are assessing the services we provide in our hospitals - in some cases closing services - to ensure our expertise is focused on our specialist area of complex mental health and to meet demand from the NHS.

Rebuilding trust

We know that rebuilding trust will take time, and we will be judged not by our words but by our actions. St Andrew’s Healthcare was founded to serve those most in need, and that remains at the heart of everything we do. We are resolute in our commitment to creating a culture of openness, compassion and excellence, where every patient receives the care they deserve, that patients and carers have a voice, and every staff member feels empowered to speak up and make a difference.

This is a turning point for our charity, and we will not stop until we have earned back the confidence of our patients, their carers, and the public.