• Staff allege “active deception” of CQC in inspection and a “cover-up culture”
  • CQC inspectors also told of “falsified records” in previous inspections
  • Most recent “well led” inspection finds improvement in many areas but is not confident staff can speak up without reprisal

Staff at a mental health provider complained about a “cover up culture” where allegations of poor care and abusive behaviour were concealed by falsifying records, a new report reveals.

The Care Quality Commission’s inspection of the leadership of St Andrew’s Healthcare, a charity that provides mostly NHS-funded care in the Midlands, said staff complaints “pointed to a culture in which management sought to actively manage how their service was perceived by CQC”.

The regulator’s report, published today after visits in October, said: “Patients, staff and relatives raised concerns that management may either not be aware of or are not responding to issues including poor and selective reporting, falsifying records, intimidation of staff, and active deception of [the] CQC.

“[They] attributed these behaviours to management. However, it was not always clear from comments whether ‘management’ referred to senior leaders, or ward level management.”

The inspectors were also shown evidence that staff who had been dismissed following abusive or threatening incidents with patients had been re-employed by the organisation.

CQC deputy chief inspector for mental health and community services Kevin Cleary said: ”Though Inspectors witnessed some areas where St Andrew’s was using processes that supported good care, there were also repeated and systemic failings relating to procedures and clinical governance. These failings hindered the provider’s ability to provide safe and effective care and treatment.

“Leaders had comprehensive knowledge of challenges faced, but many of their plans were in their infancy. Although leaders were visible and approachable, we were not assured staff were always confident to raise concerns without fear of reprisals, with one employee not being afforded appropriate legal protection when making a disclosure.”

The report into St Andrew’s comes four months after the trust lost an employment tribunal against a nurse it had wrongly dismissed for whistleblowing.

A previous CQC inspection had rated the service “inadequate” overall in October 2018.

There has been significant turnover in board members since July 2018, when previous chief executive Gil Baldwin left.

The report said “The newly formed leadership team had the capacity and capability to work towards the delivery of high-quality sustainable care for patients. There was a clearer focus on clinical leadership and a need to further define and develop the assurance function within a non-executive director and governor role.”

It added that the clinical and operational leads “spoke highly” of the new senior leadership team and chief executive, Katie Fisher.

The CQC included in the “must” section of its areas for improvement report “ensur[ing] effective governance systems and processes are embedded across all services to support the delivery of sustainable and high-quality care” and ordered a review of “the arrangements for the independent challenge of decisions made by the executive team”.

A spokeswoman for the charity, which has its headquarters in Northampton, said it had appointed four “freedom to speak up guardians” to work across the trust.

In a statement she said: “We have a new leadership team in place who are committed to making improvements and creating a culture of complete openness, honesty and transparency to make sure that we are always doing the right thing by our patients and staff. But as the CQC highlighted such plans are in their infancy and cultural change can take time, especially in a complex mental healthcare setting.”