- Independent mental health service
Cygnet Hospital Harrow
Report from 20 December 2024 assessment
Contents
Ratings - Acute wards for adults of working age and psychiatric intensive care units
Our view of the service
This assessment of West Ward took place on 4 December 2024. West Ward is an acute mental health ward for adults of working age. The ward has capacity for up to 18 patients. On the day of our inspection, there were 11 patients on the ward. The ward only admitted male patients. West Ward had opened on 16 October 2024. The service replaced the acute service for adults of working age that had been provided on Byron Ward. Data presented in this report covers both Byron Ward and West Ward. We conducted this inspection to follow up concerns raised at our last inspection in May 2023. At that inspection, we rated the service as inadequate. At this inspection we found that the service had made considerable improvements. During this inspection we found no breaches of regulation.
The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff anticipated and managed risks to patients. They minimised the use of restrictive practices and followed good practice with respect to safeguarding. All staff reported incidents and near misses. However, there was some scope for improvement in the management of some medicines and in recording the action taken after patients received rapid tranquilisation.
The service took a holistic approach to assessing, planning and delivering care and treatment to all people who use services. This included addressing, where relevant, physical health needs. Staff developed appropriate care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. All staff were actively engaged in activities to monitor and improve quality and outcomes.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions. Most patients gave positive feedback about the staff. The service had a pro-active ‘experts by experience’ programme to engage patients in developing the service.
The service provided person-centred care. Staff planned patients’ discharge, collaboratively with each patient’s local service. Staff responded to the religious and cultural needs of patients. The service displayed information about how patients and carers could make a complaint and ensured that complaints were investigated.
Leaders at all levels demonstrated appropriate experience, capacity and capability needed to deliver care. Staff held a shared purpose. Governance arrangements enabled senior staff to have a good oversight of the service. Staff felt confident that they could raise concerns if they became aware of poor practice. They were working on initiatives to improve specific aspects of service delivery. However, the daily tasks of the ward manager tended to focus on administration and oversight. The service may benefit from ward managers engaging more with staff and patients.
Mental Health Act and Mental Capacity Act Compliance
Mental Health Act
The service admitted patients under the Mental Health Act 1983. At the time of the inspection, five patients were detained in hospital for assessment and three patients were detained for treatment. Three patients were not detained under the Act.
Staff received and kept up-to-date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Training on the Mental Health Act was mandatory for staff and the compliance rate was 91%.
Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff received assistance from the Mental Health Act manager, based at the hospital.
The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. For example, the pharmacist’s weekly audit of medicines included checks to ensure that medicines prescribed to patients detained under the Mental Health Act had the appropriate certification. When the pharmacist found medicines that were not included in the certification, this was reported to the ward manager.
Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s notes each time. This was recorded in the patient's record. The multidisciplinary team explained patients’ rights to them during ward rounds. This included discussions about the right to appeal against detention.
Staff made sure patients could take section 17 leave (permission to leave the hospital) when this was agreed with the responsible clinician. The use of leave from the ward was agreed by the multidisciplinary team. Arrangements for leave were made at the daily planning meeting.
Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to, although at the time of the inspection, none of the patients fell in scope of this requirement.
Staff stored copies of patients’ detention papers and associated records correctly and staff could access them when needed. The original copies of detention papers were held in locked filing cabinets in the Mental Health Act office. Copies of these documents were held on the ward.
Mental Capacity Act
Staff received and kept up-to-date with training in the Mental Capacity Act and had a good understanding of the five principles. Training on the Mental Capacity Act was mandatory for staff. This training was provided as part of the induction process.
Staff assessed and recorded capacity to consent clearly each time a patient needed to make an important decision. Staff completed an assessment of each patient’s capacity to consent to admission and treatment on admission. Further assessments took place during reviews by the multidisciplinary team.
People's experience of this service
During this inspection, we spoke with 4 patients. Feedback from patients was predominantly positive. Patients said there were plenty of staff on the ward and that these staff were kind and helpful. They said they regularly met with their doctor and multidisciplinary team, and that they felt included in decisions about their care and treatment. Patients told us about activities they were involved in, including gym sessions, therapeutic groups and creative activities. One patient was less positive about their experience, saying that they did not feel listened to. All patients said they felt safe on the ward.
Throughout the inspection, we saw positive engagement between staff and patients. We saw that staff were kind towards patients. Senior staff commented that there was a culture of compassion within the staff team.
Cygnet Health Care had a proactive approach to user involvement. An expert by experience visited the ward at least once a week to talk to patients about their experiences on the ward and engage patients in discussions about the service.