Cygnet Hospital Harrow

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence on how the service provided was effective. At the last inspection in 2023, we rated this key question as requires improvement. At that inspection, the service was in breach of regulation 18 (staffing). At this inspection, the rating has changed to good. This means that the service had taken action to improve the effectiveness of its care and treatment, particularly regarding the provision of regular good quality supervision for staff. We found no breaches of regulations in relation to this key question.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive mental health assessment of each patient either on admission or soon after. All patients received a comprehensive mental state assessment by a nurse and a doctor on admission. This included an assessment of the patient’s capacity to consent to admission and treatment. Following this assessment, staff wrote up a care plan for the first 72 hours of the admission. Each patient received a full assessment by the multidisciplinary team within the first 48 hours of their admission.

Patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward. Staff reviewed patients’ physical health on admission and at least once a week thereafter. This included checks of patients’ temperatures, pulse, oxygen saturation and blood pressure. Staff carried out an electrocardiogram on patients, prior to administration of antipsychotic mediation. However, we found one instance of a patient having weekly physical health checks, when the care plan said this should be done daily.

Staff developed a comprehensive care plan for each patient that met their mental and physical health needs. Each patient had a collection of care plans, including plans specifically relating to treatment and discharge. Care plans were personalised and recovery orientated. Plans for treatment set out the patients’ goals, as well as arrangements for occupational therapy, psychology and risk management. They included the views of patients and carers.

The service planned and delivered people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment suitable for the patients in the service. Patients were typically admitted to the ward with acute mental illness, covering psychosis, depression, bi-polar disorder, emotionally unstable personality disorder, anxiety or post-traumatic stress disorder. Care and treatment involved prescribing medicines, therapeutic activities, individual psychology and group therapy. Staff supported all patients to develop a better understanding of their condition. This included support in understanding the reasons why medicines were prescribed and identifying the events and circumstances that could cause a deterioration in their mental health. Some patients attended groups to help them develop their skills for independent living such as shopping and budgeting. Staff also worked with patients to help them manage their condition through using distraction and coping techniques when they felt they were becoming distressed.

Staff delivered care in line with best practice and national guidance. The National Institute of Health and Care Excellence recommends that people with an acute exacerbation or recurrence of psychosis or schizophrenia should be offered oral antipsychotic medication in conjunction with psychological interventions. Records showed that care and treatment was consistent with this guidance. In addition to providing medicines and psychology, the service provided therapeutic activities and support with the skills, facilitated by an occupational therapist and activity co-ordinator. Doctors ensured they stayed up to date with guidance through engagement with the Royal College of Psychiatrists and the National Association for Psychiatric Intensive Care Units.

Staff used technology to support patient care. At the time of inspection, this included video calls with relatives during meetings about patient care.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. The service conducted monthly audits of medication, patients’ records, observations and engagement (including a review of CCTV). The service had scored above 85% for all these audits. The service also conducted a quarterly hand hygiene audit and a quarterly simulation of an incident involving resuscitation.

Managers used results from audits to make improvements. For example, when the service scored below 85% in an audit, the audit was repeated until sufficient improvements had been made.

Staff held regular multidisciplinary meetings to discuss patients and improve their care. Each patient was reviewed by the full multidisciplinary team at least every two weeks. The responsible clinician, ward doctor, nurse, occupational therapist and activity co-ordinator all attended the meetings. At these meetings, staff reviewed the patients’ progress and the effects of medication.

Staff made sure they shared clear information about patients and any changes in their care, including during handover meetings. Nurses and healthcare assistants held a handover meeting at the start of each shift. The multidisciplinary team met each day to review risks and incidents.

Ward teams had effective working relationships with other teams in the organisation. Communication across the hospital worked well. A meeting for senior staff across the hospital was held each morning, typically lasting for half an hour. At this meeting, staff shared information about staffing, maintenance, incidents, enhanced observations, patients’ physical health, safeguarding, discharges, referrals and plans for the day. Discussions in this meeting were calm and friendly. Everyone in the meeting was fully engaged in the conversations and gave their feedback.

Ward teams had effective working relationships with external teams and organisations. For example, the wards had regular contact with the independent advocacy service. Managers also worked closely with bed managers in NHS trust’s that placed patients at the service. In particular, the ward had regular contact with the bed managers at a trust that had block booked nine beds on the ward. Bed managers were invited to multidisciplinary team meetings every two weeks to discuss the progress of, and plans for, their patient.

The service supported people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff identified patients’ physical health needs and recorded them in their care plans. Staff conducted checks of each patient’s pulse, temperature, weight, height and blood pressure each week. Staff wrote up detailed progress notes for each shift covering patients’ compliance with medication, food and fluid intake, personal hygiene and sleep.

Staff made sure patients had access to physical health care, including specialists as required. Patients were seen promptly by a doctor when they felt unwell.

Staff continuously monitored patients’ health, their mental state and well-being. At twice daily handover meetings, staff noted details of patients’ sleep, food and fluid intake, personal hygiene, compliance with medication, and engagement in activities. Any changes in a patient’s presentation were discussed at the daily multidisciplinary team meeting.

Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes. For example, doctors used the Global Assessment of Progress to measure patients progress and outcomes. The Glasgow Antipsychotic of Side-Effects Scale (GASS) was used to measure any adverse effects of medicines.

The service told people about their rights around consent and respected these when we deliver person-centred care and treatment.

Staff assessed each patient’s capacity to consent to admission and treatment on admission. Capacity was monitored and recorded at multidisciplinary team meetings. Records showed that these assessments covered the four elements of capacity.

If a patient was detained under the Mental Health Act 1983, the arrangements for their detention and treatment were consistent with the requirements of the Act and accompanying code of practice. Staff supported patients to understand how the Mental Health Act applied to their situation and that patients understood their right to appeal.

When staff felt a patient may have lacked capacity to make a decision, staff provided support. For example, if a patient was thought to lack capacity to consent to treatment, staff explained why the treatment was important, how they would benefit from it and described any possible side-effects.

Staff engaged with patients’ families to understand each patient’s history and interests.