Cygnet Hospital Harrow

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence on how the service provided was well-led. During an inspection in May 2023, we rated this key question as inadequate. At that inspection, the service was in breach of regulation 17 (good governance). At this inspection, the rating has changed to good. The service had made improvements and is no longer in breach of regulations. The service had taken action to improve its governance and oversight systems. 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 had a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and communities.

Significant changes had taken place at the hospital since the inspection in May 2023. A psychiatric intensive care unit was scheduled to be opened shortly in an adjacent area of the hospital.

Leaders now had a shared direction that made sure each individual person was at the centre of their support when decisions about their lives were being made. Closed culture risks were identified, assessed and mitigated. Following the inspection in May 2023, staff underwent performance exercises to ensure they were suitable to work on the wards.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. Patients and carers were involved in decision-making about changes to the service. The provider’s senior leadership team had communicated the provider’s vision and values to the staff and to people who use the service, through a variety of events. For example, there was a summer BBQ where patients, carers and staff were invited to attend. It promoted all the work at the hospital. One cabin displayed the building plans for the wards and all the finishes for the different wards.

The service had inclusive leaders with the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

Staff told us that the hospital had received enhanced support and investment from Cygnet Health Care after the CQC rated the hospital as inadequate in 2023. This included the transfer of a new hospital director. Staff and patients told us that the hospital director was visible throughout the service, approachable and engaged well with staff and patients. Managers said that this support had enabled the hospital to improve.

Senior leaders were skilled, experienced and knowledgeable. They had a strong understanding of the services they managed. They could explain clearly what improvements had been made in the Springs Service following inspections in May 2023 and February 2024. They could explain clearly how teams were now working to provide good quality care.

The ward manager in Springs Centre had been in post since 2018. They were skilled, knowledgeable and experienced. Staff told us that they found the ward manager approachable and knowledgeable. The ward manager of Springs Wing had recently left the service, and the role was being filled by a team leader. The team leader enjoyed this leadership development opportunity, and had the skills, knowledge and experience to perform the role well. Staff spoke highly about them coming into post.

At the time of the inspection, the posts of clinical services manager and deputy services manager were vacant. This meant that the ward managers were directly managed by the hospital director. The hospital director had experience of managing and leading improvements at similar hospitals.

The service assigned a senior member of Cygnet Health Care to the role of Freedom to Speak Up Guardian. Information on how to contact the Freedom to Speak Up Guardian was displayed in the nurses’ offices. Staff said they felt confident in raising concerns about poor professional practice or inappropriate conduct towards patients.

The service worked towards an inclusive and fair culture by improving equality and equity for people who worked there.

The hospital had a variety of support networks set up for staff. These included a multicultural network and a network for lesbian, gay, bi-sexual and transgender staff.

The service employed a diverse team of staff from international backgrounds. Employment practices promoted equality of opportunity. Managers said the service did not discriminate against staff from minority groups. Staff did not raise any concerns about discrimination.

The service had clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support.

We found that the service had made considerable improvements in the governance and oversight of the hospital since the inspection in May 2023.

The service carried out three types of governance meetings, which included meetings for clinical governance, heads of departments and ward staff. There was a clear framework of what must be discussed at a ward, team or directorate level in meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level.

Clinical governance meetings were held for the whole hospital. The ward managers from Springs Service attended this meeting. The meeting was chaired by the hospital directors. These meetings covered standard agenda items including safety, training and education, effectiveness, the experience of patients and carers and lessons learned from incidents. Each ward was required to submit a monthly clinical governance report. This meant the service now had more effective monitoring of key aspects of service delivery. Springs Service had improved in this area of work and was now compliant with the previous requirement notices.However, Springs Centre was using a seclusion room for one patient, that was not fit for purpose. This breach of regulation was not detected under this governance process.

The risk register for the hospital included five risks. These were: the risk of ligature incidents, compliance with fire regulations, training for staff, the hospital alarm system and risks relating to building work taking place at the hospital. The risk register included a score for the severity of each risk, actions being taken to address the risk (including immediate mitigation) and timescales for completing those actions.

The role of the expert by experience was fully integrated into the governance processes. The expert by experience visited the hospital, met with patients and facilitated community meetings. They met with the hospital director to give feedback on patients’ and discuss patients’ experiences more broadly. This information was then discussed at the Cygnet Health Care regional governance meeting. This also informed the work of the Cygnet Health Care lived experience advisory group that met four times each year with the Chief Executive and the Director of Nursing.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. For example, there were audits in medicines, risk assessments and care plans, hand washing, and infection prevention control. There were posters in the nursing offices to outline what good practise in patient care records looks like. For example, there were reminders to state where any referenced documents can be found.

The service worked well with other agencies including commissioning bed managers, health and social care professionals and the local authority safeguarding team. Following the comprehensive inspection in May 2023, the provider had set up weekly quality assurance meetings with key agencies to discuss their inspection action plan and progress that has been made and any remaining actions. Commissioners told us they had strong collaborative working with the service and that there had been great improvements made in the service.

Staff engaged with their professional bodies and undertook specific roles within these organisations.

The service focussed on continuous learning, innovation and improvement across the organisation and the local system.

The consultant psychiatrist was the quality improvement (QI) lead for the ward. Staff were given the time and support to consider opportunities for improvements and innovation and this led to changes. There were a variety of QI projects in the service. This included QI projects to achieve a reduction in medication errors by prescribing doctors, to improve the quality of discharge summaries and improving engagement with carers.The service had appointed a service educator to monitor compliance with procedures and improve professional practice across the hospital.

The service participated in accreditation schemes relevant to the service and learned from them. For example, the service was in the process of gaining accreditations in the triangle of care and was about to commence an accreditation in autism friendly services.

Innovations were taking place in the service. The hospital had been involved with an initiative stemming from work with experts by experience and patients. The hospital was one of the provider’s first location to develop a social hub. These are non-clinical spaces off the wards where patients from different wards can meet and take part in meaningful activities. We found the social hub to be a spacious, welcoming and non-clinical space. They were co-produced, designed and installed by staff and patients working together. The provider had analysed data on the use of physical interventions across five locations with a social hub. This data showed a reduction in the use of physical interventions, over time.