Cygnet Nield House

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 reviewed all 7 quality statements in the well-led key question. This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last inspection we rated this key question as Requires Improvement. At this assessment the rating has changed to Good.

Managers had a good understanding of the service and a clear overview of service performance. They were able to describe risks and challenges the service faced as well as actions to address them.

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.

Staff knew and understood the provider’s vision and values and how they were applied to the work of their team. Staff told us that these were reflected in the work they did with patients, and that the organisation’s values were included as part of the service’s appraisal structure.

The provider had stated organisational values, vision, purpose and mission. The organisation’s values were integrity, trust, empowerment, respect and care. These were described and discussed as part of the staff induction programme.

Managers we spoke with had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service. Staff generally found managers approachable and supportive. Managers we spoke with demonstrated a good understanding of the challenges their services faced and were able to describe plans to address them.

Leaders and managers in the service had access to leadership and development training. Managers we spoke with had either completed, or were in the process of completing management training. Senior managers were supported by the wider organisation, such as by finance, human resources and facilities.

Staff generally felt confident to raise concerns, and would usually approach a senior member of staff or manager. They knew who their Freedom to Speak up Guardian was or how to find this information. Although staff felt able to raise their concerns, they did not always get feedback about what had happened with the information they had shared.

The provider had a Freedom to Speak Up (FTSU) and whistleblowing policy. Staff could contact the Freedom to Speak Up Guardian, or the local FTSU champion. The FTSU Guardian had visited the service.

The provider carried out an annual staff survey. The response rate for this service was 68%, and confirmed staff were aware of the FTSU Guardian. Managers created an action plan following this survey to address key areas.

Staff were aware of equality and diversity ambassadors within the hospital. Staff could apply for flexible working arrangements, within the scope of working in an inpatient service.

The provider had staff networks for equality, inclusion and diversity; a multicultural network; an LGBT+ network; a women’s network; and a disability network. These were accessible to all staff, and were included in the corporate induction workbook.

Managers were able to describe the governance and reporting structure at ward and hospital level as well as the quality and assurance processes in place with commissioning bodies. Leaders and senior managers demonstrated a good understanding of the issues and challenges faced by the service.

Staff understood their roles and responsibilities. They were able to describe how different roles and professions within the multidisciplinary team worked together to deliver care and treatment.

Managers led a monthly governance meeting where information about the service was monitored and discussed. Managers implemented the provider’s annual audit schedule, and reported and took action from the findings in the monthly governance meeting. Actions from previous meetings were followed-up, and there was feedback into and from the regional and corporate governance process. This showed that action was taken in response to concerns, or where improvement was required.

Managers maintained a risk register for the hospital. This identified potential risks within the service, and actions that had been or needed to be taken to remove or mitigate against them. This was a live document, and included previous risks that had now been addressed.

Staff had access to a suite of policies, procedures and operational guidance to support them in the delivery of care. Staff could access further support from hospital and provider level teams and specialists where required.

We did not get any specific information or concerns from patients and carers about partnerships and communities. Many patients lived in different parts of the United Kingdom, and had their care commissioned by health organisations in their home area.

Managers described positive relationships with key external stakeholders including commissioning bodies.

Patients were admitted to the ward from across the United Kingdom, so their support was provided by different care teams from their home area. Staff told us they generally had good relationships with each patient’s local care team, but that the level of engagement from the teams varied.

The local host commissioners requested feedback from commissioners for each patient on the ward, in order to any identify any themes and trends, or areas of positive or concerning practice. The hospital managers and local host commissioners met every 3 months, and reviewed information submitted by the managers. No issues were raised about this quality statement.

Patients were from across the United Kingdom, so needed to have access to physical health services in the hospital’s area. Patients were registered with one of 4 GP practices in the local area, and remained with the practice throughout their stay in hospital.

The local host commissioners had oversight of and met regularly with the provider. This included representatives from commissioners of patients’ care packages, and the local authority safeguarding team.

Manager told us that improvements to the service had been made following feedback from patients and staff. This included bringing in a person with lived experience of mental health services to meet with patients and raise awareness with staff; the development of a patients’ kitchen for food preparation and cooking (although this was temporarily closed) and a sensory room; and improvements to the Ada suite where patients received nasogastric feeding.

Staff we spoke with were up to date with their mandatory training. Staff were able to access additional training that was relevant to their role if they wished.

Learning from incidents was disseminated to staff within morning meetings and via email.

The provider had a corporate quality improvement (QI) handbook. The handbook clearly described how to carry out a QI project, using recognised approaches.

The service had focused on learning from incidents to improve care for patents.