The Care Quality Commission
  • Mental Health
  • Independent mental health service

Cygnet Hospital Beckton

Overall: Good read more about inspection ratings

23 Tunnan Leys, Beckton, London, E6 6ZB (020) 7511 2299

Provided and run by:
Cygnet Health Care Limited

All Inspections

11-12 April 2022

During an inspection looking at part of the service

Hooper Ward at Cygnet Hospital Beckton provides psychiatric intensive care for adults of working age. Our rating of this service improved. We rated it as good.

  • The service provided safe care. The ward environments were safe and clean. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented 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. This included prescribing oral antipsychotic medication in conjunction with psychosocial interventions. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards, including nurses, doctors, a clinical psychologist, an occupational therapist and a social work assistant. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged most of their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • 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.
  • Some patients said that the care and treatment they received was good and that staff behaved kindly towards them, although others patients found it difficult to express their views about the quality of care.
  • The service managed access to beds well and patients were discharged promptly once their condition warranted this.
  • The service was well-led and the governance processes ensured that ward procedures ran smoothly. Leaders had clear oversight of the safety and quality of care provided.
  • Staff felt respected, supported and valued. They said the service promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.

However:

  • The service did not have enough permanent registered nurses but was in the process of recruiting to vacancies.
  • Staff did not dispose of all out-of-date dressings and saline solutions in accordance with manufacturer's instructions
  • Documents relating to patients’ care and treatment are were stored in different places and on different systems. The meant it could be difficult to access essential information quickly.
  • Assessments of patients’ mental capacity were not complete on all the records.

18 and 19 January 2022

During an inspection looking at part of the service

Our rating of this location improved. We rated it as good because:

We rated both services that were open at the time of the inspection as good overall. Our overall rating for wards for people with learning disabilities or autism improved from requires improvement to good, as we now rated it good for all five key questions. We rated wards for people with a personality disorder as good overall, although it remained requires improvement for the safe question. The hospital’s acute ward for adult of a working age, which we rated inadequate when we previously inspected it in May 2021, was not open at the time of this inspection. We will inspect this ward again when it reopens.

The hospital had made progress in addressing the concerns identified at previous inspections. This included achieving a reduction in the use of restraint and a reduction in safeguarding incidents. The service was recruiting new staff. The hospital had increased training in managing violence and aggression, training in ward specific skills and training in leadership for ward managers.

Managers and staff had a good understanding of the risks and pressures on the wards. Each ward held a multi-disciplinary team meeting each morning to review any concerns or incidents that had arisen on the previous shifts. These concerns were escalated to the daily meeting for senior staff.

Wards were clean and well-maintained.

On Hansa Ward, staff provided safe, person-centred care. Staff were aware of patients’ needs and could easily access information providing instructions on how to engage positively with each patient. The ward employed a specialist speech and language therapist to improve communication with patients.

However,

Over the last year there were times when the staffing on the wards fell significantly below the minimum required for safe nursing. On New Dawn and Upping Wards, a high number of staff vacancies, high turnover of staff and high use of agency staff had led to unfilled shifts, inconsistencies in care and an increased risk of harm to patients.

Incidents of self-harm continued to occur when patients were on one-to-one observations. The service recognised there needed to be better communication and engagement with patients when staff were assigned to close observations.

13 May and 10 and 11 June 2021

During a routine inspection

Cygnet Hospital Beckton provides gender specific hospital for women with complex mental health needs, including those with learning disabilities and personality disorders.

We undertook this unannounced comprehensive inspection following our focused inspection in March 2021. At the inspection in March 2021, we rated this location inadequate, took urgent enforcement action and placed the hospital into special measures. At this inspection, the rating for this location has improved to requires improvement. The location remains in special measures.

During this inspection we found:

  • The ward for people with learning disabilities, Hansa Ward, did not meet the principles of right support, right care, right culture (CQC). This was because the ward environment was institutional and did not meet patients’ sensory needs and preferences and patients did not have care plans they could understand.
  • Staff did not always undertake intermittent observations of patients according to the provider’s policy. Observation records on New Dawn Ward showed that on three occasions staff observed patients at exactly the same intervals for four or five hours consecutively. There were further examples of staff observing patients at the same time for two hours consecutively. Intermittent observations should have been carried out at unpredictable intervals so that patients could not plan risky behaviour when staff were not observing. On Hansa Ward, an incident following the inspection showed that a staff member had recorded intermittent observations of a patient but they had not been carried out. Patients on New Dawn Ward said that staff did not always carry out intermittent observations.
  • Patients with a learning disability on Hansa Ward did not have easy-read care plans. This meant patients may not be able to understand the content of their care plan.
  • The environment on Hansa Ward was not therapeutic. The corridors were long and bare and sounds echoed and carried to other parts of the ward. The environment did not support patients’ sensory needs. However, there were plans to redesign the ward later in 2021.
  • Only some staff on Hansa Ward had knowledge of STOMP (stopping over-medication of people with a learning disability). This meant some staff were unaware of how to ensure minimal prescribing of psychotropic medicines.
  • On New Dawn Ward, patients and the advocate said that the ward manager did not welcome complaints and concerns they raised were not acted upon.
  • Whilst the provider had undertaken a strong recruitment drive and recruited to many vacant nursing posts, there were still a significant number of vacant support worker posts. For example, on Upping Ward there was a 49% vacancy rate for registered nurses. Three of the six vacant posts had been recruited to.
  • Patient's relatives and carers were not consistently contacted by ward staff or involved in patients’ care and treatment.

However:

  • Staff had an exceptional and sustained focus on the physical health care of patients. Physical health interventions exceeded those recommended in best practice guidance. A wide range of actual and potential patient health care needs were addressed, from seizure management and pressure ulcers to incontinence, falls, mouthcare and footcare. Nursing staff were trained to undertake 12-lead electrocardiograms and training on foot care was planned. There were very effective links with primary care, the local mental health trust and other specialists, such as a specialist dentist for people with learning disabilities.
  • Staff communication with patients was supportive and respectful. Staff were compassionate, respected patient choices, and demonstrated a non-judgemental attitude.
  • Patients’ care plans were person-centred and holistic. They addressed all of the patients’ identified needs.
  • The relaunch of the least restrictive practice programme had led to a reduction in incidents of restraint. All staff had been trained in restraint techniques. CCTV showed that staff spent considerable time attempting to defuse incidents without use of restraint. When staff did restrain patients, they used authorised techniques for the shortest time possible.
  • There was a strong focus on learning from incidents. Learning was advertised in a newsletter for staff, discussed at ward business meetings and at hospital clinical governance meetings. Incident reporting had improved in terms of the quality of incident reports and previous under-reporting of incidents had been addressed.
  • Staff had undertaken skills-based training specific to the patient group on the ward they worked. Bank and agency staff also attended this training.
  • There was a robust system to ensure that staff followed the requirements of the Mental Health Act, including regularly informing patients of their rights.
  • There were good systems for infection prevention and control and sufficient stocks of personal protective equipment.
  • There was a strong focus, at hospital management level, on engaging with and supporting patients’ relatives and carers. This included a carers support group, co-production, a carers newsletter, and a carers strategy.
  • There was a strong and effective governance system to monitor safety and the quality of care provided to patients. Patient risk assessments, complaints, safeguarding referrals, staffing and recruitment and incidents were all carefully reviewed at hospital governance meetings.
  • The hospital’s local leadership team had the knowledge, skills and experience to drive improvements in safety and quality.

1, 3 and 8 March 2021

During an inspection looking at part of the service

We undertook this focused inspection of the psychiatric intensive care unit and the ward for patients with learning disabilities, following four incidents of the alleged abuse of patients by staff. The service had informed us about these incidents.

We did not inspect the two wards for patients with a personality disorder during this inspection. Due to the overarching concerns we have about the hospital, we have suspended the ratings for personality disorder services.

Following this inspection, the Care Quality Commission took urgent enforcement action under section 31 of the Health and Social Care Act 2008. This means there are a number of conditions on the provider's registration, including that the hospital cannot admit any patients.

Letter from Professor Ted Baker, Chief Inspector of Hospitals:

'I am placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.’

We found:

  • There had been four serious incidents between December 2020 and February 2021 which had raised concerns about the potential abuse and poor care of patients. The service had informed us about these incidents. One incident on the psychiatric intensive care unit and two incidents on the ward for patients with learning disabilities demonstrated unacceptable care practice. We saw evidence of unjustified restraint, the use of unauthorised restraint techniques, seclusion without appropriate safeguards and the apparent physical abuse of a patient by staff.
  • We also randomly reviewed closed circuit television (CCTV) of a further two incidents on each ward. One of these incidents showed staff using unauthorised restraint techniques, which could have caused the patient significant harm. We had also been informed by the provider of a further incident where staff had locked a patient out in the ward garden for at least 20 minutes following an aggressive outburst. This happened in February 2021 when the weather was cold. CCTV footage was not available of this incident.
  • Staff were not reporting serious incidents in line with the providers policies and procedures. Staff had not raised any of the above incidents of the use of unauthorised restraint techniques, seclusion without safeguards or alleged abuse, with managers. Managers learnt of three incidents following complaints from patients. The fourth incident was identified during an investigation into a patient injury. Having heard about the serious incidents described above, the management team had not reviewed CCTV of all other incidents on the wards in order to assure themselves of patient safety.
  • The closed-circuit television system was outdated. It was hard to review CCTV footage and images were not saved for 28 days. This meant that the provider might not be able to check the footage for serious incidents. Random reviews of CCTV footage by ward managers had been introduced but did not always take place as planned.
  • Registered nursing and support worker vacancies led to the high use of agency staff who may not know the individual needs of the patients and how to meet their complex needs. The vacancy rate for registered nurses on the psychiatric intensive care unit was 66%, including two team leader posts. The vacancy rate for support workers on both wards was 50% although the number of support worker posts had recently been significantly increased to provide more permanent staff and consistent care. Also, the hospital manager had ensured there were very few registered nurse vacancies on Hansa Ward which is the ward for people with a learning disability. This was due to the specific needs of patients and the need for consistency of care. The manager also tried to use long-term agency staff where possible.
  • Safe staffing levels were not always maintained on the wards. There were a number of shifts, over a period of three months, when both wards were below their current minimum safe staffing levels. In addition, the current staffing levels at night were not sufficient. Four staff were allocated to each ward at night. This included if one patient required continuous observation by staff. With staff breaks, this meant there were insufficient staff on the wards to keep patients safe at night if, for example, staff needed to restrain a patient.
  • Senior leaders in Cygnet Health Care had not sufficiently addressed the ongoing challenges of the recruitment and retention of registered nurses. The number of vacancies of registered nurses in the hospital had been on the hospital risk register since November 2018. The hospital manager had repeatedly raised this with senior managers, including suggested solutions. The provider’s senior managers had not taken effective action in a timely manner to address this.
  • Ward managers and team leaders had not had access to appropriate leadership training to support them to carry out their roles to a high standard. This had been raised by the hospital manager since November 2019. The hospital manager had not been supported by senior managers to put these learning and development opportunities into place in a timely way.
  • Feedback from patients, the patients' advocate, and relatives was mixed. They said staff could be rude, relatives were not always involved in patients' care and treatment, and some patients felt neglected and ignored. However, approximately half of the patients’ relatives we spoke with were very positive regarding staff and their involvement in patients' care and treatment.

However, we also found:

  • The hospital management team informed the local safeguarding team, CQC and the police, following incidents of alleged abuse.
  • There had been a relaunch of the least restrictive practice programme to ensure patients did not have unnecessary restrictions placed upon them.
  • The hospital manager had identified gaps in the care provided to patients. Regular night visits by hospital managers had been introduced.

Shortly after this inspection we received two further allegations of poor treatment of patients on the psychiatric intensive care unit and the ward for patients with learning disabilities. These allegations were referred to the local authority. One of the allegations was not upheld following a safeguarding investigation. A safeguarding investigation of the other allegation was ongoing when this report was published.

11 and 12 November 2019

During a routine inspection

We rated Cygnet Beckton as good because:

The hospital provides mental health services for females across four wards for psychiatric intensive care, personality disorders, forensic and learning disabilities and autism.

  • Staff worked hard to provide safe care in most areas across the hospital. The ward environments were safe and clean. Hooper (psychiatric intensive care unit), New Dawn (specialist personality disorders) and Hansa (learning disabilities and autism) wards had enough nurses and doctors to meet the needs of patients in their care. Staff across the hospital assessed and managed risk well. Staff participated in the providers reducing restrictive practice initiative that championed the use of anticipating, de-escalating and managing challenging behaviour. Staff followed good practice in protecting patients from abuse after the provider improved the service’s safeguarding system. Staff on Hansa Ward knew about and worked towards achieving the aims of the stop over-medicating people with a learning disability programme.
  • Staff across the hospital developed holistic, recovery-oriented 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. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. This included consultant psychiatrists, occupational therapists and psychologists. Staff worked well together as a multidisciplinary team to provide effective care and treatment to patients.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. Staff participated in patient involvement programmes such as the Peoples Council and ‘Safewards’ to empower patients and staff to collaborate in their care and treatment.
  • Staff involved patients in decisions about the service. Patients co-produced the hospital newsletter, outlining what activities and projects the hospital was hosting.
  • Staff ensured that patients had good access to physical healthcare and supported patients to live healthier lives. Staff supported patients with their social and educational wellbeing. The service had a gym onsite that all patients could access. In addition, patients used the hospital’s recovery college to enrol on courses about mental health and wellbeing.
  • Staff supported patients to make decisions on their care for themselves.Staff understood the principles of the Mental Capacity Act 2005, assessed and supported patients who might have impaired mental capacity. Staff made sure they could explain patients’ rights to them under the Mental Health Act 1983.
  • The service was well-led and the governance processes ensured that ward procedures ran smoothly. Staff engaged actively in local and national quality improvement activities. There was a great commitment towards continual improvement and innovation. The service had been proactive in capturing and responding to patients’ concerns and complaints. There were creative attempts to involve patients in all aspects of the service.

However:

  • Although medicines were stored and administered safely, improvements were required on Hooper Ward to oversee the administration of medicines and the implementation of action to prevent medicines errors. We found staff had made two similar errors in the dispensing of the same patient’s ‘as required’ medicine and given over the prescribed amount in a 24-hour period. This meant the patient had been overmedicated and could lead to physical health complications.
  • Staff did not always ensure that physical health monitoring of patients’ vital signs was undertaken after every use of rapid tranquilisation, record physical health observations accurately for patients, and seek medical advice when indicated.
  • Not all patients had access to an alarm to call for help should they need it in an emergency. The provider had installed some on each ward and patients who were deemed at risk of needing to call for help more than others were given these bedrooms. However, staff did assess the risk for patients on most wards and said they would give alarms to patients if they needed one. Not all patients knew about this.
  • Staff on Hooper Ward imposed a blanket restriction on patients. Staff locked away snacks from patients and this was not based on individual patient risk.
  • Staff did not always respond to complaints in a timely manner. This meant complainants may not know what stage their complaint was at.

14-16 March 2017

During a routine inspection

We rated this service as good because:

  • During this most recent inspection, we found that the services had addressed the issues that had caused us to rate safe and effective as requires improvement following the July 2015 inspection.
  • Following the last inspection in July 2015, we also made a number of recommendations for the service to consider improving. At this inspection we found that these improvements had been made.
  • The hospital provided good care in challenging and complex circumstances. Staff sought to minimise incidents of self-harm, aggression, violence and other challenging behaviour in a caring and supportive way.
  • Staff consistently responded to patients with care and compassion. They said that morale within their teams was good and that they felt supported by their managers.
  • Staff knew which patient safety incidents to report and how to report them. Senior managers monitored incidents through the clinical governance process. Through this monitoring, managers looked for trends and ways to reduce the number of incidents.
  • The service had introduced a programme to reduce restrictive practices. As a result, patients had unrestricted access to dining rooms, activity areas and quiet rooms. Patients were also now able to make hot drinks whenever they wished.
  • Senior managers demonstrated a strong culture of seeking improvements to the service.
  • Staff assessed risks to patients using standard risk assessment tools. Staff updated risk assessments during patients’ admission, either at regular multidisciplinary team meetings or after incidents.
  • The services used evidence-based therapies to work with patients across the wards.
  • Cygnet Health Care had appointed an Expert by Experience Lead. At this hospital, they had established meetings to promote the views of patients across and facilitating further service user involvement.
  • The hospital had achieved national quality accreditation for the psychiatric intensive care unit, the forensic ward and the ward for people with learning disabilities.

28-31 July & 25 August 2015

During a routine inspection

We rated Cygnet Hospital Beckton as requires improvement because:

  • The provider had not identified in its risk assessments, all the points where a ligature could be tied. Where it had identified potential ligature points and work was required, the provider had not set dates when this would be completed.
  • For two patients, the assessments completed prior to their admission were either not available, or had not been considered by staff when developing initial risk assessments along with the measures required to manage or mitigate the risks. One patient on Hooper ward did not have areas of the care plan that addressed their holistic needs and two care plans for patients on Bewick ward did not contain their views on their care and treatment.
  • Staff could prevent patients from leaving the de-escalation room on Hooper ward. Staff did not recognise that this constituted seclusion and did not provide patients with the proper safeguards. Staff had not recorded some incidents of restraint properly and had not carried out some of the checks required after rapid tranquilisation of patients. The provider monitored the use of restraint but staff were not able to identify trends in the use of restraint.
  • Staff had not recognised a significant safeguarding concern at the hospital and had not followed appropriate safeguarding procedures. The provider did not have robust systems to share learning about incidents and complaints between wards.
  • Not all staff understood how to apply the Mental Capacity Act or the circumstances when a capacity assessment would be appropriate. The provider did not have robust systems in place to ensure that they were using the Mental Capacity Act appropriately.
  • Staff had not administered all medicine appropriately and within the prescribed guidelines. For some patients, staff had not addressed how they were meeting  physical health care needs in care and treatment records.
  • When some patients received rapid tranquilisation, staff had not appropriately monitored their physical health afterwards. New Dawn one and two shared an emergency grab bag which may have resulted in delays in an emergency.
  • On New Dawn ward not all nursing and support staff had received dialectical behavioural therapy training. The provider did not have figures for the numbers of staff who had completed this training and patients commented that nurses and support staff did not understand their needs or the necessary therapeutic approach.
  • Some patients on Hooper and Hansa wards were not able to access drinks and snacks without having to ask staff to open the dining room.

However:

  • Wards were clean and well maintained. The provider maintained safe staffing levels and staff had access to personal alarms. Staff completed appropriate mandatory training.
  • Patients were able to access a range of psychological therapies and the multidisciplinary team included an appropriate mix of disciplines.
  • We observed positive interactions between patients and staff. Staff were caring and respectful of patients’ needs. Overall, patients spoke positively about staff and felt they were friendly. Staff had a good understanding of patients’ individual needs and projected a caring approach when discussing patients.
  • Staff held regular community meetings on each ward. Patients were also able to participate in staff recruitment and quality improvements within the hospital and feed back on the care and treatment they received.
  • Overall, staff provided appropriate activities on the wards. Patients had unrestricted access to outside areas and a range of communal spaces were available on each ward. A range of meals were available to meet patients’ dietary requirements. Staff could support patients to access spiritual support. Staff could request interpreters, if required.
  • Line managers supported staff appropriately. Managers at different levels had oversight of incidents, complaints, supervision and appraisals. The provider met targets for a range of key performance indicators. Staff undertook audits, with actions identified and followed through.
  • Sickness rates were low and overall staff morale was good. The hospital had developed a values-based recruitment process and recruitment to vacant posts was on-going. The hospital was part of the accreditation for inpatient mental health services (AIMS) and was an “investor in people”, an independent framework to promote leadership, support and good management of staff.

15 May 2013

During an inspection looking at part of the service

People were referred to the hospital from a number of different health trusts and organisations throughout England. We found people's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Staff told us they often do not get enough information in the initial referral and would have to send a follow up email to get more information before a decision could be made. They said dates and times of admittance were agreed in advance.

The hospital manager told us at the time of the last inspection they were piloting a new care plan form titled 'my shared pathway' which allowed for more information to be documented.

The hospital manager told us that all staff including temporary staff received a comprehensive induction. We were told an induction form was completed for all staff which they signed and kept a copy for their records. Staff we spoke to confirmed this.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. One person we spoke to told us they had made numerous complaints and were not always happy with the response or outcome but that did not stop them making other complaints.

19 December 2012

During a routine inspection

Patients had mixed reviews about the service. One patient said, 'the place is ok, sometimes staff just hear, but don't really listen." Another patient said, 'I like it here, Its just one person who makes too much noise and is always picking on everyone." whilst another person said, "on the whole care is ok."

Patients were assessed before they were treated. Care plans were reviewed as people's conditions changed. There was evidence of involvement of patients in planning care. There were advocacy services available and these were accessed by patients regularly. We found that records that related to patient care were not always accurate as they did not reflect the input we observed and the input described by staff. Other records for the management of the service were up to date.

Patients were cared for by staff that were trained and had been recruited appropriately. There was evidence that staff renewed their professional registration and that staff had been asked to do a criminal records bureau check before they were employed.

We found that medicines were stored and administered safely and patients knew when they took their medication. Staff had been trained and were able to administer medication safely.

Equipment was clean and staff were able to use them. There was equipment available to promote the comfort of the patients. One patient said, "this my home for now. I don't mind it as staff are ok. My room is very nice and I brought in my personal items."

9 January 2012

During a routine inspection

Overall people we spoke to told us that they were happy with the arrangements that were in place to meet their needs and that the hospital compared favourably to other hospitals they had experienced. We received comments about the hospital that included: 'The staff explained things to me when I arrived here'. 'The staff are nice and it makes such a difference'. 'The hospital is run properly and the staff do a great job'.

We visited Cygnet Hospital Beckton was a planned routine inspection which was intended as a follow up to the previous inspection where concerns had been identified. We found that improvements had been made in all areas that we followed up.

19 January 2011

During a routine inspection

Please note: Asterisks **** are used throughout this report so that patients cannot be identified from what they told us.

We found that patients had mixed opinions about the hospital and their experiences of the treatment and care that they had received from Cygnet Hospital Beckton. All patients are detained under a section of the Mental Health Act and comments are considered in the context that treatment and care is of a compulsory nature.

On commenting about care planning processes patients said:

'Yes, I am aware of what my aims and goals are. These are worked with by staff and I am moving on soon.'

'I have things to work on but I am struggling with things. I'm not happy with the move on place' ('step down' accommodation).

'I have clear objectives, my CPA is on *** and I will be moving to the other side of (the ward).'

Another patient felt that she knows what she is to work on as she works towards her discharge. 'I don't find it easy to contribute to my care plan. I have ***** issues and feel ashamed, but I'm not given space to say what I think about this. I feel I have become institutionalised.'

'I don't agree with all the areas in my care plan and I signed it to state that'.

On staff attitude and helpfulness patients said:

'Staff are okay. If they're busy they ignore you. They spend a lot of time doing paperwork. Should have 1 more nurse ' 4 instead of 3'. 'Some staff are helpful, some can be a bit rude and abrupt'

'The staff are professional and there are no concerns at all'.

On therapeutic activity patients said:

'I have to wait until my therapist is here so sometimes I don't see him for 2 weeks because he can be busy on the ward. It's a strict regime once we do it.'

'They are going to start groups at the weekend but there haven't been any yet'.

'I found the psychology sessions very helpful', another stated; 'The rehabilitation and recovery group really enabled me to sit by and think carefully ' given my behaviour before'.

One patient told us that she had been to the cinema recently. Another patient told us; 'I enjoy the mental health awareness group, as we discuss medication and the next steps in moving on'.

On the use of restraint patients told us:

'Some staff are rougher than others', the patient went on to name the two ward staff who she said are known for being rough. 'I have never had a meeting after restraint to talk about it.'

Another patient said 'The atmosphere is not good on the ward, it's hostile because of different patients. I don't feel safe anymore. There's violence on the ward, nurses get attacked and one had her head bashed on the wall'.

'They bend my wrists back and my wrists hurt for hours or the day afterwards'. 'It's better here than in other places' she added.

'Once I had calmed down the staff spoke to me about the incident. I think their actions made me safe'.

On the management of physical conditions patients told us:

'The other week I ***** and was so weak that staff had to stop me from ******. The doctor was called but they didn't come to see me. I had to wait until the next day- the ward doctor took ages to come. I suffer from *****, it isn't worked with here.'

'I need a dentist check up. I mentioned it to a doctor, (ward doctor) who said to mention it in the ward round. I spoke to a ward doctor about seeing an optician who said the same as before'.

Another patient said they had **** ***** 'a while ago'. 'Sometimes it plays up, I could hardly move and was taken to hospital. The doctor said she couldn't give me painkillers because she didn't know enough about my antipsychotics. The doctor here didn't give me painkillers because she said it was out of her area of expertise'. 'I am still on my own with this.'

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.