Cygnet Hospital Beckton

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• 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

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 good. At this inspection the rating has changed to requires improvement. We found a breach of regulation in relation to governance. This meant the service was not always consistently managed and well-led. However, leaders and the culture they created promoted high-quality, person-centred care.

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This service scored 62 (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 which people could contribute to and ensured that it promoted equity, diversity and inclusion.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Provider’s values were displayed throughout the hospital and were part of new starters’ induction and mandatory training for staff. Supervision records contained sections about the values and how the work of staff reflected these. Staff said there was a positive and supportive listening culture involving staff and patients where learning was shared.

Staff had the opportunity to contribute to discussions about the strategy for their service, including when the service was changing. Available forums included reflective practice sessions, staff relation group meetings, access to Freedom to Speak Up ambassadors and guardians, quality improvement meetings and staff surveys. Experts by experience visited the hospital weekly to provide peer support to patients, participated in people’s council meetings and contributed to improvement ideas. For example, a social hub was developed after the expert by experience lead explained that hospitals with social hubs see reductions in incidents. This was a permanent space away from the immediate ward environment and patients had been involved in choosing activities for it. Leaders created actions from staff feedback and monitored their progress for completion.

Staff and leaders gave examples of how equality and diversity was actively promoted within the service. There were policies in relation to equality and diversity, and most staff and leaders had completed their promoting human rights training. Staff had access to equality networks and told us the service organised events for staff and patients which celebrated diversity. The provider collected data through the Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) at a national level, but we did not see proactive discussions or actions related to findings from these reports.

The service had leaders who understood the context in which it operated, with the appropriate skills, knowledge, experience and credibility to lead effectively.

The hospital’s leadership team had been relatively stable, with a clinical services manager post dedicated to the acute and PICU wards.

Leaders were usually knowledgeable about issues and priorities for the services they managed. They held regular meetings where information about the services was shared. A patient we spoke with told us they could speak with senior staff when needed. Most staff we spoke with said leaders were visible in the service, however 2 staff felt that leaders could be more present. Four out of 8 carers we spoke with felt it was not always easy to talk to staff or managers when needed. Two staff told us they had raised issues through Freedom to Speak Up but felt no action had been taken. At the same time, staff reported a friendly, open and supportive culture between colleagues and the leadership team. For example, one staff member told us about the support they received from their manager and colleagues after an incident they were involved in.

Most staff we spoke with said the provider offered good opportunities for training and development. For example, staff had access to management development programmes to support their career progression. Some leaders previously worked for the provider in other roles before progressing to their current positions.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service did not always have effective systems and processes in place to ensure areas of risk and improvement were identified and mitigated in good time.

Staff undertook local clinical audits and participated in the provider’s corporate audits. The provider’s quality assurance team carried out additional audits and checks. Although staff completed audits and leaders reviewed their findings, this did not always result in improvements being made. For example, the post-rapid tranquilisation (RT) audits had identified some gaps in relation to how patients were monitored following RT, however we found a number of shortfalls in this area described in other sections of this report. Following our feedback, leaders submitted an action plan in response to our concerns and told us that they have reviewed the audit process to check that physical health observations were carried out following RT. Issues around consent for medicines administration and the lack of Independent Mental Health Advocacy (IMHA) provision had also been highlighted to the service previously, but had not resulted in actions to address these.

Senior staff explained the regular processes which were in place to ensure all necessary staff employment checks were completed. However, we observed gaps within the most recent employment checks audit. A recent change in the provider’s systems had caused issues with the data and although leaders provided verbal assurance of these checks, we were concerned the service was unable to demonstrate evidence of a robust system to ensure all necessary information was in place as required.

Staff told us the provider’s estates team actioned maintenance requests promptly. Staff said the service did not keep a log of these requests and it was not always clear if they were completed. After our inspection, the provider sent evidence of a maintenance log which was held and updated by the maintenance staff.

However, some governance processes worked more effectively. The service maintained a risk register and staff could escalate concerns when required. Most staff concerns matched those on the risk register. The service had an up-to-date business continuity plan which outlined actions in emergencies to ensure business processes could continue. The service submitted notifications to external organisations as required.

Leaders were mostly aware of areas where improvements could be made. For example, leaders had identified violence and aggression as a common type of incident on the wards and introduced crisis resolution training for staff to help mitigate this. Staff told us it had been effective in helping to reduce the number of these incidents. Leaders were prompt in addressing some of the risks we identified during our inspection.

The service had a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information was shared and discussed. Lessons learnt and performance were on the agenda of staff meetings.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. Staff involved other providers when required, including GP, dentists, hospitals and care coordinators. The service had a reducing restrictive practice policy and involved patient representatives and experts by experience in reviewing restrictive practices in use.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.