Cygnet Hospital Beckton

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

This means we looked for evidence of a positive culture, service leadership, and effective governance and management systems.

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 consistently managed and well-led. However, leaders and the culture they created promoted high-quality, person-centred care.

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 that was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of patients and their communities.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. 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. Leaders created action plans from staff feedback and monitored their progress for completion.

Experts by experience were well embedded into the ward and were involved in collecting patient feedback and service development. The social hubs had been developed as a permanent space based on the idea and vision of the expert by experience lead.

Staff and leaders gave examples of how equality and diversity was actively promoted within the service. Staff had access to equality networks, and organised events for staff and patients which celebrated diversity. There were policies in relation to equality and diversity, and most staff and leaders had completed their promoting human rights training. 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 inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively and did so with integrity, openness and honesty.

The leadership team had been relatively stable, and a clinical services manager role dedicated to the personality disorder services was created during a staffing restructure. Leaders were knowledgeable about issues and priorities for the quality of services. For example, they had started a quality improvement project about safe practices which focused on 3 areas they had identified for improvement: record keeping, searches and least restrictive practices. They planned to roll out quarterly workshops to all staff starting from early 2025.

Leaders had a good understanding of the services they managed. They held regular meetings where information about the service was shared, and some leaders attended ward community meetings with patients. Most staff we spoke with said leaders were visible in the service. Patients felt leaders and staff were approachable. One staff member we spoke with expressed their gratitude towards leaders for the compassionate support they provided during a difficult time in their personal life. All staff reported a friendly, open and supportive culture between colleagues and the leadership team.

Most staff we spoke with felt there were good development opportunities.

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 or participated in local clinical audits and services were also reviewed by the provider’s quality assurance team. Leaders monitored compliance rates of audits during monthly clinical governance meetings, but these oversight processes did not always ensure effective mitigation of some risks. For example, the ligature risk assessment in April 2024 had identified a blind spot on Upping Ward that required a CCTV camera to be installed, but this had not been installed at the time of our inspection in December 2024. The service did not have a maintenance log, so it was unclear how leaders monitored outstanding actions to ensure they were completed promptly. An audit of patient fridges on Upping Ward that repeatedly identified issues with the fridge temperatures had not resulted in swift action to address the matter. We did not see that actions from the reducing restrictive practice audits were discussed monthly during clinical governance as per the provider’s expectation, and patients continued to raise concerns around bedroom searches. Existing processes had not identified the gaps in post RT physical health monitoring or the shortfalls in side effect monitoring of some patients on high risk medicines. Leaders monitored mandatory training and supervision compliance, but we found low compliance rates for some courses and bank staff supervision.

Leaders had not taken action to facilitate patient access to IMHAs for qualifying patients following concerns we previously raised following a Mental Health Act review in September 2024.

The risk register did not always reflect known issues in the service. For example, some staff and leaders described issues with staffing, but this did not feature on the risk register.

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 a senior leader provided verbal assurance of these checks, but we were concerned the service was unable to demonstrate evidence of a robust system to ensure all necessary information was in place as required.

However, some governance processes worked effectively within the service. Staff regularly discussed patient risks, issues and performance through a variety of meetings. The service had made improvements to their safeguarding systems and processes, and staff listened to and acted on recommendations from reviews of incidents, complaints and patient feedback. Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. The service had plans for emergencies to ensure business processes could continue. Staff had access to the equipment and information technology needed to do their work. The service submitted notifications to external organisations as required.

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.