Cygnet Hospital Beckton

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service had now improved its processes to complete comprehensive mental and physical health assessments.

We viewed 8 care and treatment records. Physical health assessment on admission included choking risk assessment, venous thromboembolism (VTE) screening, and a baseline electrocardiogram (ECG). Allergies were appropriately recorded. Staff developed care plans that met the needs identified during assessment. All care plans were personalised and holistic, created with patient involvement. For example, for an autistic patient, sensory assessment had been completed and a hospital passport was in place. Where applicable, there was evidence of active carer involvement in patients’ care. All care plans had been regularly updated in ward rounds, with patient and multidisciplinary team (MDT) input. Regular one-to-one nursing sessions and ongoing medical reviews were clearly documented.

Staff monitored patients’ physical health needs daily. Following admission, physical health checks were completed annually, and referrals to GP or specialist care were completed as needed. Mobile dentists visited the wards regularly.

All eligible staff on both wards had completed mandatory training in physical health awareness and physiological observation. The hospital recently employed a new dedicated physical health lead who actively supported staff and patients. Due to an increased incidence of self-harm on the wards, the physical health lead had delivered wound care training to staff.

We spoke with 5 patients, all of whom told us they were involved in their care planning and had access to a copy of their care plan. They said their individual needs were met, although one patient said their sensory needs could be met better. In the 2 ward rounds we observed, patients contributed openly to discussions about their care. MDT demonstrated a good understanding of the patients and their needs.

The service planned and delivered patients’ care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff delivered a range of care and treatment interventions which were recommended by guidance from the National Institute for Health and Care Excellence (NICE). These included medication and psychological therapies. On both New Dawn and Upping wards, staff provided DBT (dialectical behavioural therapy), compassion focused therapy (CFT), CBT (cognitive behavioural therapy) and eye movement desensitisation reprocessing (EMDR). New Dawn offered a more structured DBT programme. The care and treatment records demonstrated that care was provided in line with current guidance, with well-embedded psychology input. We reviewed psychology formulation records for 2 patients. Both records demonstrated high quality and were holistic and personalised.

Due to patients’ complex presentations often associated with trauma, care was trauma informed. On both wards, 100% of staff had completed mandatory training in trauma informed care.

Care records showed that patients engaged in a broad programme of therapeutic activities in one-to-one and group settings. These included psychology sessions, self-care support groups, workshops, games, cinema, recovery college, social club, arts and crafts, pampering, and exercise. Patients we spoke with were positive about the choice and availability of activities on offer.

The multidisciplinary team (MDT) included, or had access to, the full range of specialists required to meet the needs of patients. These were doctors and nurses, psychologists, psychotherapists, occupational therapists (OTs), social therapists, dietitians, social workers, activity practitioners, and experts by experience.

Staff participated in clinical audit and quality improvement (QI) initiatives. The audit schedule covered physical health, care planning, medicines, restrictive practices, primary nurse sessions, and family and carer contacts. Psychology team carried out audits to evaluate ward atmosphere. Physical healthcare was an area of current quality improvement focus, and staff told us about an ongoing project on weight management.

Staff had access to regular team meetings, reflective practice, debriefs, peer support, professional supervision, and specialist training and development. Support staff received training in DBT and personality disorders. OT staff were trained in sensory integration and supported wider team development in this, including presenting at a recent awayday.

The service worked well across teams and services to support patients. They shared their assessment of patients’ needs when they moved between different services.

Staff shared key information about patients in daily huddles and handover meetings. Staff described handovers as comprehensive, and permanent staff additionally briefed bank and agency colleagues on patient-specific risks. Staff we spoke with described working well together as a multidisciplinary team (MDT). Disciplines including nursing, psychology, social work and allied health professions were well-embedded. The care and treatment records we viewed reflected MDT discussions and decision-making.

The MDT meetings we observed were well-attended by the professionals. However, some staff said that managerial and clinical governance meetings often overran.

The service worked well with other teams within the provider group and externally. Key system partners included NHS commissioners, local authorities, GPs, secondary care, and community mental health teams. GPs and dentists attended the wards regularly, and women’s health screening was carried out by the local hospital. Staff involved care coordinators by inviting them to ward rounds, although we heard they did not always attend. A care coordinator joined 1 of the 2 ward rounds we observed. Staff offered Care and Treatment Reviews (CTRs) to autistic patients in line with statutory requirements. CTR is a person-centred review with an independent panel to ensure that care is delivered in the least restrictive way. However, for one patient recently diagnosed with autism a CTR had not yet been completed.

The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

There were activities on offer to help promote a healthy lifestyle for patients. These included facilitated gym sessions, mindfulness, nature walks, smoothie making, one-to-one cooking sessions, and weekly smoking cessation groups. All clinical staff received training in smoking cessation, and the service supplied nicotine replacement products to patients. Therapy animals visited the hospital to promote mental wellbeing. There was an incentive scheme linked to patient participation in gym sessions, with prizes available. Sessions offered through Sports for Confidence (an initiative to widen access to physical activity) such as swimming, aqua aerobics and racquet sports took place twice a week at a local sports centre.

Staff referred patients to a dietitian, who liaised with the physical health lead and kitchen staff about individual needs.

Posters promoting women’s health screenings were displayed prominently on the wards. Further work was planned to strengthen staff and patient education around women’s health.

The service routinely monitored patients’ care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of patients themselves.

In the care and treatment records we viewed and ward rounds we observed, we saw evidence that staff used recognised scales and outcome measures. These included Glasgow Antipsychotic Side-effect Scale (GASS), Dialog+ (questionnaire to assess patient satisfaction and needs), and the National Early Warning Score (NEWS2). In one ward round, staff reviewed and discussed the GASS score with the patient, alongside the medication and its side effects.

We identified an area for improvement in relation to NEWS2 record keeping, particularly following incidents of self-harm. We discussed with staff that this could be strengthened by clearly documenting rationale when discontinuing monitoring, or when scores are escalated. We were assured that the recently appointed physical health lead had already identified this through audits and had taken steps to reinforce the correct processes to staff.

Staff we spoke with confirmed they had the time and opportunities to participate in clinical audits and quality improvement activities.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

Staff followed the provider’s policies on consent to treatment. Across both wards, 100% of staff had completed training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately, on a decision-specific basis. In the care and treatment records we viewed, capacity discussions relating to medication, finances and treatment decisions were clearly documented.

Staff recorded patients’ consent to involve carers in their care, or whether they chose to decline this. With consent in place, staff supported carers to be involved in patients’ care and discharge planning.