Cygnet Hospital Derby

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has remained Good. This meant people were supported and treated with dignity and respect; and involved as partners in their care.

Staff demonstrated consistent commitment to privacy, dignity, and person-centred care, responding sensitively to the unique needs of patients detained under the Mental Health Act and those requiring secure rehabilitation. They empowered patients to understand, manage, and make informed choices about their care and treatment, actively involving them in care planning, risk assessments, and decisions wherever possible according to individual capacity. Staff also proactively anticipated patient needs and continuously sought feedback to improve care quality and outcomes.

Families and carers were fully engaged, informed, and supported, with staff fostering a culture of partnership, respect, and collaboration. The service monitored and audited patient and carer involvement, communication, and satisfaction, with oversight at all leadership levels, including external Cygnet audits, ensuring that care consistently exceeds comparable secure services nationally.

Patient and carer feedback, alongside internal and external audits, demonstrated that staff provided care that was not only kind and empathetic but also measurable, responsive, and consistently outstanding in impact, reinforcing a culture of excellence throughout the secure service.

We have not awarded this service a score for Caring.

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

We carried out observations of interactions on the rehabilitation ward over a two-day period and spoke to 7 staff. Staff consistently demonstrated a visible, person-centred culture, providing care that was exceptionally compassionate, dignified, and kind. Patients received help, emotional support, and advice proactively, exactly when they needed it. Even in situations where patients’ diagnoses and behaviours placed staff under pressure, staff maintained a consistently caring approach and always acted with professionalism and empathy, reflecting a culture that exceeds expectations.

Patients reported being as fully involved as possible in their care and treatment planning,

according to their individual capacity. They consistently said they could approach staff when in distress, and staff responded promptly, sensitively, and compassionately. Patients explained that staff clarified changes to medicines or treatment plans, involved them wherever possible, and made urgent decisions in their best interests, demonstrating attentiveness and exceptional responsiveness. The service continuously audited patient involvement, with oversight from managers at all leadership levels, including external Cygnet audits, ensuring that participation remained meaningful, effective, and aligned with individual needs.

Patients highlighted that staff treated them with dignity and respect at all times. One patient explained: “Staff treat us with dignity and are always very respectful.” Another commented: “They involve me in everything; the staff are great.” Patients also said they felt known and understood as individuals, with their personal preferences, wishes, and histories actively reflected in their care. Staff focused on building open and honest relationships with patients and, where appropriate, with families and carers.

Patients reported feeling confident that information about them was treated confidentially and shared only appropriately. Staff communicated in ways that were accessible, adapting their approach to meet individual needs. Families were involved sensitively in care planning and decision-making, reflecting the service’s commitment to person-centred, family-inclusive care.

Staff ensured that on admission all patients were provided with a welcome pack with essential hygiene products, writing equipment and if required clothing and shoes. Patients were encouraged to decorate their rooms and personalise them. Staff would buy items to support this.

The most recent report from the Lived Experience Network (LENS) in July 2025 highlighted positive patient experiences on Wyvern Ward. LENS, an independent organisation amplifying the voices of people with lived experience, reported that patients were highly engaged, openly discussed their progress and wellbeing, and participated actively in communal and therapeutic activities. Despite some patients experiencing significant mental health challenges, opportunities to express themselves were effective in supporting mood and engagement. The feedback noted peer support and appreciation of staff, demonstrating a caring, recovery focused environment that promoted emotional wellbeing and a sense of community.

Staff stated they could raise concerns about disrespectful, discriminatory, or abusive behaviour without fear of reprisal, and felt supported to uphold dignity, respect, and compassion in all aspects of their work.

Overall, observations, patient feedback, and staff accounts provided strong evidence of a culture in which kindness, compassion, and dignity are embedded across the forensic secure wards. Staff were highly motivated, empathetic, and proactive in their care, fostering strong, trusting relationships and consistently exceeding expectations, even during times of pressure. The service actively monitored and audited practice at all leadership levels, including through external Cygnet audits, to ensure the sustained delivery of exceptional, person-centred care.

The service ensured that patients were treated as individuals at all times, with care consistently tailored to meet their personal needs, preferences, and circumstances. Staff demonstrated exceptional compassion and responsiveness, proactively anticipating patient requirements and adapting care to ensure every person was supported to achieve the best possible outcomes. All staff encouraged people to explore their care and support options and provided guidance on additional sources of help and advice, approaching this with particular care due to the complexity and risk profile of this patient group.

In addition to person-centred care, the service invested in extensive work to improve understanding of Equality, Diversity, and Inclusion (EDI) among staff and patients. This included dedicated training sessions and workshops to raise awareness about the experiences and needs of patients who identified as gender different from their sex assigned at birth. Staff and patients were encouraged to discuss respectful language, pronoun use, and the importance of recognising individual identity in all aspects of care. This work fostered an inclusive and supportive environment, reduced misunderstandings or microaggressions, and improved relationships between staff and patients. As a result, patients reported feeling safer, more respected, and more comfortable expressing themselves, contributing to a calmer and more positive ward atmosphere. The embedding of EDI principles further enhanced patient experience, promoting dignity, respect, and understanding across all aspects of care, and contributing to a more cohesive, positive, and inclusive ward culture.

Information about treatment, rights, and complaints was provided in accessible, personalised formats, including easy-read leaflets for patients with learning disabilities and materials in different languages where required. All staff positively welcomed the involvement of advocates.

Where advocacy or information sources were not readily available, the service worked with sector stakeholders to fill the gap. Managers ensured that staff and patients had timely access to language interpreters and deaf services, and the use of these adaptations was monitored and audited across all leadership levels, including external Cygnet audits, recognising the heightened governance needs of secure services.

Patients reported being fully informed and actively involved in their care, treatment, and rights, with information delivered in ways they could understand and regularly reviewed with them. Staff consistently supported patients to make choices and decisions about their care, empowering them to participate as fully as possible according to their capacity. Continuous auditing of patient involvement included security-focused considerations, ensuring that risk management and safety were balanced with personalised care.

Wherever possible, staff actively supported patients to make their own decisions about their care, treatment, and wellbeing, tailoring approaches to individual capacity and preferences. Patients’ rights were explained in clear and accessible ways, using a range of communication methods, including easy-read materials, interpreters, and one-to-one discussions, ensuring that everyone could understand, make informed decisions, and be fully involved. Staff regularly reviewed and monitored communication needs and understanding throughout each patient’s stay, recognising the additional challenges posed by the secure environment and higher-risk patient group.

Patients consistently reported feeling confident, informed, and genuinely empowered to make choices about their care. Patients were involved in and led on the development of the occupational therapy timetables. In addition, each patient had a ward therapy and individual timetable which was reviewed regularly to ensure it met their individual needs.

A food focus group was set up on response to patients request and advocacy input to plan seasonal menus. The menus had input from a dietician and a nutritic system to ensure the menus provided a balance diet for patients.

Staff supported patients and held monthly “People council” meetings. The meetings had a dedicated patient chair and a representative from each ward to give feedback on the service. Outcomes of the meetings were shared in clinical governance meetings to ensure that agreed actions were completed.

Although some patients were subject to the Mental Health Act and could not have full control over all aspects of their care, staff still maximised involvement, independence, choice, and control wherever possible. Patients were actively involved in decisions about medication changes and treatment plans, and staff explained urgent decisions made in their best interests clearly and sensitively. Staff ensured all decisions balanced patient autonomy with risk management considerations specific to a secure setting. One patient said: “They involve me in everything, the staff are great.” The service continuously audited patient involvement and decision-making, with oversight from managers at all leadership levels, including external Cygnet audits, with added scrutiny for security and safety compliance, to ensure that practice remained consistent, meaningful, and aligned with best practice.

Staff encouraged patients to maintain important relationships and community connections, recognising their central role in wellbeing. Family visits were supported flexibly, with staff adapting arrangements to meet individual needs. Visits were carefully risk-assessed and supervised where necessary to maintain safety. One patient commented: “My daughter comes to see me, staff are so flexible, and they know how important that visit is to me.”

Examples of personalised involvement included individuals with histories of substance misuse who were supported to engage in group work and one-to-one sessions. Through tailored care planning and therapeutic support, people progressed to safer leave arrangements and, over time, moved on to education, training, or more independent living.

Other individuals who initially found engagement challenging, including those returning from leave intoxicated, were supported through structured, multi-disciplinary harm-reduction plans. This enabled improved participation in therapy and group activities, alongside the development of confidence, coping strategies, and positive relationships.

Staff also supported people to reconnect with families and maintain important social bonds, offering flexible, risk-assessed visiting arrangements where appropriate to promote inclusion, recovery, and emotional wellbeing.

The service actively promoted independence and recovery, providing opportunities for patients to take part in activities that built skills, confidence, and resilience. Activities were structured to meet the needs of a secure patient population and minimise potential risks while still promoting autonomy. Patients could access community-based activities that supported autonomy, health, and wellbeing, when permitted under risk-assessed leave arrangements. One patient said: “I’ve been accepted for a placement, and all the teams worked together to support me to get it.” Staff consistently empowered patients to develop skills and confidence, even when restrictions were necessary for safety, ensuring a balance between protection and personal growth.

By providing personalised support, practical tools, and a consistently caring and empowering culture, staff enabled patients to have genuine involvement and maximise their independence, while maintaining safety and security, resulting in improved outcomes, increased confidence, and a meaningful sense of control over their care.

Staff quickly recognised and responded when patients’ needs changed. Every patient had a daily risk assessment, which helped staff understand how they were that day and what support they may need. Staff discussed these assessments at every shift handover, during ward meetings with the MDT, and at managers’ morning meetings. This ensured that everyone was aware of any changes or potential risks and could respond quickly.

Staff were skilled at noticing when patients’ risks or behaviours began to change and acted promptly. They were trained in de-escalation techniques—calm, supportive approaches that reduced stress, anxiety, and distress—so that physical interventions were only used when necessary. Given the higher-risk patient population, staff applied these techniques rigorously, prioritising safety for all patients and staff. We observed staff using effective de-escalation techniques when patients became distressed or agitated. The hospital had also worked hard to reduce restrictive practices, giving patients more independence, more opportunities for leave, and greater involvement in everyday life. All leave and activities were risk-assessed and supervised according to security protocols. This approach not only reduced the need for restraint but also supported patients to achieve meaningful personal goals. For example, one patient arrived from a medium secure service with very high levels of distress and challenging behaviour. Through consistent support and responsive planning, they made significant progress, reduced risks, and moved towards a lower-security placement within the secure pathway.

Patients also reported that staff reacted quickly when they had physical health concerns. Each ward had a physical health clinic on a weekly basis to support monitoring people’s health. The clinic aimed to monitor all aspects of patients physical health. Efficiency of the clinics was monitored by the service leaders.

One patient explained: “I recently had a physical health issue, the staff were on it. Really compassionate and caring.” Staff closely monitored physical health within the constraints of a secure environment, ensuring rapid intervention when needed.

At times, patients’ diagnoses placed staff under intense pressure due to behaviours that could be very challenging. Nevertheless, staff maintained a professional and caring approach, ensuring that patients’ needs were met without judgment and always with respect. Staff emphasised maintaining dignity and therapeutic engagement while managing risks specific to the secure setting.

Cygnet Derby implemented the Herbert tool, which was introduced following lessons learnt from AWOL (absent without leave) incidents at Cygnet Derby, in order to aid communication between Cygnet Derby, the police, and the missing persons team should an AWOL incident occur in the future. Since its implementation at Derby, all Cygnet services nationwide have been encouraged to adopt this.

Staff reported feeling respected, valued, and supported in their roles. They described leaders as approachable and consistently present on the wards, with an open-door policy. Posters displaying the organisation’s vision and ward philosophy reminded staff of the shared values they were working towards. Staff said they felt safe raising concerns and confident that these would be listened to without fear of backlash.

The provider invested in staff wellbeing and offered a wide range of benefits. These included access to a 24/7 employee assistance programme, counselling support, and health plans giving staff access to GPs, nutrition advice, and fitness programmes. The provider also offered peer support schemes, such as Trauma Risk Management (TRiM) and Sustaining Resilience at Work (StRaW), to support staff following incidents or during times of high pressure. Staff could access practical benefits, including free meals, onsite gym use, free parking, smoking cessation support, and sanitary items. Given the higher acuity and risk in secure wards, staff reported particular value in TRiM and structured debrief sessions after challenging incidents.

The provider demonstrated strong recognition and reward systems. The “Characters of Care” scheme celebrated staff who went above and beyond, and long-service awards recognised ongoing commitment. Staff were also eligible for “Employee of the Month,” with rewards such as additional leave. These initiatives helped staff feel valued and proud of their work.

All registered nurse posts were filled, with no vacancies and even a waiting list of applicants. Support worker posts were in place, with some additional roles identified for patients needing higher observation. Staffing gaps were rare, but occasional temporary agency use occurred to maintain high-risk supervision safely. Sickness levels were low, and turnover mainly reflected bank support staff moving on from the most complex ward.

Managers supported staff to develop their skills and careers. Appraisals and supervisions included discussions about career progression, and staff had opportunities to take on new responsibilities, apply for training, and pursue specialist roles. Staff in secure wards also received additional training in risk management, de-escalation, and therapeutic engagement for high-risk patients.

Leaders held annual team building days for all staff. These focussed on, achievements and celebrations, innovation, patient experience and improvement, training. Part of the day was a fun activity for team building and morale.

Support was provided to staff ny the psychology team to promote their wellbeing. This included incident debriefs, both individual and group to further support staff.

Overall, the provider demonstrated a strong commitment to supporting and enabling the workforce. By looking after staff health and wellbeing, maintaining safe staffing levels, and recognising and developing staff, the service enabled staff to deliver person-centred care with confidence and pride.