Cygnet Hospital Derby

On this page

• 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

Effective - 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.

Staff thoroughly assessed the physical and mental health of every patient on admission, developing care plans that were tailored, dynamic, and reviewed regularly through multidisciplinary discussions. Care and patient outcomes were monitored continuously through internal audits, quality improvement initiatives, and benchmarking against comparable services, including external Cygnet audits and analysis of HONOS outcome measures. This demonstrated that patients consistently achieved good outcomes in areas such as recovery progress, engagement in treatment, and physical health monitoring.

A wide range of specialist treatments and interventions were delivered consistently in line with national guidance and best practice, with staff demonstrating exceptional skill, knowledge, and responsiveness. The ward team included, or had ready access to, the full spectrum of specialists required to meet patients’ diverse needs, and professionals from different disciplines collaborated seamlessly to ensure care was coordinated, patient-focused, and anticipatory.

Staff demonstrated a comprehensive understanding of their roles and responsibilities under the Mental Health Act 1983 and the Code of Practice, applying this knowledge confidently and consistently to support patient rights, autonomy, and involvement. Leadership ensured that these practices were embedded across all levels of the service, continuously audited, and evaluated against internal and external benchmarks, resulting in care that met expectations, strengthened patients' independence, and achieved good outcomes.

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.

We reviewed five care records. Staff completed comprehensive mental health assessments for patients promptly, at or shortly after admission. They also assessed physical health needs without delay. Staff developed care plans based on these assessments, ensuring they were personalised, holistic, and recovery-oriented, and updated them as needed to maintain accuracy. They made appropriate referrals to external services to support patients’ wider health needs, including GP’s and specialist physical health clinics.

We saw evidence of patients actively participating in ward rounds and multidisciplinary meetings. During our visit, one patient attended their care review and contributed meaningfully to planning their treatment. Patients reported feeling confident that their individual needs had been fully assessed and understood.

Staff applied their learning effectively, leading to positive outcomes and enhancing patients’ quality of life within a secure environment. They also considered carers’ needs during assessments, helping carers to stay well and provided them with safe, effective support.

The service proactively planned and delivered care and treatment in partnership with patients, in line with legislation, focusing on what mattered most to them. Staff developed, embedded, and advanced evidence-based practice, consistently delivering care of an exceptionally high standard. They demonstrated a thorough understanding of their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice, applying this knowledge confidently, consistently, and effectively.

Staff delivered a comprehensive range of interventions tailored to the patient group, including medication management and psychological therapies, such as Acceptance and Commitment Therapy (ACT) Informed Approaches, Schema Therapy, Trauma Focused Cognitive Behavioural Therapy (TF-CBT), Compassion Focused Therapy (CFT) Informed approaches, Drama Psychotherapy, Eye Movement Desensitisation and Reprocessing (EMDR), Psychoeducation, Psychopathy (PCL-R), Fire Intervention Programme for Mentally Disordered Offenders (FIP-MO) and a comprehensive package of Dialectical Behavioural Therapy (DBT). Most recent achievements of the care delivered by the psychology team included implementing more trauma-informed language, providing patients with support when an incident has occurred, even if they have not been directly involved and informing the service users more around depots.

Staff were trained in the safewards model, an evidence based, nurse led model designed to reduce conflict and restrictive practices in inpatient mental health settings.

All interventions were delivered in line with guidance from the National Institute for Health and Care Excellence (NICE), ensuring care was both effective and safe. This contributed reinforced a therapeutic, person-centred environment.

The service delivered care through a clearly defined and structured Model of Care for Mental Health High Dependency Inpatient Rehabilitation, which supported patients from assessment through to recovery and discharge. The model was person-centred and strengths-based, focusing on understanding each patient’s past experiences, current needs, and future goals. Care was delivered through a multi-disciplinary approach, with coordinated input from medical, nursing, psychology, and occupational therapy teams across staged phases of assessment and engagement, recovery, and consolidation. This enabled patients to develop insight, build practical and social skills, manage risks positively, and increase independence at a pace aligned with their readiness for change. The model promoted continuity, therapeutic relationships, and recovery-focused outcomes, supporting patients to progress safely towards greater autonomy and community integration.

Patients had access to physical healthcare. Staff completed comprehensive physical health assessments on admission and maintained monitoring through weekly observations, six monthly blood tests, and electrocardiograms (ECGs). A dedicated physical health lead nurse championed initiatives such as healthy eating and lifestyle promotion. Staff supported patients to attend weekly GP clinics, specialist hospital appointments, and national screening programmes. Robust record-keeping and monitoring systems ensured that no physical health check was missed, and patients reported feeling confident and reassured that their physical health was effectively managed alongside their mental health.

Innovation was embedded throughout practice. Staff led a quality improvement project introducing point-of-care blood testing, reducing the need for venepuncture, supporting patient preference, and improving timely access to Clozapine for treatment-resistant schizophrenia. This approach enabled earlier detection of conditions such as anaemia, infection, and sepsis, enhancing patient outcomes and promoting safer, more responsive care.

The team included, or had access to, the full range of specialists required to meet patients’ needs, including doctors, nurses, psychologists, occupational therapists, pharmacists, social workers, speech and language therapists, dieticians, and support workers. Staff were highly experienced, skilled, and qualified, receiving specialist training relevant to their roles, regular supervision, annual appraisals, and opportunities to further develop skills and knowledge. Managers proactively identified learning needs, addressed performance issues promptly, and ensured new staff completed a thorough induction. Staff also had access to regular team meetings to reflect on practice, share learning, and continually improve care.

Staff participated actively and systematically in clinical audit, benchmarking, and quality improvement initiatives, ensuring care was consistently measured against national standards and aligned with best practice. Patients were fully involved in these developments through the trauma-informed care (TIC) group, co-producing policy revisions and best-practice guidelines with staff. Patients told us they valued being actively engaged in shaping how care and treatment were delivered, reflecting a culture of collaboration, empowerment, and excellence.

Staff in the rehabilitation service worked effectively across teams, ensuring patients experienced coordinated care that supported recovery and progress toward community reintegration.

Staff worked with commissioners to support discharge ensuring that they were not delayed. They shared assessments, risk information, and care plans promptly when patients moved between rehab wards or transitioned to community placements, reducing the need for patients to repeat their story. Patients consistently described joint working as smooth and well organised.

Staff worked closely with an external provider to support carers to access an assessment of their needs when their relatives were admitted to the service.

Rehab wards held daily MDT handover meetings, attended by the MDT and nursing staff. These meetings followed a structured format covering risks, physical health, patient goals, activity engagement, and progress toward discharge, reflecting the rehabilitative focus. Minutes were shared electronically, stored on the shared drive, and displayed in ward offices to ensure all staff had access to current information.

Communication systems supported effective teamwork. Outcomes from ward rounds were shared promptly across the team so changes to care plans, leave, or activities were clearly understood. Staff across the pathway were kept informed via the monthly service newsletter, supporting consistency and shared learning.

Rehabilitation ward managers participated in the Ward Managers Task and Finish Group, ensuring rehab perspectives, including community leave, vocational activities, and discharge planning, informed service-wide governance. Staff used the Staff Relations Group (SRG) to raise ideas and challenges, many relating to recovery and patient engagement, which were then shared through newsletters or escalated regionally for wider learning.

Staff attended bimonthly steering groups. The group discussed case studies, lesson learnt from incidents and best practice. Staff from each ward send out a monthly newsletter to share information. It highlighted new referrals, admission, information on staff well being and employee of the month.

These systems ensured that when patients were supported by multiple rehabilitation teams, including OT, psychology, nursing, activity coordinators, and community services, their care remained coordinated, recovery-focused, and centred on individual goals.

The rehabilitation service supported patients exceptionally well to manage their health and wellbeing, with a strong focus on promoting independence and preparing people for community living. Staff worked collaboratively with patients to develop personalised approaches to health that reflected their goals, preferences, and level of independence. Patients were fully involved in health assessments, progress reviews, and physical health monitoring, and the MDT ensured patients accessed the right health and social care professionals at the right time. Regular audits enabled the team to track outcomes and continually refine the support offered.

Rehabilitation staff encouraged patients to make meaningful and sustainable lifestyle changes through a comprehensive group programme covering motivation, relapse prevention, substance misuse awareness, and education. The SMART model was used across the rehab wards, mirroring community recovery frameworks and supporting consistency after discharge. The programme was available in Easy Read formats for patients with communication or cognitive needs, and patients were encouraged to co-facilitate sessions, strengthening confidence and independence.

The service promoted healthier living through practical initiatives such as smoking cessation support, diet and nutrition advice, healthy cooking sessions, and one-to-one lifestyle coaching. Staff anticipated risks early, offering targeted interventions for cardiovascular health, substance misuse, weight management, and general wellbeing. Staff were trained in relevant physical health monitoring tools and used these proactively in line with rehabilitation goals.

A wide range of ward-based and community activities supported patient recovery and promoted long-term healthy habits, including walking groups, fitness sessions, sports, equine therapy, community cycling training (Bikeability), Kung Fu classes, and structured activity schedules. These activities strengthened independence, improved physical health, and prepared patients for successful community reintegration. Participation and outcomes were monitored to ensure activities remained meaningful and effective.

Patients told us they felt informed, supported, and motivated to take control of their health. They described staff as proactive, encouraging, and skilled at helping them make positive changes. They valued practical support with sleep, diet, exercise, and general wellbeing, and consistently told us these interventions improved their confidence, independence, and quality of life. Staff monitored outcomes closely to ensure progress was sustained and support remained tailored to individual goals.

The hospital also had an Addictions Recovery service. The team supported patients across all wards with substance-related needs. Over the past 12 months, the team prioritised smoking cessation across all three wards, using disposable vapes with clear protocols and risk assessments in place. Service users signed vaping agreements and were offered drop-in sessions or one-to-one support based on identified need. Care plans included vaping support and addressed other areas such as gambling. Group-work programmes focused on motivation, education, and relapse prevention and were delivered using the SMART model.

Service users were actively involved in co-facilitating groups, and programmes were adapted into Easy Read formats to ensure accessibility for people with learning difficulties or those on the autism spectrum.

Positive outcomes included individuals with complex histories of substance misuse and associated risk behaviours who initially found engagement challenging. Through consistent multi-disciplinary working, personalised harm-reduction planning, and regular therapeutic input, individuals demonstrated improved engagement, reduced incidents related to substance use, and safer leave outcomes. Some service users progressed to active roles within the ward community, including participation in trauma-informed groups, involvement in safeguarding initiatives, and undertaking meaningful vocational opportunities within the hospital. Feedback from individuals highlighted increased insight into the impact of substance use on their wellbeing and trauma, alongside increased confidence about progressing to more independent or supported community placements.

Staff consistently monitored patients’ care and treatment to drive continuous improvement. Staff ensured that outcomes were positive, consistent, and met both clinical expectations and patients’ own goals.

Recognised tools, including HoNOS, were used to monitor symptom change and progress against rehabilitation targets, and assessments were regularly reviewed to ensure treatment remained effective and responsive to patients’ needs.

At the time of the inspection the service was working towards their triangle of care accreditation.

The ward placed equal emphasis on improving independence, autonomy, and wellbeing alongside clinical progress. Work to reduce restrictive practice increased opportunities for extended leave, participation in structured group work, and preparation for transition to the community. For example, one patient with a history of substance misuse engaged fully with group work, 1‑to‑1 sessions, and structured support, progressing safely to unescorted leave and eventually moving on to independent living and college. Another patient, who initially returned intoxicated from leave and was disengaged, developed a harm-reduction plan with the team, consistently engaged with therapies, and successfully managed unescorted leave while building relationships, daily living skills, and personal confidence.

Patients achieved a wide range of outcomes during their admission, including vocational achievements, development of social and daily living skills, and participation in walking, sports, and wellbeing programmes. Personal goals included building confidence, progressing in community-based activities, and preparing for future transitions. Several individuals successfully reintegrated into the community, demonstrating improved independence, resilience, and sustained recovery.

The rehabilitation ward maintained robust governance systems, including review at the Task and Finish Group, to monitor themes, identify learning, and implement improvements. Shared learning from other Cygnet sites supported staff to adapt practice and continue enhancing outcomes, ensuring patients received consistently high-quality, recovery-focused care.

Staff completed and used clinical assessment tools to assess and tailor patients’ treatment plans to their individual needs. These included, Global Daily Risk Assessment (DRA) Assessment of Progress (GAP).

Staff informed patients about their rights around consent and respected these rights when delivering person-centred care and treatment. Staff took all practical steps to enable patients to make their own decisions wherever possible. For patients who might have impaired mental capacity, staff completed and recorded decision-specific capacity assessments appropriately, in line with the Mental Capacity Act 2005.

Patients told us they felt supported to understand their rights and treatment, with staff using different forms of communication to ensure information was clear and accessible. One patient said, “I’m very involved in my care; my Nurse discusses it with me regularly. My family is also involved and consulted about plans and changes.”

When patients lacked capacity to make specific decisions, staff acted in their best interests, taking into account the person’s wishes, feelings, cultural background, and history. Staff recognised the importance of providing information in ways patients could understand and used tools such as Easy Read materials and advocacy support when appropriate.

As most patients were detained under the Mental Health Act, staff sometimes provided treatment without consent. Staff followed the correct legal processes and ensured patients were informed of their rights. Staff supported patients to express their views and to be involved in planning and reviewing their care wherever possible, even when treatment was provided under legal authority.