Cygnet Hospital Derby

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant people in long-stay or rehabilitation ward were protected by a strong and distinctive approach to safeguarding, while staff encouraged positive risk-taking to support independence and recovery. Patients were fully involved, and the provider was open and transparent when things went wrong.

The ward was safe, clean, well equipped, well maintained, and fit for purpose. Staff assessed and managed risks to patients and themselves effectively and understood how to protect patients from abuse. The service worked well with other agencies to safeguard patients. Staff used systems and processes to safely prescribe, administer, record, and store medicines, and the service managed patient safety incidents appropriately to support ongoing rehabilitation.

We have not awarded this service a score for Safe.

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

Staff maintained a proactive and transparent approach to safety and learning. Staff reported all incidents, including near misses, falls, and allegations, through the electronic incident reporting system, which was fully embedded into daily practice. Anyone witnessing an incident was expected to complete a report immediately, and staff confirmed this occurred consistently. Learning from incidents was routinely discussed during team meetings and formally reviewed through clinical governance processes. Staff provided examples of learning implemented following safeguarding concerns, including community grooming cases, which prompted coordinated multi-agency action with the police.

In addition, staff and patients co-produced a trauma informed reflective learning document which was used following incidents. It supported staff to identify learning after incidents.

Staff felt psychologically safe to raise concerns and described regular debriefs following serious incidents. Patients were also supported through debriefs when appropriate, and some reported positive changes following incidents, such as improved physical health checks and enhanced monitoring of visitors. The service also utilised external platforms, such as the Cygnet Learning Lessons portal, to understand and apply learning from other settings. This had led to practical changes in how contraband items were monitored and managed, particularly regarding visitors bringing inappropriate items or exploiting patients.

Staff demonstrated strong awareness of risks to patients across their care journeys. The service took a proactive and effective approach to identifying and managing these risks, from referral and admission through to discharge. Referrals were only accepted when staff were confident that the service could safely meet the patient’s needs. Risk assessments were completed promptly using recognised tools such as the Dynamic Risk Assessment (DRA), Simple Triage and Rapid Treatment (START) with specialist assessments provided by psychology when required. These assessments were reviewed and updated daily, and crisis plans were integrated into individualised care plans, which were regularly audited to ensure effectiveness.

Relatives generally reported that patients were safe during transitions and valued the collaborative work between multidisciplinary teams and external partners, which helped maintain continuity of care in the secure and forensic environment. While communication during transitions was mostly effective, a small number of relatives noted minor gaps in updates, which staff acknowledged and aimed to improve.

The service actively monitored and managed the effectiveness of these risk management processes, ensuring patients remained safe throughout their care and treatment journeys within the secure and forensic environment.

Staff worked proactively with patients and healthcare partners to understand what being safe meant to them and how best to achieve it. They focused on improving patients’ lives while protecting their right to live free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. Staff raised safeguarding concerns promptly and appropriately.

Staff completed safeguarding training, understood how to raise alerts, and acted decisively when necessary. They protected patients from harassment and discrimination, including those with protected characteristics under the Equality Act 2010. Staff identified adults and children at risk of, or suffering, significant harm and collaborated effectively with other agencies. They followed safe procedures whenever children visited the service.

Staff used restraint only as a last resort and documented its use in line with policy and national guidance. The service actively promoted the reduction of restrictive practices, recognising the positive impact on people’s quality of life. Staff adopted a flexible, person-centred approach that improved patient wellbeing. Teams discussed reducing restrictions at every meeting and forum. Mandatory training included co-facilitation by service users, who shared how reduced restrictions enhanced their wellbeing. The service also piloted an organisation-wide project to embed this approach.

The service developed a Safeguarding Champions group at the request of service users, who co-produced a Hospital Safeguarding Charter with the team. This initiative has been recognised as a “flagship project” by the corporate Safeguarding Team and demonstrates exemplary coproduction and patient involvement. The co-produced group now actively participates in the Making Safeguarding Personal programme with the Safeguarding Adults Board and Integrated Care Board. This ensures that the voices and experiences of service users directly inform local safeguarding policy and practice. This approach strengthens partnership working across teams and services, enabling coordinated safeguarding support and ensuring that people do not need to repeat their story when moving between services.

Staff worked with patients to understand and manage risks holistically, ensuring care was safe, supportive, and addressed individual needs. They assessed and managed risks to patients and themselves thoroughly, following best practice to anticipate, de-escalate, and respond effectively to challenging behaviour. Staff used restraint and seclusion only as a last resort, after all de-escalation techniques had been attempted. They actively participated in the provider’s restrictive interventions reduction programme, contributing to safer, more patient centred care.

There were 121 recorded incidents of restraint this year; although the number was high, each incident was carefully documented, reviewed, and used appropriately. The use of rapid tranquilisation, seclusion, and long-term segregation was consistent with policy and national guidance and applied only when absolutely necessary.

Staff used restrictive practices to keep people safe. This was based on individual patients’ needs and risk assessments. When restrictions were put in place staff wrote a care plan, clearly highlighting what and why the restrictions were in place, which was reviewed regularly.

Staff involved patients in developing and reviewing care plans and risk assessments. Patients had access to their care plans and participated in multidisciplinary team reviews. Staff tailored communication to ensure all patients, including those with communication difficulties, understood their care and treatment. Staff supported patients to provide feedback through surveys and community meetings. They also facilitated advance decisions to refuse treatment when appropriate and ensured access to advocacy services. While the service faced challenges in accessing Independent Mental Health Advocacy (IMHA) due to external availability issues, advocates remained accessible to patients.

Staff followed clear policies for observation levels, with new admissions often placed on one-to-one observations based on assessed risk. Managers assessed ligature risks annually, and staff carried out regular visual audits to maintain awareness. Staff conducted patient searches using a red, amber, green system, reducing unnecessary searches while balancing safety with patient privacy and dignity.

Patients and relatives generally reported feeling involved in discussions about risk and appreciated the staff’s careful balance between maintaining safety and encouraging independence.

Staff completed regular risk assessments of the care environment, supported by multiple layers of oversight. The clinical team and managers conducted internal reviews, and corporate teams and independent external providers carried out annual audits covering fire safety, infection control, and health and safety. Senior leaders monitored risks through a weekly operational and quality audit dashboard, which guided local strategies and action planning.

Staff designed ward layouts to support effective observation and assessed ligature risks using detailed risk assessments and heat maps. Where residual risks existed, staff implemented control measures and reviewed them regularly. Male and female patients were cared for on separate wards. When patients mixed for social activities, staff carried out individual risk assessments to ensure their safety.

Staff equipped clinic rooms with accessible emergency drugs and resuscitation equipment and checked them regularly. They used nurse call systems and alarms appropriately.

We observed a calm and well-maintained environment. Staff described the culture as proactive, and safety focused. When staff used long-term segregation (LTS), they followed national guidance and maintained an appropriate and safe environment.

Staff secured the environment by keeping ward doors locked at all times. They ensured informal patients rarely left without agreement and clearly communicated a list of banned items to staff and patients. Staff restricted smoking to designated outdoor areas and encouraged strict compliance.

Most patients and relatives reported that staff safely managed the ward environments effectively. Some patients described occasional anxiety related to other patients’ behaviour, but they said staff responded promptly, provided support, and maintained a safe and calm atmosphere.

The service maintained safe and effective staffing levels to deliver person-centred care. Managers calculated required numbers and grades of nurses and support workers and adjusted staffing daily to reflect patient risk and clinical need. A local, regional and national on call rota was in place. This provided a 24-hour 7 day a week to support to staff if required.

A qualified nurse was always present and available in communal areas, and staff ensured patients had regular one-to-one time with their named nurse.

Staff were assigned lead roles which provided oversight of specific tasks that needed to be completed. For example, audit lead, clinic lead, physical healthcare lead.

Managers recruited staff safely, completing all appropriate employment checks before they started work. Patients were encouraged to participate in the recruitment process. When necessary, managers deployed agency staff to maintain safe staffing levels. The Registered Manager explained that agency use was higher than preferred due to supporting patients with complex forensic needs awaiting transfer to a more suitable setting. All agency staff completed a local induction and became familiar with the wards and patients. The service maintained adequate medical cover day and night, and a doctor could attend quickly in an emergency.

Staff achieved 93% compliance with mandatory training. They reported that training was tailored to their development needs and areas of interest, including Dialectical Behaviour Therapy (DBT), working with sexual offending behaviours, and risk management. While staff expressed a desire for more externally accredited clinical training, such as master’s level courses, they felt well supported through internal and provider-led training opportunities. Leaders ensured that nursing staff had access to a variety of training to support them in their roles. The training included specific training on different mental illnesses, psychological interventions and medication management.

Staff at all levels had regular supervision, and managers addressed poor performance appropriately. Policies and guidance documents supported the supervision process and promoted professional development. Leaders ensured that nursing, therapy and medical staff had protected time dedicated to learning and research as part of their continued professional development.

One of the consultant psychiatrists ensured that all medics within Cygnet had medical appraisals. This included discussion up to date guidance, performance monitoring and clinical discussion about complex cases.

Patients told us they felt safe and supported by knowledgeable staff. Relatives also described staff as well-trained, attentive, and responsive. Staffing pressures rarely resulted in cancelled activities or leave. Staff consistently reported having the training, support, and resources needed to meet the complex needs of their patient group.

Staff conducted rigorous and ongoing monitoring of Infection Prevention and Control (IPC) practices, including frequent spot checks and audits that effectively identified and addressed potential issues before they arose. They actively engaged in IPC discussions during team meetings, reflecting a strong culture of accountability and shared responsibility for maintaining the highest standards.

Staff encouraged patients to participate in IPC awareness, providing information in accessible formats to promote a shared understanding of infection control principles. Senior leaders demonstrated clear commitment by regularly reviewing IPC performance data and driving continuous improvements. Patients consistently reported that the wards were clean and well maintained, with one noting, “The place is always clean, and the cleaners do a sterling job.”

The physical environment was designed to minimise infection risks, featuring easy-to-clean surfaces, strategically placed hand sanitising stations, and clear signage promoting hygiene practices. Combined with well-maintained equipment and thorough cleaning schedules, these measures contributed to a consistently safe and clean setting.

During the assessment, staff consistently adhered to IPC procedures, including handwashing and correct use of Personal Protective Equipment (PPE). Patients and relatives consistently reported feeling safe and confident in the service’s cleanliness and infection control measures. External inspections confirmed the service’s excellent standards, with no concerns raised.

Staff maintained a high standard in medicines management, ensuring safety, effectiveness, and patient involvement. They followed best practice and national guidance in handling medicines, including secure storage, accurate recording, safe disposal, and appropriate use of covert medication. They completed training and passed competency assessments before administering any medicines.

Patients reported they could easily contact the doctor to discuss their care and treatment. Staff routinely reviewed each patient’s medicines during monthly multidisciplinary team meetings. They involved patients in decisions about their medicines wherever possible and clearly documented preferences and capacity in care plans. While most patients were detained under the Mental Health Act, which sometimes limited choice, staff consistently encouraged understanding and supported patients to take an active role in decisions about their medicines wherever they could.

Staff monitored the effects of medication on physical health in line with guidance, particularly for patients prescribed high doses of antipsychotics. They reviewed as-required (PRN) medicines regularly to ensure ongoing need and appropriateness and ensured people’s behaviour was not inappropriately controlled by medication.

Staff stored and disposed of medicines, including controlled drugs, securely and appropriately. They raised no concerns about medicine supply, and an external pharmacist completed regular audits. Managers monitored audit findings, shared alerts, and addressed any required actions through clinical governance meetings. Staff completed medicines reconciliation at key transition points and maintained up-to-date records to ensure continuity of care when patients moved between services.

Patients and relatives provided positive feedback, reporting that staff explained medicines clearly and that they felt safe and informed.