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 tailored, dynamic care plans that were reviewed regularly through multidisciplinary discussions. Care and patient outcomes were monitored continuously through internal audits, quality improvement initiatives, and benchmarking against comparable rehabilitation 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, independence, and physical health monitoring.

A wide range of evidence-based 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 rehabilitation 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 in long-stay or rehabilitation mental health wards. Staff completed comprehensive mental health assessments 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-focused, and updated them as needed to maintain accuracy. They made appropriate referrals to external services to support patients’ wider health needs, including GPs and specialist physical health clinics.

We observed 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’ independence and quality of life. They also considered carers’ needs during assessments, helping carers stay well and providing 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 support people in their rehabilitation process by offering psychological therapies, such as dialectical behaviour therapy (DBT), cognitive behavioural therapy (CBT), and eye movement desensitisation and reprocessing (EMDR). On rehabilitation wards, patients benefited from highly structured programmes of activities, skills training, and work opportunities, supporting independence and promoting successful community reintegration. 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.

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 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. 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.

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.

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 exceptional 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 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.

Daily MDT handover meetings took place, 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. 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.

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 rehab pathway were kept informed via the monthly service newsletter, supporting consistency and shared learning.

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.

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.

Patients were supported, 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. 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.

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 that 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, safer leave outcomes, and reduced incidents related to substance use. Some people 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 trauma and wellbeing, alongside increased confidence about progressing to supported community placements and developing independent living skills.

The rehabilitation ward closely monitored patients’ progress and used outcome data to continuously improve the quality and effectiveness of care. Staff ensured that outcomes were positive, personalised, and aligned with both clinical objectives and individual goals.

Staff monitored peoples care and treatment to ensure that they continuously improved patient’s individual outcomes. They used Health of the Nation Outcome Scale, Global Assessment of Functioning (GAF) Clinical Outcomes in Routine Evaluation (CORE-OM) and Mental Health Clustering Tool MHCT and Model of Human Occupation Screening Tool (MOHOST). Staff reviewed the outcomes within patients care programme approach (CPA) meetings with the patients, family and external professionals. Assessments were regularly reviewed to ensure treatment remained effective, responsive, and tailored to people’s needs. 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.

The ward placed equal emphasis on improving independence, autonomy, and wellbeing alongside clinical progress. Work to reduce restrictive practices increased opportunities for extended leave, participation in structured group work, and preparation for transition to the community. Individuals with histories of substance misuse and disengagement were supported through personalised care planning, one-to-one interventions, and group-based therapies. Over time, people demonstrated improved engagement, safer leave outcomes, and increased confidence in managing risks, relationships, and daily living skills.

Patients achieved a wide range of outcomes during their admission, including vocational and educational achievements, development of social and daily living skills, and participation in walking, sports, and wellbeing programmes. Personal goals focused on building confidence, increasing community-based activity, and preparing for future transitions. Several individuals successfully progressed to more independent or supported community placements, demonstrating improved autonomy, resilience, and sustained recovery. The services was involved Quality Network for Forensic Mental Health Services (QNFMHS) for low and medium secure services. The purpose of this network is to evaluate evidence, from self review and peer review of low and medium services to determine is in meets the required standards. Litchurch met the required standards and was accredited under the scheme.

The rehabilitation ward maintained robust governance systems, including oversight through the Task and Finish Group, to monitor themes, identify learning, and implement service improvements. Shared learning from other Cygnet sites supported staff to adapt practice and continue enhancing outcomes, ensuring people 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. They took all reasonable steps to enable patients to make their own decisions, promoting independence and choice in line with the principles of rehabilitation. Where patients might have impaired mental capacity, staff completed and recorded decision-specific capacity assessments appropriately in accordance with the Mental Capacity Act 2005.

Patients reported that staff helped them understand their rights and treatment options, using different communication methods to ensure information was clear. One patient told us, “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 certain decisions, staff made decisions in their best interests, considering their wishes, feelings, cultural background, and personal history. Staff used accessible formats, including Easy Read information and advocacy involvement, to support understanding and participation.

Most patients were detained under the Mental Health Act, and in these circumstances treatment was sometimes provided without consent. Staff followed the correct legal processes and ensured patients were kept informed of their rights. Staff supported patients to express their views and be involved in planning and reviewing their care as much as possible, maintaining a strong focus on rehabilitation and empowerment.