Cygnet Hospital Harrogate

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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last inspection we rated this key question good.

At this inspection the rating has remained good.

The service had access to a full range of multidisciplinary professionals and specialist services to meet patients' needs, and staff were well supported through supervision, appraisal and training, with compliance rates meeting organisational targets. Effective MDT working, handovers and collaboration with internal and external services supported coordinated care, and stakeholders described staff as knowledgeable, kind and thorough. Patients were supported to maintain their physical and mental health through a range of therapeutic interventions, physical health monitoring and recognised assessment tools. Patients were offered meaningful activities, community access opportunities and a choice of healthy, culturally appropriate food. Staff supported patients to make decisions wherever possible and completed appropriate capacity assessments.

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 scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive health assessment and safety formulation as soon as possible after admission, usually within 24 hours of admittance and then a more comprehensive one within 2 weeks involving the multidisciplinary team (MDT).

We viewed 7 care records that demonstrated staff developed care plans with the patients that met their needs identified, during assessment.

We attended a ward round with a mix of MDT staff, as part of our inspection, where a patient’s financial and spiritual needs were discussed, along with coping strategies.

Medication was discussed and explained in terms of the type and amount prescribed. A nurse had offered to bring leaflets and to discuss these with the patient on a one-to-one basis, after the meeting, to help inform their choice. Physical health checks were also raised.

We also attended a morning meeting, called a board round, for Sanctuary ward, with a mix of different staff including a consultant, doctors, OT, nurse, psychologist, assistant social worker and medical secretary. Each patient was discussed in turn regarding physical health, observations and risk and the safety formulations and care plans were checked and updated where necessary.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s 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.

The team included, or had access to, the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, patients could access others such as a dentist, speech and language therapist and a urologist or neurologist.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided staff with supervision, both clinical and managerial. These were meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development. All clinical departments were at 92% compliance with clinical supervision, and managerial supervision compliance was 91%. The percentage of staff that had an appraisal completed in the last 12 months was 90%. All were in line with or above the target set by the organisation.

Managers ensured that staff had access to regular team meetings. They identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge and ensured that they received the necessary specialist training for their roles.

Mental Health Act

Staff received training in the Mental Health Act, and the overall compliance rate was 95%. Staff had a good understanding of the Mental Health Act, the code of practice and the guiding principles. Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrator was. The provider had relevant policies and procedures that reflected the most recent guidance and staff knew how to access these.

Patients had easy access to information about independent mental health advocacy. However, from speaking with patients and stakeholders, there were at times some uncertainty with the roles of the Independent Mental Health Advocates (IMHA) and those provided by the service which meant patients could not easily distinguish between the provider’s advocate and the IMHA. The service mitigated this by ensuring all detained patients had an automatic referral to an IMHA. This had, however, increased the caseloads of the organisation providing this independent advocacy service, resulting in more advocates needing to be trained.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records, (for example, Section 17 leave forms), correctly, so that they were available to all staff that needed access to them. The service displayed a notice to tell informal patients that they could leave the ward freely. Regular audits were carried out to ensure that the Mental Health Act was being applied correctly.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings (MDT) and shared information about patients at effective handover meetings within the team (for example, shift to shift). From our observations the team worked together well, sharing information and risks and discussing strategies for supporting patients. It was clear that the team knew patients well.

Staff told us they had observed that student nurses in Harrogate on rotation, or new starters, were very well supported, given tours around the hospital and a full handover explaining risks, observations and leave.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation (such as, care coordinators, discharge teams, and specialist teams). Stakeholders did feedback that, at times, patients did not get to know in advance when their ward round was so had little or no time to prepare if an advocate was not involved.

Further stakeholder feedback praised the way staff conducted their MDT meetings; that they were ‘brilliant’ and that they had ‘immense knowledge of the patients’. They were also described as ‘kind and thorough.’ When people moved between different services, details were shared where needed, including care plans for stepdown services.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

As part of the activity planning process, patients were given choices of activities to participate in, for example, three different choices on a particular day, so that they could choose what suited them. The options included a green walk, chair yoga, shop and cook, playing badminton on the hospital grounds and attending the gym or the tennis courts, in the community.

The hospital made sure that patients had choice with food, offering variety and healthy and culturally appropriate options. Patients reported that the food was good, and it met their dietary and cultural needs. Fruit was always readily available in the patient’s kitchens.

There were smoking cessation initiatives in place. External referrals were made to drug and alcohol services, where applicable.

Care records evidenced that patients were supported to manage their physical and mental health. Food and fluid monitoring was documented.

Therapy was available for those patients who were anxious about going out into the community. Graded exposure, (a type of therapy which is a structured, step‑by‑step method where feared situations are met in a planned hierarchy from least to most distressing), was offered to enable them to access this in a safe and supported way.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s 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 people themselves.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes.

Food and fluid charts were used by staff to monitor patients’ nutrition and hydration needs. Staff used rating scales to monitor physiological status and to identify deteriorations such as National Early Warning Score (NEWS) 2.

Clozaril bowel monitoring was carried out for those patients prescribed anti-psychotic medication. Patients using neuroleptic (anti-psychotic) drugs had a LUNSERS (Liverpool University Neuroleptic Side Effect Rating Scale) form filled in (this is designed to help clinicians assess side effects associated with antipsychotic drug use).

There was also an assessment tool (LESTER) used to check cardiovascular conditions, such as diabetes and high blood pressure, and metabolic risk. The Global Assessment Programme (GAP) was used to measure functioning, including psychological and social, and Waterlow scale was used to identify risks, such as diabetes and included BMI monitoring.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions.

For patients who may have had impaired mental capacity, staff assessed and recorded capacity to consent appropriately.

They did this on a decision-specific basis regarding significant decisions and not as a blanket lack of capacity overall. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

We checked patient records and capacity assessments were carried out, were both time and decision specific and recorded appropriately. Advocates confirmed that they had been invited to and attended best interest meetings.

We reviewed 7 care plans and there was clear evidence of rights being explained and recorded.