Cygnet Hospital Stevenage

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The service had a risk register that was regularly reviewed to keep patients safe. Policies were in place to support equality amongst staff and patients. There were individual policies related to supporting transgender staff, shared parental leave, menopause, and equality and diversity.

The service understood their duty to work in partnership, so services worked seamlessly for people.

However, the service did not always create a positive culture where people felt they could speak up and their voice would be heard. Staff reported feeling unable to report incidents and concerns about staffing.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service promoted equality, diversity and inclusion, and had a strategy to enable them to achieve this.

Policies were in place to support equality amongst staff and patients. There were individual policies related to supporting transgender staff, shared parental leave, menopause, and equality and diversity.

There was also a corporate discrimination group.

Leaders ensured there was a vision, mission and values which were shared with staff at induction. Staff completed training in equality and diversity.

The provider also had a 5-year strategy, it included short- and long-term goals with a plan of how to achieve them.

However, not all staff said they felt respected, valued and supported.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and supported and embodied the culture and values of their workforce and organisation. They had the skills, knowledge and experience to lead effectively.

Staff told us clinical managers were visible within the service and that they knew the patients well.

In the 2025 staff survey 80% of staff said that their manager took an interest in their health and wellbeing.

Induction, supervision and training records were up to date. Leaders had regular and ongoing support and access to ongoing development.

A senior management team ‘snack and chat drop in’ session was held bimonthly and different members would be available to communicate with staff.

The service did not always create a positive culture where people felt they could speak up and their voice would be heard.

In the last 12 months the service received 4 whistleblowing concerns. Themes were work culture, staff safety, staff misconduct and patient care. None of these were upheld.

However, in the recent staff survey which concluded in June 2025 55% of people said they felt they would be listened to if they raised a concern and 61% of people said they felt there were enough staff at the unit to enable them to do their job. The survey had an action plan which demonstrated actions to be taken to improve this.

Some staff told us they were concerned about not feeling able to report low staffing levels.

The wards displayed visual posters about the 3 freedom to speak up guardians.

Feedback from carers was that there were gaps in being able to make a complaint.

The service told us they valued diversity in their workforce and tried to work towards an inclusive and fair culture.

The service employed a diverse team of staff from international backgrounds. Managers said the service did not discriminate against staff from minority groups. However, the recent staff survey in 2025 showed that 17 staff reported discrimination from managers and 24 staff said they were discriminated against by other colleagues. The survey had an action plan which demonstrated actions to be taken to improve this.

Staff and leaders gave examples of how equality and diversity were actively promoted within the service.

The service ensured it provided sexual harassment training for staff.

At the time of inspection, 100% of staff had completed training in equality and diversity. Ninety nine percent of staff had completed The Oliver McGowan Mandatory Training on Learning Disability and Autism.

The service had clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The service had a risk register in place with mitigations in place to help reduce risks. These risks were discussed within governance meetings alongside other issues including incidents, staffing, staff training and safeguarding. Each area was discussed in detail and where required, appropriate actions were put in place, which were then reviewed at the next meeting. Staff completed audits to provide assurance and made improvements where required.

Managers and staff attended governance meetings held monthly to maintain transparency. Key performance indicators and monthly audit processes were in place to help give oversight to the service to managers. Managers we spoke with were able to describe the governance and reporting structure at ward and hospital level.

All staff told us they were involved in auditing.

However, HR systems had merged and this meant it was difficult to find older HR files and DBS checks for staff who had been in post for some time.

There was a new system where referrals for admission were being reviewed centrally by an admission team. Staff told us that this sometimes impacted the level of information the service received, making it difficult to ensure the level of necessary care required. This was a pilot process and was being reviewed regularly.

We saw within clinical governance meeting minutes there had been 3 information governance breaches within the last 3 months. The appropriate process was followed, duty of candour completed, and lessons learnt identified and shared.

The service understood their duty to work in partnership, so services worked seamlessly for people.

Patients were encouraged to stay in touch with relevant healthcare professionals / teams from their local areas. Staff routinely invited relevant professionals to MDT meetings to discuss progress and discharge. Patients we spoke with knew they could speak freely to staff, ward managers and the hospital manager.

The service worked well with other agencies including commissioning bed managers, health and social care professionals, the police and the local authority safeguarding team. For example, the safeguarding lead held regular meetings with the local safeguarding team and the police.

The service encouraged continuous learning, innovation and improvement. Staff were given the time and support to consider opportunities for improvements and innovation and this led to changes.

There was a focus on continuous learning, innovation and improvement across the organisation. The service had a positive and robust approach to improvement and learning from incidents and all staff we spoke to were able to give us good examples of where lessons had been learnt and changes made after incidents.

Staff told us that Closed Circuit Television (CCTV) footage was reviewed after every incident of restraint and there were preventative management of violence and aggression (PMVA) leads who could provide a second level of oversight on this.

The service had Continuous Professional Development (CPD) events every month where staff were encouraged to identify subjects to discuss.

Psychology staff were working on research within reflective practice and outcomes for staff.

The service maintained its Triangle of Care Star 1 this year. The Triangle of Care is a quality improvement scheme for health and social care providers that promotes safety, recovery and wellbeing by including and supporting unpaid carers.

The service was awarded the Quality Network for Psychiatric Intensive Care Unit (QNPICU) Accreditation.