Cygnet Hospital Wyke

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

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 assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

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.

We reviewed 6 patient care records during this inspection, 4 for patients on Phoenix ward and 2 for patients on Bennu ward. We also reviewed a sample of patient notes, and observation and seclusion records.

Patients care plans were personalised and reflected individual needs and preferences. They included the patients’ goals for the future and considered their individual risks surrounding discharge planning. They demonstrated a holistic and recovery-oriented approach by covering a range of needs, including supporting patients to access the community whilst in hospital in a way that was meaningful to them.

Patient records also showed that comprehensive mental and physical health assessments took place in a timely manner at admission, and care plans and risk assessments were regularly reviewed and updated.

For patients who had been cared for in seclusion, medical and multi-disciplinary team reviews took place regularly and in line with guidance. Patients had appropriate seclusion care plans in place which supported their individual needs.

Most patient observation records documented observations relating to indications of the patient’s physical and mental state, interactions, and activity. All entries into these records clearly documented the observed signs of life.

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. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well

Patients had access to a range of appropriate care and treatment interventions delivered by a multidisciplinary team which demonstrated a commitment to supporting innovative ways of working. This team included nursing, psychiatry, psychology, occupational therapy, and social work professionals.

Both wards had access to dedicated occupational therapists who provided a variety of interventions which were tailored to the needs of each patient at that specific time. Staff explained to us how the occupational therapy programme was designed to support patients to develop a variety of skills to support their wellbeing and social interactions. Occupational therapy staff explained how they had observed from speaking with patients that social skills were one of the largest difficulties faced by patients after discharge, which contributed to difficulties maintaining employment opportunities and social circles.

Occupational therapy at the service had also been supported to implement the use of the ‘Vona du Toit Model of Creative Ability’ (VdTMoCA). This occupational therapy tool differs from more commonly used outcome measures as it also provides therapists with guidelines or principles to inform their interventions. The tool supported therapists to consider a patient’s mental, physical, emotional, social, and spiritual abilities within the context of their environment. Staff told us how this enabled more effective communication with patients and supported a person-centred approach to intervention.

Staff throughout the service told us the approach the occupational therapy team took, and the time they had taken to explain this to other staff, had "completely changed their understanding of the role of occupational therapy". They described occupational therapy staff as an integral part of the multidisciplinary team and told us how the knowledge they shared had been key in shaping how they supported and communicated with patients.

During our inspection of the service, we observed a group activity led by the occupational therapy team in an off-ward activity room. Patients from both wards engaged in the group activity and staff were supportive and encouraging. We observed the group to be well-planned, inclusive, and informed by evidence for good practice. Both wards also had access to an activities co-ordinator who delivered activities planned alongside the occupational therapy team.

Patients were supported to access appropriate physical healthcare. The service had a dedicated physical health nurse within the team who supported patients from both wards. The service also received visits from a dentist who held a regular clinic for service users on the hospital site.

Staff assessed patients’ food and drink needs. Where additional needs were identified specialist input could be arranged, care plans were updated, and staff were provided with specialist support and training as necessary. For example, staff had recently supported a patient at the service who had difficulty swallowing. They had consulted with a speech and language therapist for advice, and staff were supported by the physical health nurse to meet the patient’s needs.

Staff were supported to reflect on and develop their practice. The service had a clear process for managing staff performance, including where concerns had been raised regarding staff conduct. Staff received clinical supervision at least monthly and we saw evidence that some staff accessed this more frequently. These processes were described as supportive and aimed to consider staff wellbeing whilst also keeping patients safe.

On Bennu ward, we heard about a strong culture of supporting staff to develop their independence and confidence with decision-making. We also heard how closed circuit television (CCTV) was used to help staff reflect on their approach to supporting service users. Feedback from staff included that they found this to be a helpful way of learning and developing their practice.

Staff were also encouraged to reflect on good practice within their regular team meetings. These meetings provided a space where staff could raise any concerns about patient care or potential risks on the wards and proactively put plans in place to manage them.

Mental Health Act

97% of staff on Phoenix ward and 91% of staff on Bennu ward had completed their mandatory training in the Mental Health Act.

Information about independent mental health advocacy was clearly displayed around the ward for patients, and staff could explain the different between independent and generic advocacy services.

Patient records showed that staff explained patient’s rights to them, and some patients demonstrated a comprehensive understanding of their rights under the Mental Health Act. Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to the staff that needed access to them. Staff also had access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice.

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.

The teams on both wards had effective working relationships. Staff told us how they supported each other, and highlighted feeling able to approach their peers and members of the leadership team for support or with suggestions.

Both wards had regular team meetings and handovers which ensured staff had the information they needed took place at the start of each shift. An additional meeting took place at the start of each shift where staff discussed any recent changes with patients risks, needs, or care plans in more detail. During this meeting, action points were identified and assigned to staff on shift to ensure a distribution in responsibilities and support a team-based approach.

Staff at the service had also built effective working relationships with some teams outside of the organisation, including the local police and local authority safeguarding team.

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, reduce their future needs for care and support.

Patients were supported to live a healthy lifestyle. They had access to an on-site gym and walking groups facilitated by staff at the service. Patients were also offered a balanced variety of food options and meals which were prepared on-site.

The service had recently introduced a no-smoking policy on site. Whilst this change had presented some challenges with lighters being hidden on the ward by patients, staff had a clear plan in place to manage this safely. We heard how the change had supported some patients to stop smoking, and one patient told us how they felt one of the biggest benefits of being on the ward was that it had helped them to become healthier as they had switched from smoking cigarettes to using e-cigarettes.

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.

The service used recognised tools to assess and monitor patient outcomes. We saw evidence that the tools used were carefully selected to ensure they supported patient care effectively. The service had recently switched to using a formulation-based approach to assessing and planning for safety, in line with good practice guidance. Staff spoke positively about the change as it was continuing to be implemented for all patients at the service. They told us that it supported a more rounded approach to considering safety for patients and supported more personalised safety planning.

Service-level incident data was collected within the service's incident management system and regularly reviewed to identify potential areas for improvements with patient care.

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.

Patients were supported to make their own decisions wherever possible. Patients reported feeling able to tell staff about things they didn't like about their care, and most patients told us they felt listened to when they did this.

Decisions surrounding mental capacity took place on a decision-specific basis. Staff understood the need to make decisions in the best interests of their patients where they were assessed as lacking capacity. They told us how they would still try and reflect the patient's preferences within those decisions wherever possible.

Patients were able to access an Independent Mental Capacity Advocate, and staff demonstrated an understanding of when a referral to this service would be required or beneficial. Information for patients about their rights relating to their care and treatment was also clearly displayed on both wards.