Cygnet Hospital Wyke

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• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff we spoke with demonstrated an awareness of the providers vision and values. They told us about the key principles guiding the service's approach, such as delivering person-centred care and working towards least restrictive practice. Staff and patients were involved in a range of forums where they were able to provide feedback on care in relation to these key principles.

Leaders at the hospital could explain how they were working to deliver high quality care within the budgets available. They also worked to engage with staff to support their contributions to the development of the service.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of how the different wards worked to support patients with different needs and could explain clearly how staff teams were working to provide high quality care.

Leaders throughout the service were visible and staff we spoke with described them as approachable and having an ‘open door’ policy.

When we spoke with senior leaders at the service, they were not aware of some of the concerns staff shared with us during our inspection regarding the admissions process. However, when we reviewed the minutes of a sample of recent staff forums and team meetings, we did not see evidence that staff had formally escalated these concerns previously. Immediately following our inspection, senior leaders at the service met with staff to explore their concerns in more detail and to provide staff with additional clarity on the process.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients were able to give feedback on the service in a variety of ways which reflected different preferences and individual needs. Methods of feedback available for patients ranged from giving verbal feedback to staff to attending corporate meetings to share their views. The carers we spoke with told us they did not know about a formal procedure for giving feedback to the service however they told us they would feel comfortable sharing feedback with staff when requested or required, including if they had concerns.

Managers at the service had access to patient and carer feedback and this was used to inform improvements. These improvements included ‘every day’ aspects of life on the ward such as improving the quality of personal hygiene items available to patients. Staff spoke with compassion and respect about how they felt it was important to action feedback that related to these quality of life areas and not just focus on feedback surrounding more clinical parts of the care provided.

Staff at the service could provide feedback in a variety of staff meetings and forums. Staff we spoke with told us they felt able to raise concerns with leadership and mostly felt their concerns were taken seriously.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders at the service worked to support an inclusive and fair culture for staff. Staff we spoke with told us about how the service had been supportive of circumstances relating to their personal lives and some staff described adjustments that were in place to support these. This included the ability to apply to work flexibly to account for personal circumstances such as caring responsibilities and health issues.

Staff could access a variety of equality networks which operated across different Cygnet Health sites including a 'multicultural network', 'women's network', 'disability network', 'LGBTQ+ network', and a 'carers network'. Information on these networks was provided to staff by the service.

The service also hosted themed cultural events where staff and patients could celebrate and share their knowledge and experience of different cultures.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings. We saw agendas and minutes from a variety of governance and ward team meetings which demonstrated clear and consistent structures, and ensured that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff had implemented recommendations from reviews of incidents, complaints, and safeguarding alerts at service level. Staff also undertook or participated in a variety of ward-level and service-wide clinical audits. Regular audit topics included the use of pro re nata (as needed) medications, Mental Health Act documentation, Mental Capacity Act documentation, care plans, safety formulations, and the ward environment. We heard from staff on Bennu ward how they had recently changed the structure of their weekly audits to allow time for any actions to be completed over a weekend when staff had more availability. They told us this had improved the responsiveness of the team when actions were identified.

The service used systems to collect data from wards on a variety of topics, including incidents, which was regularly reviewed. Staff conducted reviews which aimed to identify patterns and trends indicating areas for improvement. Leadership regularly reviewed this data as part of ensuring the safe and effective operation of the service. Staff did not report any concerns with the administrative requirements relating to reporting this data.

Staff had access to the equipment and information technology (IT) needed to do their work. The IT infrastructure, including the telephone system, worked well and was regularly developed to help improve the quality and safety of care. Staff we spoke with shared their excitement surrounding the upcoming introduction of an electronic prescribing system. They told us about the plans in place to support its smooth implementation and could describe the intended benefits for efficiency and safety in prescribing and dispensing medications.

Information governance systems included confidentiality of patient records.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The service had a clear pathway for patient feedback to ensure that patient's voices were heard throughout hospital and corporate governance spaces. Patients were supported to attend a monthly 'people's council' where patients were able to share feedback to inform service development. Feedback like this was used by the service to help make improvements. For example, the service had invested into improving its social spaces for patients which had improved patient access to recreational activities outside of those which were regularly scheduled.

Staff at the service told us how they worked with external agencies to build positive working relationships. For example, they had recently established a formal link with the local police which staff told us supported information sharing and risk management.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

We saw evidence of continuous learning, improvement, and innovation during our inspection of the service.

Staff we spoke with told us how innovative practice within the occupational therapy team had been particularly well-supported. We also heard about a significant amount of work underway on Bennu ward as part of pursuing accreditation with the Quality Network for Psychiatric Intensive Care Units at the Royal College of Psychiatrists. Work had included projects ranging from patient involvement in staff interview panels to the re-decoration of the multi-faith room where patients had designed and been involved in painting the space. Work was also ongoing at the service to pursue the Triangle of Care accreditation which focuses on support for carers.