Cygnet Hospital Woking

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• 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 reviewed all 6 quality statements in the effective key question. This means we looked for evidence that patients’ care, treatment and support achieved good outcomes and promoted a good quality of life, based on the best available evidence. At our last inspection we rated this key question as Good. At this assessment the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patients had a number of care plans in place and these were updated regularly. We saw examples of staff providing individualised care to patients. However, care plans were not always recovery orientated. We reviewed 16 care plans and found in 12 of those, they did not always set out the patient’s goals or the support they needed. They did not always include the views of patients and their carers and they were not always personalised with the patients’ needs and wishes recorded. Some patients told us they were not always involved in creating their care plans and had not been offered a copy. Other patients told us they did know what was in their care plan but felt they could be more simplified and more visual aids used and not just written information.

Qualified nurses or doctors completed a comprehensive mental health assessment of each patient either on admission or soon after. Assessment documentation was comprehensive and covered all relevant areas. This included an assessment of the patient’s capacity to consent to admission and treatment. Staff we spoke with were able to describe the assessment process. They were able to describe how they were informed of the outcomes of patient assessments and how risk management plans were then created. Staff we spoke with described how updated information on each patient was shared at handovers between shifts. Staff described how patient observation levels were assessed and reviewed daily.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Physical health screening was completed within 24 hours of admission, by either the doctor or nurse. Physical health assessments included baseline bloods and an electrocardiogram.

Multi-disciplinary discussions during the patients’ individual care reviews were supportive, there was appropriate discussion and challenge between team members, and the focus was on improving care and outcomes for the patients.

We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). These included medication and psychological therapies, as well as supporting daily living skills. The psychological therapies offered were tailored to the individual’s needs, and patients were offered both group and 1:1 session.

Ward teams included a range of specialists to meet the needs of patients. This included nurses, healthcare assistants, doctors, psychologists and occupational therapists.

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

Patient’s had access to a range of activities throughout the day, including weekends. We saw activities taking place as planned across the wards. For example, on Acorn ward staff regularly played group badminton with the patients and they could join in anytime they wished. We observed other patients dancing to music. However, some of the patients told us they would like more TV channels and access to online streaming services to be able to watch more movies and sports events.

Managers provided new staff with an appropriate induction. Staff told us they had received an induction, which included time to shadow staff on the ward before starting their role.

Staff received monthly clinical supervision. In these meetings they were able to discuss clinical cases, safeguarding, audits and learning.

Staff had completed their appraisal. This included discussions around staff member’s achievements and strengths as well as a development plan to help them progress.

Managers ensured that staff had access to regular team meetings. Team meetings were held monthly, and staff could attend in person, or remotely. Minutes from the meeting were saved on the hospital’s shared drive, which all staff accessed, and were also emailed to the team.

Provider policies were written in line with national guidance. There were governance structures at hospital and provider level to review and disseminate new guidance. Staff completed clinical audits to ensure compliance with relevant standards and guidance. Staff participated in clinical audit, benchmarking and quality improvement initiatives to make improvements to the service.

We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

Staff held regular multidisciplinary meetings to discuss patients and improve their care and outcomes. Each patient was reviewed by the full multidisciplinary team at least every two weeks. The responsible clinician, ward doctor, nurse, psychologist and occupational therapist all attended the meetings. At these meetings, staff reviewed the patients’ progress and made changes to their care and treatment, where needed.

Staff made sure they shared clear information about patients and any changes in their care and treatment or risk indicators. Nurses and healthcare assistants held a handover meeting at the start of each shift. The multidisciplinary team met each day to review risks and incidents. A flash meeting for senior staff across the hospital was held each morning. At this meeting, staff shared information about incidents, safeguarding, staffing, maintenance, patients enhanced observation levels, patients’ physical health, discharges, admissions and referrals and plans for the day. We observed the meeting and found conversations between colleagues to be friendly, supportive and engaging with appropriate challenge.

Staff we spoke with described a supportive multi-disciplinary team within the ward and told us that they worked well together. Staff were able to describe the processes for sharing information within the multidisciplinary team and with external professionals and services. They were able to discuss examples where they had worked collaboratively with staff, teams and services to deliver care and treatment and support patient’s future care needs.

There were clear processes and systems in place to support admissions, discharges and transfers of care. There were bed management and patient flow services at provider level that helped manage and facilitate this. There were clear pathways and referral procedures into the service. Staff worked with bed commissioners and local services to support discharge. Staff had access to policies and procedures to support transitions and pathways into and out of the service.

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives. For example, through participation in smoking cessation schemes, healthy eating advice and supporting with issues relating to substance misuse.

Staff assessed patients’ physical health needs and recorded them in their care plans. Staff completed checks of each patient’s pulse, temperature, weight, height and blood pressure each week. Staff wrote up detailed progress notes for each shift covering patients’ compliance with medication, food and fluid intake, personal hygiene and sleep.

Staff made sure patients had access to physical health care, including specialists as required. Patients were seen promptly by a doctor when they felt unwell or taken to an Urgent Treatment Centre or A&E, if required.

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

Patients we spoke with told us that their care and treatment was well coordinated and that felt well supported by staff. They told us that the care and treatment they received was helping them to improve their mental and physical health and well-being.

Staff used recognised rating scales to assess and record severity and outcomes; these were used for both mental and physical health outcomes. Staff were able to show how patients were progressing through their treatment.

Staff took part in clinical and benchmarking audits. They were supported by audit, assurance and performance monitoring teams within the service and wider organisation. Results from some audits and quality assurance processes were used to make improvements.

Staff used technology, for example accessing and storing medical results electronically where needed and the patients’ records were stored electronically which made information sharing easier and quicker.

Data on patient outcomes was reviewed and analysed within the hospital and provider wide governance structure and in external governance and performance meetings with commissioning bodies.

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

Staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions such as treatment and personal finances. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Family members were involved, where appropriate.

Staff completed mandatory training around the Mental Health Act and Mental Capacity Act. Staff we spoke with were able to describe the five principles of mental capacity and give examples of when capacity had been assessed and considered as part of care and treatment. The service regularly audited Mental Capacity Act compliance on the ward.