Cygnet Hospital Clifton

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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

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 the best available evidence. At the previous inspection, the service was rated requires Improvement. At this assessment, the rating has changed to good. The service had made improvements and is no longer in breach of regulations.

Patients received care and treatment that reflected current legislation, national guidance and evidence-based practice. A skilled multidisciplinary team worked collaboratively to support recovery and rehabilitation. Patients had access to a range of specialist interventions, physical healthcare support and occupational therapy programmes, and staff applied the Mental Health Act and Mental Capacity Act appropriately

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.

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.

Patients and, where appropriate, their carers were actively involved in assessment, care planning and treatment reviews. One patient told us, “I have been able to complete my care plan with my named nurse, and I was given a copy.” Another patient explained that any proposed changes to their care were discussed with them beforehand and that they felt involved in decisions affecting their treatment and recovery. 

We reviewed 8 care records and found assessments were comprehensive, person centred and regularly reviewed. Staff assessed patients’ physical health, mental health, emotional wellbeing, social circumstances, communication needs, risks, and recovery goals. Staff wrote care plans in the patient’s voice and reflected individual strengths, aspirations, and support needs. Staff updated records following incidents, changes in presentation and multidisciplinary reviews to ensure care remained responsive and relevant. 

Staff clearly identified and supported patients’ communication needs through the use of adapted information, easy-read materials, visual timetables, and personalised resources. Staff demonstrated a good understanding of how communication needs could affect engagement and participation and adapted their approach accordingly. 

Patients benefited from a holistic assessment process that considered both physical and mental health needs. Records demonstrated that full assessments were completed on admission or shortly afterwards, and patients were supported to access annual physical health checks and specialist services when required. Care planning remained focused on achieving meaningful outcomes and supporting patients to progress through the rehabilitation pathway. 

Families were encouraged to participate in care planning and reviews where appropriate and were provided with information, support and signposting to relevant services, including advocacy and carer support organisations. One relative told us, “I always feel involved and able to contact the service if I have any concerns or questions" 

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.

The service delivered treatment that reflected current legislation, recognised clinical guidance and the needs of the patient group. Staff used psychological formulations to understand the factors influencing patients' behaviours, risks and experiences, which informed treatment planning and supported a consistent approach to care across the multidisciplinary team.

Patients had access to a range of specialist psychological interventions appropriate to their needs, including Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), compassion-focused approaches, trauma-informed interventions and offence-related work where clinically indicated. These interventions supported patients to develop healthier coping strategies, improve emotional regulation and work towards their individual recovery goals.

Occupational therapy formed a key part of treatment delivery and focused on helping patients develop the skills required for greater independence and successful progression through the rehabilitation pathway. Patients were able to engage in practical and meaningful activities aligned to their individual goals and aspirations, including vocational opportunities, education, community-based activities, digital literacy and independent living skills development.

Staff encouraged patients to contribute to the development of therapeutic activities and rehabilitation opportunities through regular feedback, occupational therapy reviews and community meetings. Leaders demonstrated a commitment to ensuring patients had access to a minimum of 25 hours of meaningful therapeutic engagement each week.

We saw evidence of positive outcomes from treatment interventions. Staff were able to demonstrate how patients had developed confidence, practical life skills and greater independence as part of their rehabilitation journey. For example, staff supported 1 patient who had spent more than 20 years within prison and secure services to develop digital skills, use public transport independently and prepare for successful reintegration into the community.

Staff considered nutritional and hydration needs as part of treatment delivery. Staff monitored patients' dietary requirements and ensured individual health; cultural and dietary needs were met.

Mental Health Act 

Staff demonstrated a good understanding of their responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice. Mental Health Act training compliance was 96%, and staff had access to Mental Health Law Practitioner support, local policies, procedures and guidance to support the effective application of the Act.

Patients were supported to understand and exercise their rights throughout their admission. Staff explained patients' rights on admission and reviewed these regularly throughout their stay. Information about Independent Mental Health Advocacy (IMHA) services was readily available, and advocates played an active role in supporting patients to participate in ward rounds, Care Programme Approach (CPA) reviews, Hospital Managers' hearings and treatment discussions. During the reporting period reviewed, advocacy services completed 297 patient contacts, demonstrating that advocacy support was well established within the service.

Staff applied legal safeguards appropriately and ensured the requirements of the Act were followed in practice. Section 17 leave was managed in accordance with individual risk assessments and care plans, supporting patients to access community opportunities whilst maintaining safety and promoting rehabilitation. Where required, staff sought input from a Second Opinion Appointed Doctor (SOAD) and ensured consent to treatment arrangements complied with legal requirements.

Mental Health Act documentation, including detention papers, consent to treatment records and Section 17 leave documentation, was completed appropriately, maintained securely and readily accessible to relevant staff. For patients subject to Section 117 aftercare arrangements, care plans reflected ongoing aftercare needs and discharge planning requirements to support continuity of care following discharge.

Leaders maintained effective oversight of Mental Health Act compliance through regular audits, pharmacy reviews and governance processes. Findings were reviewed and used to support learning, continuous improvement and assurance that the Act was applied consistently and in line with statutory requirements. Overall, staff supported patients to understand their rights and applied the Mental Health Act appropriately to promote recovery, rehabilitation and safe progression through the care pathway.

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.

Patients and carers benefited from coordinated care delivered through effective multidisciplinary and multi-agency working. Staff worked collaboratively across nursing, psychiatry, psychology, occupational therapy, social work and support worker teams to ensure care remained consistent, responsive and focused on recovery. Team communication within the service was effective. Regular ward rounds, multidisciplinary team meetings, care reviews and handovers ensured staff shared information promptly, and that treatment plans reflected patients’ current needs, risks and recovery goals. We observed handovers taking place at the start of each shift and found these were structured, concise and effective, enabling staff to maintain continuity of care across both wards. 

We also observed a daily MDT handover attended by representatives from all clinical disciplines. The team reviewed incidents, safeguarding concerns, risks and significant events from the previous 24 hours and agreed to any immediate actions required. Key information was then shared across both wards to ensure staff had a consistent understanding of current issues, risks and priorities. This demonstrated a coordinated approach to communication and decision-making across the hospital. 

The service worked effectively with external partners, including commissioners, local authorities, advocacy services, community mental health teams, probation services, safeguarding teams, and MAPPA. These partnerships supported care planning, risk management, progression and discharge planning, helping patients move safely through the rehabilitation pathway and towards successful community reintegration. 

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.

Staff supported patients to manage their physical health, mental wellbeing, and recovery as part of a holistic approach to care. Patients had access to GP services, annual health checks, specialist referrals, smoking cessation support, physical health clinics, and routine physical health monitoring. Staff worked proactively to identify emerging health concerns and ensured patients received timely intervention and treatment where required. 

Promoting healthier lifestyles formed an important part of the rehabilitation pathway. OT and ward-based activities supported patients to improve their physical wellbeing, develop healthy routines, and increase community participation. Staff ensured patients had access to activities including cooking, gardening, community engagement opportunities, health and well-being groups and programmes designed to build confidence, independence and life skills. 

Kitchen staff prepared fresh meals on site, and patients had access to a varied menu that reflected individual preferences, dietary requirements and cultural needs. Staff encouraged healthy lifestyle choices whilst respecting personal choice and autonomy. Patients spoke positively about the quality and variety of food available and told us healthy options were consistently offered. 

Leaders maintained oversight of physical healthcare arrangements through governance processes and physical health audits. Leaders introduced monthly National Early Warning Score 2 (NEWS2) audits to strengthen monitoring and assurance processes, supporting the early identification and management of physical health deterioration. 

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.

There were effective approaches to monitor patient’s care and treatment and their outcomes. The service routinely monitored patients' progress, treatment effectiveness, and recovery outcomes using a range of recognised assessment tools and outcome measures. These included the Health of the Nation Outcome Scales (HoNOS), Goal Attainment Progress (GAP), Dialog+, Recovering Quality of Life (ReQoL) and the Model of Human Occupation Screening Tool (MOHOST). These measures enabled staff to evaluate progress, identify areas requiring additional support and ensure interventions remained focused on individual recovery goals. 

The MDT regularly reviewed outcome measures and these and informed care planning, risk management, Care Programme Approach (CPA) reviews, rehabilitation planning, and discharge decisions. OTs used the MOHOST to assess occupational functioning, motivation, routines, independence skills and the impact of environmental factors on recovery. Staff described how these assessments supported patients to progress through the rehabilitation pathway and increase their independence. 

People who used the service consistently experience positive outcomes. These met agreed expectations as set out in legislation, standards and evidence-based clinical guidance. Staff supported patients to develop practical life skills, engage in education and vocational opportunities, access community environments and increase their confidence and independence. Staff were able to demonstrate examples of patients progressing towards less restrictive environments and preparing for successful discharge into the community. 

Leaders maintained oversight and outcomes through a comprehensive programme of audit and governance activity. This included care plan audits, NEWS2 audits and complaints audits, Audit findings were reviewed through governance meetings and used to develop action plans and Improve outcomes for patients.

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 supported patients to participate in decisions about their care and treatment wherever possible and promoted a person-centred approach to decision-making. Care records demonstrated that patients were actively involved in care planning, treatment reviews and discussions about their recovery goals. Patients told us they felt included in decisions affecting their care, with one patient explaining that staff discussed proposed changes to treatment with them before decisions were made.

Staff demonstrated a good understanding of consent, capacity and patients' rights. Where patients required additional support to participate in decision-making, staff made reasonable adjustments to maximise involvement. For example, staff used easy-read materials, visual resources, personalised schedules and adapted communication methods to help patients understand information and express their views, wishes and preferences.

Where a patient's capacity to make a specific decision was in question, staff completed and documented decision-specific capacity assessments in line with the Mental Capacity Act 2005. When patients lacked capacity, staff followed best-interest decision-making processes and consulted with relevant professionals, advocates and family members where appropriate. Records demonstrated that staff considered patients' wishes, beliefs, preferences and individual circumstances when making decisions on their behalf.

Patients had access to advocacy services to support them in understanding their rights and participating in decisions about their care and treatment. Staff worked collaboratively with advocates, family members and other professionals to ensure that patients who experienced communication difficulties or were unable to express their views independently were still involved in decisions affecting their care, treatment and future plans wherever possible.

All patients at the service were detained under the Mental Health Act 1983. Staff demonstrated a good understanding of their responsibilities under the Act and ensured patients were informed of their rights in a way they could understand. Records showed that Section 132 rights were explained on admission and reviewed regularly thereafter, including following changes in legal status, treatment plans or Responsible Clinician arrangements.

Mental Health Act documentation, consent to treatment records and Section 17 leave documentation were appropriately completed, maintained and audited. We reviewed these records and found no concerns. Overall, staff applied the principles of consent, capacity and legal safeguards appropriately, ensuring patients remained at the centre of decision-making and were supported to exercise choice, autonomy and control wherever possible.