Cygnet Hospital Clifton

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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 the previous inspection, this key question 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.

Leaders had strengthened governance, oversight and quality assurance arrangements since the previous inspection. Staff described leaders as visible, approachable and supportive and felt positive about the direction of the service. Governance systems supported effective oversight of risk, performance, incidents, safeguarding activity and patient outcomes.

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.

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.

The service had a clear vision and shared culture that was centred on recovery, rehabilitation and supporting patients to achieve greater independence. Staff consistently described a shared commitment to delivering person-centred care and helping patients progress through the rehabilitation pathway. The provider's values of Trust, Integrity, Care, Respect and Empowerment were reflected in daily practice and were understood by staff across all disciplines.

Staff understood the purpose and direction of the service and were able to describe how their roles contributed to improving patient outcomes, promoting recovery and supporting successful discharge. Multidisciplinary teams worked collaboratively towards shared goals and demonstrated a consistent approach to care, treatment and rehabilitation.

Leaders promoted a culture that valued equality, diversity, inclusion and respect. Staff understood the importance of delivering care that recognised patients' individual needs, experiences and backgrounds. Equality and inclusion initiatives formed part of wider service improvement activity and supported the development of a culture where patients and staff were treated fairly and respectfully.

The service had made significant progress since previous inspections, particularly in relation to workforce stability, governance arrangements and service culture. Staff spoke positively about teamwork and described a strong sense of collective purpose. They told us there was a culture of collaboration, accountability and continuous improvement that supported both staff wellbeing and positive patient outcomes.

The culture of the service encouraged learning, reflection and continuous improvement. Staff felt able to contribute ideas, discuss concerns and participate in service development, supporting an environment where feedback was valued and used to improve the quality of care provided.

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 lead the service effectively. They demonstrated a strong understanding of the service; the needs of the patient group and the risks associated with delivering care within a specialist low secure environment. The Hospital Manager was able to clearly describe current risks, quality improvement priorities, safeguarding concerns, staffing arrangements, governance systems and future service developments.

Leaders were visible, approachable and supportive. Staff told us leaders maintained a regular presence across both wards and were accessible when support, guidance or advice was required. The Hospital Manager described a leadership style focused on being visible, present and available to support both staff and patients. Staff interviews confirmed this approach and highlighted positive relationships between frontline teams and service leaders.

Leaders promoted learning, development and career progression. Staff had access to apprenticeships, preceptorship programmes, leadership development opportunities and additional specialist training. The Hospital Manager encouraged staff to pursue career development opportunities and supported training requests wherever possible. Staff told us they felt valued and supported to develop their skills and progress within the organisation.

Leaders acted with integrity, openness and honesty. During the assessment, they spoke transparently about medicines incidents, environmental issues, equality and inclusion matters and incidents involving racist abuse towards staff. Leaders were able to describe actions already implemented and areas requiring continued improvement. This transparency increased our confidence in leadership oversight and the effectiveness of quality assurance arrangements.

Leadership arrangements remained stable despite organisational changes. Leaders had managed transitions within the senior leadership team effectively and maintained continuity of oversight, support and governance throughout periods of change.

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.

The service fostered a culture where staff felt able to speak up and were encouraged to raise concerns, provide feedback and contribute ideas for improvement. Staff told us they felt comfortable approaching managers and senior leaders with concerns and were confident that issues raised would be listened to and acted upon appropriately.

Staff had access to multiple routes for raising concerns. Freedom to Speak Up (FTSU) information was clearly displayed throughout the hospital and included contact details for the local FTSU Lead and the organisational FTSU Guardian. Staff also had access to whistleblowing procedures, organisational reporting systems and direct management support, providing a range of options for sharing concerns, seeking advice or escalating issues.

Leaders promoted an open and transparent culture and described FTSU as an important mechanism for enabling staff to raise concerns confidentially or anonymously where required. Staff had access to guidance explaining the purpose of FTSU, common barriers to speaking up and the support available to those raising concerns.

Leaders listened to concerns and used feedback to support learning and improvement. Themes identified through Freedom to Speak Up processes were reviewed through governance arrangements and escalated through regional and organisational structures where appropriate. The Hospital Manager described a culture focused on openness, learning and finding solutions rather than attributing blame.

Staff told us they felt supported to speak up and were aware of the processes available should they wish to raise concerns about patient safety, quality of care or workplace issues. These arrangements supported a culture where staff voices were heard and concerns could be raised without fear of disadvantage.

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.

The evidence showed a good standard. The service valued diversity within its workforce and worked to promote an inclusive and fair culture where staff were respected, supported and able to thrive.

Leaders demonstrated a strong commitment to equality, diversity and inclusion and had established arrangements to support an inclusive, respectful and supportive working environment. Staff completed equality, diversity and inclusion training and were familiar with the organisation's values of care, respect, empowerment, trust and integrity. Equality and inclusion matters were monitored through governance arrangements and staff engagement activities.

Staff told us they felt respected, supported and valued by leaders and colleagues. The service promoted diversity through staff engagement initiatives, awareness events and recognition programmes for different professional groups. Staff also had access to a range of organisational support networks, including multicultural, LGBTQ+, disability, women's and men's health networks, alongside wellbeing resources available through the employee assistance programme.

The organisation supported equality and inclusion through designated equality champions, participation in organisational steering groups and ongoing staff development opportunities. Leaders encouraged staff from all backgrounds to share experiences, contribute ideas and participate in service development and quality improvement activities.

Some staff described experiencing racist abuse from a small number of patients. Leaders acknowledged these concerns and responded proactively through a range of measures designed to support staff and promote respectful behaviour. These included educational sessions with patients, work in partnership with local community police officers and reinforcing expectations regarding acceptable behaviour. Staff told us leaders took these concerns seriously and were taking action to improve staff experiences and wellbeing.

Overall, staff described a culture that was supportive, inclusive and respectful, and told us they felt able to be themselves at work and contribute positively to the service.

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.

Leaders had clear responsibilities, roles and systems of accountability that supported the delivery of safe, effective and sustainable care. Governance arrangements were well established and operated through ward, hospital, regional and organisational governance structures. These systems enabled leaders to identify, monitor and respond to risks, themes and performance issues in a timely manner.

Leaders used information about risk, performance and outcomes to support decision-making and service improvement. A comprehensive programme of audits and quality assurance activities provided oversight of key areas, including medicines management, controlled drugs, National Early Warning Score 2 (NEWS2), care records, observations, Closed Circuit Television (CCTV), complaints, environmental standards and restrictive practice. Leaders reviewed audit findings regularly and monitored actions through governance processes to ensure improvements were implemented and sustained.

Leaders maintained effective oversight of quality and safety through timely performance information and service data. Governance systems enabled leaders to identify emerging risks, monitor trends and maintain oversight of improvement activity across the hospital. Staff and leaders were able to describe how information was used to support service development and improve patient outcomes.

Information governance arrangements were robust and ensured confidential and sensitive information was managed securely and appropriately. Staff understood their responsibilities in relation to information governance and records management, and governance arrangements provided assurance that information was stored, shared and protected in line with organisational requirements.

The service demonstrated a commitment to continuous quality improvement and sustainable service development. Governance systems supported learning, accountability and ongoing improvement, helping leaders maintain oversight of quality, safety and performance across the service.

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 worked effectively with commissioners, local authorities, advocacy providers, probation services, MAPPA, community services, safeguarding teams and healthcare providers. 

Discharge planning involved close collaboration with partner agencies. Weekly meetings with commissioners enabled active monitoring of progression and discharge pathways. 

Triangle of Care Star 1 Accreditation recognised the service's work to involve carers and strengthen family communication.

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.

The service demonstrated a strong commitment to learning, quality improvement and innovation. Leaders used information from incidents, audits, complaints, safeguarding concerns, patient feedback, outcome measures and governance reviews to identify opportunities for improvement and strengthen the quality of care provided.

Learning from incidents, complaints, safeguarding concerns, audits and quality reviews was routinely shared with staff through team meetings, supervision, governance forums, leadership drop-in sessions, policy updates and safety communications. These arrangements supported a culture of openness, reflection, accountability and continuous improvement.

Leaders were able to demonstrate how learning had resulted in improvements across the service. Examples included strengthened medicines management arrangements following previous medicines incidents, improvements in physical healthcare monitoring through enhanced National Early Warning Score 2 (NEWS2) oversight, enhanced observation practice supported by Closed Circuit Television (CCTV) auditing and environmental improvements identified through cleaning and quality assurance audits.

The service demonstrated innovation in the delivery of rehabilitation and recovery-focused care. Occupational therapy was a particular strength and supported patients to develop independence, confidence and practical life skills through education, vocational opportunities, community integration activities, digital literacy programmes and personalised rehabilitation plans. Staff also promoted least restrictive practice by increasing access to technology, community leave, meaningful activity and individually tailored rehabilitation opportunities wherever appropriate.

Leaders were actively engaged in the Patient and Carer Race Equality Framework (PCREF) and had implemented actions aimed at improving experiences and outcomes for patients from diverse backgrounds. This work supported the service's wider commitment to equality, inclusion and person-centred care and ensured that patient and carer voices informed ongoing service development.

The service demonstrated a commitment to continuous learning and sustainable improvement. Information gathered through governance processes was used to strengthen practice, improve patient experiences and support positive recovery outcomes. Leaders used learning not only to address identified concerns but also to further develop innovative and effective approaches to patient care and rehabilitation.