Cygnet Hospital Wolverhampton

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.

This is the first assessment for this newly registered service. This key question has been rated Good.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Good: 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. However, it was not always clearly recorded how people were involved in the assessment of capacity.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

We reviewed 5 patient care records. Staff completed a mental health assessment for all patients at admission. Staff also assessed patients’ physical health needs in a timely manner. We saw evidence that staff had completed physical examinations on admission and tailored treatment in response to this.

Staff developed care plans that met patient needs identified during assessment. They were comprehensive, person-centred and holistic. Staff discussed patient care and treatment regularly and updated care records following incidents and multidisciplinary review.

Patients we spoke with told us they could not remember being offered a copy of their care plan. It was also not recorded in care plans if they had been offered or provided to the patient. Patients were involved in care planning through ward rounds and patients could complete a ‘my say’ form prior to ward round either on their own or with support from staff. Staff told us if a patient chose not to complete a form they would try and involve them informally in general conversations whilst completing other activities or tasks. Patients told us that staff listened to them and explained their care and offered choices especially in relation to medication. Family told us that their relative was included in meetings and understood their plan of care.

There were examples in care plans of where communication needs had been taken in to account and support provided to ensure that patients were involved in their care and treatment.

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 suitable for the patients in the service. The team included a full range of specialists required to meet the needs of patients. As well as doctors and nurses, there was a full complement of multi-disciplinary staff including occupational therapists, clinical psychologists, social workers, activity coordinators, a family liaison worker and an expert by experience.

Staff provided a range of care and treatment which was in line with best practice and national guidance. A range of staff from different disciplines completed assessments and planned care and treatment well that met their psychological, medical and physical health needs. They used a range of assessment tools and offered a range of different therapies.

There was a comprehensive occupational therapy programme in place which offered a variety of recovery-based activities for patients. Patients were involved in planning activities relevant to their goals. These included activities that focused on daily living skills, healthy lifestyles, and social skills. Staff helped patients live healthier lives by supporting them to take part in programmes or giving advice. The hospital promoted healthy eating by encouraging a healthy diet. Some patients told us that they did not always like the food provided whilst others stated that the food was good and there was always a good variety. Catering staff took onboard feedback and would provide alternative for patients who did not like the first option. Patients were able to make their own food and drinks in the ADL kitchen on Shaw ward and had access to make hot drinks on Carter ward.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. Managers used results from audits to make improvements and discussed these with staff at team meetings. The percentage of staff that had an appraisal in the last 12 months was 94.7% with Shaw ward having 100% and Carter ward 96.7%. The percentage of staff that received regular clinical supervision overall was 97% and managerial supervision was 95%.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers recruited new staff who were caring and compassionate. They acknowledged that it had taken time for new staff to gain experience and confidence in their roles, however they had seen a significant improvement in staff responses to incidents on the ward and reduction in the use of restraint.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff told us they received specialist training which met the needs of patients and were confident that if they asked for additional training managers would support them with this. We saw there were progression opportunities with some of the leaders having worked their way up through various positions in the company. Examples given included a nurse having recently commenced their nurse prescribing and the Assistant Psychologist Development Programme course that the provider offered.

Managers ensured that staff had access to regular team meetings to provide feedback and discuss items related to the safe functioning of the ward.

Mental Health Act

98.6% of staff had received training in Mental Health Act Awareness.

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

Patients had easy access to information about independent mental health advocacy which was displayed in communal areas and discussed in ward rounds.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. Care records showed that advocacy support was requested if staff were unsure if the person had fully understood their rights.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. The service displayed a notice to tell informal patients that they could leave the ward freely. Patients told us that staff ensured that they received their leave and that they could always find staff to support them when needed.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.

Staff requested an opinion from a second opinion appointed doctor when necessary although we were told that there had at times been delays in this despite the hospital making timely.

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits in staff meetings and handover meetings.

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

Staff held morning communication meetings and handovers before each shift to discuss patients and improve their care. The communication meetings were recorded and took place with a range of staff from psychiatry, psychology, nursing and occupational therapy. These meetings were effective in discussing a range of issues including changes to clinical risk, incidents, changes in observation levels, leave, medication and patient views. We observed a morning meeting where staff were engaged and were able to discuss in detail each patient and any changes in their needs. We saw detailed handover notes which included a brief overview of the patient’s MHA status, presentation, concerns, risks and any actions to be taken. Issues related to the safe running of the service were also discussed including staffing, training and environmental issues.

Each patient had a multidisciplinary team meeting every 4-weeks where their care was discussed in detail, and their relatives and all professionals involved in their care were invited. People could attend virtually if they could not attend in person. We heard from a family member how the staff included them in updates and supported them to attend virtually if they could not be there in person. However, another carer stated they had not been updated on issues happening with their family member and had only been informed of a move once the person was on their way to another hospital. The service was aware of this, and we saw that the family liaison worker now liaised with family and carers on admission, discharge and during patients stay at the hospital.

We were told how staff worked with external agencies such as commissioners to ensure that a patient was fully supported upon discharge. The provider had developed links with charities and other support services within the community to support patients with more specialist needs such as substance misuse, or support around their immigration status.

The manager and senior clinicians attended regular regional meetings. Ward teams had effective working relationships with external teams and organisations. Staff told us they had positive working relationships with the local authority safeguarding teams and commissioners, a feeling shared by the commissioners we spoke to.

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.

Patients’ physical health needs were assessed and documented within care plans. These were routinely monitored and reviewed.

We observed that staff understood the importance of ensuring patients’ physical health needs were met with the physical health nurse taking an active role in patients’ care. Staff had appropriate training to ensure that they were able to effectively assess and monitor physical health needs and had access to other healthcare professionals. The physical health nurse had also carried out training for support workers so they could also carry out physical health checks when appropriate. Staff had been given Electrocardiogram (ECG) training to support them in monitoring patients’ health.

Patients had access to healthy snacks and drinks, health and wellbeing activities were available. There was an onsite gym on both wards with the larger gym on the second floor being accessible to all patients. Patients utilised the gym and told us that they felt fitter and stronger since being there.

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.

Managers told us they tracked complaints and compliments to monitor outcomes for patients. They also tracked patient feedback from other sources, for example, community meeting minutes and discharge surveys.

Staff discussed clinical audit findings in a monthly governance meeting and shared findings and learning across the service group. Managers used results from audits to make improvements and discussed these with staff at team meetings.

Overall compliance within the service was monitored through an analytics platform, a system that had recently been introduced to collate and analyse clinical and operational data. Although still in the early stages of implementation the system appeared to be enabling the service to provide data that supported evidence-based decision-making and the delivery of safe care.

We were told that the service used the GAP tool to measure discharge outcomes and track progress over time. This tool provided a quantifiable measure of recovery and functional development, enabling the team to track progress across multiple domains and to assess readiness for discharge. We saw in care plans detailed progression towards discharge and steps needed to achieve desired outcomes.

Staff used technology to support patients effectively such as the ECG machines and technology to help support patients with diabetes.

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

Staff we spoke to told us that they ensured that people fully understood what they were consenting to and the importance of obtaining consent and followed Cygnet procedure for assessing mental capacity in relation to this. However, we saw that assessments of patients’ capacity to consent to treatment, completed prior to admission, lacked detail on how people had been involved in the assessment.

Staff explained rights to patients detained under the Mental Health Act and ensured they understood them. Patients told us that they were regularly informed of their rights.