Cygnet Hospital Sheffield

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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 best available evidence. At our last assessment we rated this key question good. At this assessment the rating has remained good.

Staff assessed the physical and mental health of all patients on admission. They developed robust individual care plans which were reviewed regularly through multidisciplinary discussion and updated when needed. Staff provided a range of therapeutic treatments and care for patients based on national guidance and best practice. The ward team had access to the full range of specialists required to meet the needs of patients on the ward at all times. Staff from different disciplines worked exceptionally well 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 and discharged these well. This meant young people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive, including external professionals and young people.

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 scored the service as 3. The evidence showed a good standard. The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them. The service had a very robust assessment process in place that ensured that assessments were holistic and encompassed all mental and physical needs of the young people.

Admissions were well-managed and appropriate; due regard was given to the mix of patients prior to admission. Admissions had been refused if deemed unsafe from clinical judgement and this was supported by hospital management in order, “to protect the service, the children and young people, the physical environment, the therapeutic environment, and the staff”. Carers fed back that young people were actively involved in the assessment process, being encouraged to consider their care and treatment as a, “partner and not a passenger”.

We looked at 9 care records during this inspection which showed that staff completed a comprehensive mental health assessment of young people in a timely manner at, or soon after, admission. Staff assessed young people’s physical health needs in a timely manner and ensured ongoing physical health oversight from a GP that visited the ward weekly. Care records evidenced that staff developed care plans that met young people’s individual needs identified during assessment and did so alongside the young person and their families. Care plans were personalised, holistic and recovery-oriented with evidence of the young persons’ voice throughout. Staff had updated care plans when necessary and these were dynamic, live documents. Young people had the ability to update their own care plans and add additional comments to their care plans when they wished. This helped bring their voice to the forefront.

Care records were robust and identified risks to both the young people and others, discharge planning and considerations for discharge to ensure these were done safely, physical health plans, Section 17 leave care plans and evidenced multi-agency discussions and collaboration throughout all 9 records. All records included the views of the MDT, carers and young people. All disciplines shaped care plans to ensure wrap around support was offered from admission to discharge.

We scored the service as 3. The evidence showed a good standard. The service always 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. They worked to develop 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.

Staff provided a range of care and treatment interventions suitable for young people. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. This included medication and psychological therapies, activities, access to education and intended to help young people acquire the necessary skills to succeed in their treatment, whilst maintaining their ability to access education required. The service had ensured that young people always had good access to physical healthcare from a GP that visited the ward weekly, including access to specialists when indicated. All three wards had a full MDT establishment with specialists. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group and spoke passionately about the care they delivered.

The service had ensured that the school within the service (rated Outstanding by OFSTED) that provided education was accredited to the National Autistic Society and all wards had accreditation with the Triangle of Care (The Triangle of Care is a therapeutic partnership framework developed by the Carers Trust to improve safety, support recovery, and sustain wellbeing in mental health care. It involves a three-way partnership between the patient, the staff member, and the carer). There were Triangle of Care monthly meetings. These meetings involved Family Liaison Officers, Family Therapists, Quality Lead and Practice Development Nurses. These fed into the Local Clinical Governance Meeting which fed into Regional Governance Meetings.

Staff participated in clinical auditing to ensure high quality care, records and outcomes were consistent and regular benchmarking and quality improvement initiatives, working alongside the Provider Collaborative. Managers also provided new staff with appropriate induction using the care certificate standards as the benchmark for healthcare assistants and ensured both bank and agency staff had the appropriate skills and training to carry out their roles.

Managers provided staff with regular monthly supervisions and gave appraisal of their work performance. Pegasus staff had a clinical supervision rate of 97%, quarterly manager supervision rate of 97% and a safeguarding supervision rate of 97%. The annual appraisal rate was 100%. Unicorn staff had a clinical supervision rate of 88%, quarterly manager supervision rate of 100%, safeguarding supervision rate of 100% and an annual appraisal rate of 93%. Griffin staff had a clinical supervision rate of 93%, manger supervision rate of 93%, safeguarding rate of 93% and appraisal rate of 91%. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge with additional training such as Post- Graduate in Patient Safety and Applied Human Factors at University of Leicester which was funded and supported with study time by the hospital managers. Reducing Restrictive Practices in Mental Health Settings, Sensory Integration Training, Sensory Preceptorship and The Voice of the Child was delivered by the Local Authority. Managers dealt with poor staff performance promptly and effectively, ensuring appropriate support, training and oversight was provided and fed back areas for improvement in regular team meetings.

Mental Health Act

100% of staff on Pegasus ward had completed Mental Health Act Awareness training, whilst 91% of staff on Unicorn and 93% of staff of Griffin had completed this. All staff we spoke with had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles and 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. Staff were aware of the service’s policies and procedures that reflected the most recent guidance.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice, whilst young people had easy access to information about independent mental health advocacy, and an advocate visited the ward regularly. The service had produced a ‘My Rights’ magazine for all young people which explained the Mental Health Act and restrictive practices as well as resources available to them during admission. Staff had explained young people’s rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. All young people we spoke with were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. Staff knew how to request an opinion from a second opinion appointed doctor when necessary.

The Mental Health Act administrator ensured copies of patients' detention papers and associated records (for example, Section 17 leave forms) were stored correctly and so that they were available to all staff that needed access to them by also making these electronically available. The service displayed a notice to tell informal patients that they could leave the ward freely. Care plans referred to identified Section 117 aftercare services for those who had been detained under Section 3 of the Mental Health Act and completed regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

We scored the service as 3. The evidence showed a good standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff held regular and effective multidisciplinary meetings. We completed 5 observations of professional only meetings during this inspection and 1 observation of a young people’s community meeting. We observed discussions relating to safeguarding, leave arrangements and risks that had been indicated from the previous day. We observed teams working collaboratively with discussions around delegated tasks, staff were confident to use their voice to express views, ideas and concerns and all agreed actions were recorded to ensure these were actioned quickly and effectively. Multi-agency working was present throughout meetings, ensuring staff were allocated to provide updates to external professionals such as social workers and community teams, as well as families. We observed excellent and diligent communication between the service's responsible clinician and community consultants in communicating medication changes and rationales for doing so.

We observed effective and robust handovers which included ward managers, senior leaders, safeguarding leads and admin staff. Staff ensured previous actions had been completed, including referrals to local authority, notifications to regulators, newly identified risks, any changes to staffing levels and planned activity for that day. The teams had effective working relationships, including good handovers with other relevant teams within the service. The teams had effective working relationships with teams outside the organisation and external agencies gave overwhelmingly positive feedback regarding communication and transparency.

We scored the service as 4. The evidence showed an exceptional standard. The service always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. The service supported people to 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 health-based initiatives, healthy eating, managing cardiovascular risks, physical health care access and ensuring young people were protected from harmful substances.

15 frontline staff were trained to be a ‘Healthy Weight Coach’ in-between April and May 2025, with plans to continue developing and supporting this with monthly Dietician Led learning. The healthy weight coaches undertook training to help de-stigmatise weight bias and educate young people on how to live healthier lifestyles without causing distress during conversations around weight. As part of the services Healthy Lifestyle Coach Network, senior managers also completed role modelling active lifestyles to inspire the network and young people to get active. The service heavily involved young people within healthy living campaigns and had a presentation from a young person on different diets and relationships with food, had ‘the breakfast club’ where young people made around 8 different healthy breakfasts for the monthly Food Forum meeting.

We saw evidence in care records that staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. The service had support from speech and language therapists, dieticians and pharmacists to support young people during admission. The wards participated in a food and nutrition improvement plan which involved a young person representative, speech and language clinician, dietician and kitchen staff for the service and also had a ‘Nourish to Flourish’ campaign which showcased healthy meals, introduced young people to the kitchen staff and options available, including a forum for young people to express what food and drinks they’d like within menu’s. 15 frontline staff were trained to be a ‘Healthy Weight Coach’ in April/ May 25 to help monitor healthier choices and lifestyles for young people. The service dietician delivered a workshop to consider the Obesogenic Environment and the role of staff in promoting this, a full day face- to- face training in Motivational Interviewing and a survey to hear what young people needed to get active and wanted to try in June 2025 with evidence this had been acted upon.

The service had an activity coordinator on each ward every day from 10am-10pm to provide engagement and meaningful activity. The service also facilitated dance sessions to increase activity on the wards, as well as encouraging Section 17 leave for therapeutic walks in the community and visiting local attractions.

We scored the service as 3. 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.

Staff used audits to monitor and improve outcomes for young people. Audits were in place to review the number of incidents and any use of restraint, which also was monitored by the services Positive and Safe Lead and discussed at operational level. Blanket restrictions were regularly reviewed to ensure least restrictive practice was being used and restrictions were discussed with the young people during community meetings for mutual understanding.

Staff encouraged the completion of surveys at all levels, including family members. We reviewed surveys which had been completed and found the responses were all positive. Staff also attended monthly team meetings in order to look at what actions could be taken to improve outcomes.

Staff used recognised national rating tools to monitor young people’s progress from admission to discharge and risk assessments were all within date and evidenced regular reviews to recognise changing risks which were reflected in care plans and risk assessment plans. The wards regularly discussed the outcomes of audits with staff teams to improve services and outcomes for the young people. Staff utilised technology to help support patients and minimise any distress. Staff were able to use technology to record risks, assessments and care records.

Cygnet Hospital Sheffield was working in collaboration with the Digital Team to develop a new platform which allowed The Health of the Nation Outcome Scales for Children and Adolescents (HONOSCA) and The Children's Global Assessment Scale (CGAS) score trends to be analysed over time including to look at ‘change per day’ to monitor outcomes. The service had also inputted data into the QNIC-ROSE database (The QNIC Routine Outcome Measurements and Service Evaluation (QNIC-ROSE), a system used to collect, monitor and analyse outcome data collected at admission, discharge and various intervals between. It allows services to input outcome measure data and download reports showing improvement over time both at a young person, and service level) since June 2025 and the next annual report is due to be published in March 26. This would allow benchmarking against other CAMHS services.

We scored the service as 3. The evidence showed a good standard. The service routinely reminded people about their rights around consent and respected these when delivering person-centred care and treatment. Staff took all practical steps to enable patients to make their own decisions and had a strong understanding of what consent meant. For young people who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately, as well as seeking advice from the services Gillick Competency lead where appropriate.

Staff assessed capacity on a decision-specific basis with regard to significant decisions and where young people lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history, involving wider teams and external professionals in decision making, such as social workers, community teams and families where this was appropriate. All care records that we reviewed evidenced that young people had, or had not given consent to share information, with clear care plans where there may have been issues with consent.