Cygnet Hospital Sheffield

On this page

• 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 our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant service leadership was exceptional and distinctive. Leaders and the service culture they created drove and improved high-quality, person-centred care.

Leaders had the skills, knowledge, and experience to excel in their roles. Staff knew and understood the provider’s vision and values, and this was well reflected in how they did their job. Staff felt respected, supported, and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected and analysed data about outcomes and performance and used this to continuously identify improvements through innovative practice.

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.

We scored the service as 3. The evidence showed a good standard. The service had a very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities. All staff we spoke with knew and understood the provider’s vision and values and how they were applied in the work of their team and spoke proudly about their work and the young people they supported. Staff told us that the leadership team were always visible, approachable and knew the wards, young people and staff teams well. We spoke with various members of the multi-disciplinary team who felt their work was promoted and respected by leaders.

We observed multidisciplinary meetings which evidenced collaborative discussions around the service delivery and approaches to enhancing care to ensure it was safe and effective. Staff told us that they had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing and could explain how they were working to deliver high quality care within the budgets available, such as the reduction of agency use through strong retention, development opportunities and leadership within service. Feedback from staff around the providers commitment to equality and diversity was overwhelmingly positive.

We scored the service as 3. 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 always did so with integrity, openness and honesty. The service had a strong and effective leadership team in place and feedback from staff, stakeholders and families reflected this. Leaders had the skills, knowledge and experience to perform their roles exceptionally well by ensuring wards were always staffed well, staff were supported in their roles and had excellent understanding of the services they managed.

Leaders we spoke with had worked for the service for a substantial amount of time and knew how to engage their staff in decision making, service improvement and maintain wellbeing. They could explain clearly how the teams were working to provide high quality care and gave examples of achievements within the service, teams and had ongoing goals for the future. The leadership team ensured staff had the resources to develop further in their roles.

Leaders were visible in the service and approachable for patients and staff. Young people knew who the managers were by name and feedback by young people about staff was positive.

We scored the service as 4. The evidence showed an exceptional standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard. Both young people and carers had opportunities to give feedback on the care and treatment they received in a manner that reflected their individual needs. Staff we spoke with all knew who their freedom to speak up (FTSU) guardian was and felt they were able to raise any concerns they had. Staff told us they’d feel comfortable speaking up without fear. Each ward had a freedom to speak up champion allocated.

We reviewed both young people and carers survey results which were positive and reflected that they felt listened to and any concerns were taken seriously and responded to. The service evidenced improvements to the service through action plans created following young people, staff and carer surveys. Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. Managers fed back results to the wider staff group through team meetings. Young people and families were given opportunities to speak and meet with managers.

The work to embed Freedom to Speak Up culture at Sheffield had been used to showcase best practice via a FTSU National Conference and shared Cygnet Wide online. This also included Cygnet Sheffield FTSU Ambassador being on a panel of speakers at the conference to share their experiences of creating a culture where speaking up became the norm. This evidenced exceptional practice and commitment for all staff to be aware and feel safe to raise concerns and share views on how to improve practice. In July 24, Sheffield held a raising awareness event which the FTSU Guardian for Cygnet attended and there was a focus on psychological safety where staff feel comfortable to speak up in all forums and informally and are responded to positively. FTSU is a mechanism of the Just Culture approach embedded across Cygnet Hospital Sheffield.

We scored the service as 4. The evidence showed an exceptional standard. The provider strongly valued diversity in its workforce. There was an inclusive and fair culture which had improved equality and equity for people who work for them. All Ward Managers, Quality Lead, Social Work Lead and Clinical Manager were trained in The Patient and Carer Race Equality Framework (PCREF). This is a national framework, launched by NHS England, designed to tackle racial disparities in mental health care; improve outcomes for diverse communities, address racial inequalities, improve experience for patients and carers and ensure services are fair, inclusive, and culturally informed.

Equality monitoring was undertaken by the provider's human resources team and via recruitment processes.

The service was committed to listening to and learning from carers and families from all ethnic backgrounds. Staff encouraged families of young people to be involved to understand the barriers and inequalities by enabling them to share their experiences with open communication with the whole multidisciplinary team and regular 1:1 contact with clinical lead supports, as well as taking part in engagement opportunities, such as meetings, visits and celebration events.

Each ward had an equality and diversity champion allocated and there was an allocated ambassador for the services Multicultural Network who was rresponsible for organising all the Multicultural Communication and events across the hospital. This role also included remaining visible and accessible as the face of the Multicultural Network at Cygnet Sheffield, being a point of contact for staff on Multicultural Network related issues using good listening skills and encouraging hope in others, raising the profile of the network and promoting inclusion and awareness of related issues in line with a steering group. Multicultural Network Steering Group/Committee meetings were completed quarterly which also enabled the service to undertake equality monitoring of staff.

The service also had flexible working policies in place and made reasonable adjustments for staff who required them. Managers had oversight of staff’s requirements and knew their teams well, enabling them to support staff, ensure wellbeing was maintained and ensured staffs needs were met.

We scored the service as 3. The evidence showed a good standard. Governance systems were effective. All areas of the service building were safe and clean and assessed regularly. There were enough skilled, trained and experienced staff within the service who received supervision and were appraised. Young people were assessed and treated well. Staff adhered to legislation, knew how to deal with complaints and reported incidents and safeguarding concerns. The medicines management arrangements worked well. Managers shared lessons learned from investigating complaints, incidents and safeguarding issues. Staff participated in audits which were effective in identifying areas for improvement and acted upon. Staff received information governance training and maintained patient confidentiality. Staff worked in partnership with other teams and services to ensure patients received high quality care and treatment.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. They always act on the best information about risk, performance and outcomes, and share this securely with others when appropriate. We completed observations of 3 morning meetings and a multi-disciplinary team meeting. There was a clear framework and agenda that staff followed of what needed to be discussed to ensure that essential information, such as learning from incidents and complaints, safeguarding issues and cany changes to risk was shared and discussed as a team.

Managers had implemented recommendations from reviews of incidents, complaints and safeguarding alerts at the service level. The service also had taken into account learning from external partners with regards to risk and learning from serious incidents. Managers undertook and participated in local clinical audits such as Mental Health Act documentation compliance, care record audits and environmental audits which included fire risk assessments, ligature risk assessments and medical devices. These provided assurance that the service was safe and staff acted on the results when required. Senior management held excellent oversight and governed this well. All staff we spoke with had a strong understanding of the arrangements for working with other teams, including within the service itself and externally to meet the needs of the young people in their care.

Management of risk, issues and performance was monitored on a regular basis and included additional supervision from social workers within the wards to ensure people continued to make safeguarding referrals and identify potential safeguarding issues when they arose. Staff maintained and had access to ward risk registers and these were dynamic as they were updated when new risks were identified, reviewed regularly at ward level and included young people in discussions regarding restrictions. Staff at ward level could escalate any concerns when required and told us they felt confident to do so. Staff told us that risks were well managed and could identify risks within the environment, which correlated with those noted on the risk register.

The service had clear business continuity and contingency plans in place and policies alongside these, for example, adverse weather or a flu outbreak and ensured compliance with relevant legislation. Staff had access to the equipment and information technology needed to do their work. Records were stored securely on electronic systems and staff worked alongside young people to update care plans, risk assessments and record any incidents.

Staff collected data which was reviewed by the service’s positive and safe lead, enabling staff to look at themes and trends which could identify areas for improvement. The information technology infrastructure, including the telephone system and internet access worked well and helped to improve the quality of care. All staff were trained in data protection and information governance systems, including confidentiality of patient records.

Team managers had access to information to support them with their management role and oversight of the wider staff teams. This included information on the performance of each ward, staffing levels and patient care. Information within the service was in an accessible format, updated regularly, accurate and identified areas for further review or discussion.

We scored the service as 4. The evidence showed an exceptional standard. Staff within the service understood and carried out their duty to collaborate and work in partnership with other services to meet the needs of patients and ensure they had access to effective, joined-up care. They always shared information and learning with external partners and collaborated regularly to drive service improvement. Directorate leaders engaged with external stakeholders such as commissioners, the local authority, the integrated care board and the Provider Collaborative through site visits, meetings and telephone communication. Staff viewed young people as partners in their care and encouraged feedback, engagement and discussions on how the service could improve. Actions plans were created from discussions, including the outcomes from the Young People’s Council- a forum where young people could make suggestions or challenges to the service to drive improvements.

Young people and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. Young people were also supported by an expert by experience, their advocate and staff on the wards to be heard. The expert by experience provided young people with support during admission, inspiring young people with their own recovery journey and feeding back to the wider MDT. Young people were supported to maintain relationships with their community mental health teams, social workers and families. The service regularly engaged with the Provider Collaborative who told us that the service provided “completely holistic and dynamic care” and “by maintaining fortnightly contact and seeing young people from their ICB, partners had a strong sense of quality assurance”.

Feedback from external stakeholders was overwhelmingly positive. Family and carer feedback corroborated this, feeling that discharges were well planned, seamless and enabled young people to transition back into the community in a supported and safe way. Staff regularly supported young people to access the community via escorted Section 17 leave, where risk assessed as safe to do so. Young people were encouraged to maintain links to the local community. The wards also had links with external sensory services which young people were able to access, including family centres, sensory zones and sports centres.

We scored the service as 4. The evidence showed an exceptional standard. The service focused on continuous learning, innovation and improvement across the service and wards. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people by involving staff, young people and carers in this process. Information from peer reviews such as the Triangle of Care reports were utilised to identify any areas for improvement. The service completed peer reviews and invited services to review themselves for continuous improvement and learning opportunities.

The service was innovative in terms of completing case studies around engagement with young people who had an autism diagnosis, including introducing games that had shown positive benefits for young people within the LGBT+ community through occupational therapy reviewed sessions. They actively contribute to safe, effective practice and research through reporting the benefits and presenting this to the wider teams.

Quality improvement remained a focus for the service and the introduction of practice development nurses provided increased support for preceptee nurses with the introduction of a ‘preceptorship audit tool’, ensuring that new nurses had the skills to succeed in their roles. Staff we spoke with all understood reporting and quality assurance processes and how this influenced and shaped practice. Staff were involved in safety summary pilots in the service and pilots for improved IT systems and recording.

The service had a strong commitment to innovative practice, with an example being the implementation of emergency absence without leave (AWOL) grab bags. Contents of the bag included; Radios, water, first aid kit, Pulse oximeter, map, High Viz jackets, whistles, torches, foil blankets, ligature knife, ear defenders, sensory toys, sour sweets for grounding which enabled staff to respond safely to young people who had absconded on leave. The service had also implemented sensory friendly alarms, to reduce distress of alarms sounding throughout wards when an incident had occurred.

The service took part in the QNIC ROSE data base reporting (Outcome Measurement and Service Evaluation Data for Inpatient Child and Adolescent Mental Health Services) the service submitted data to QNIC-ROSE, which allows access to a comprehensive benchmarking system, allowing the wards to compare their performance with similar services.