Cygnet Views

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 inspection, we rated this key question as Requires Improvement. The service had been in breach of legal regulation relating to good governance. By the time of this inspection, the service had made improvements and was no longer in breach of the regulation.

Governance arrangements had improved and were now more effective. Leaders had strengthened oversight, and the culture they created promoted high-quality, person-centred care.

At this inspection, the rating changed to Good, meaning the service was consistently well-led and effectively managed.

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.

Leaders promoted a clear set of values – Integrity, Trust, Empower, Respect, and Care – which staff consistently applied in their day-to-day roles. Staff understood the organisation’s focus on patient and staff wellbeing and explained how their work aligned with this.

The senior leadership team maintained strong visibility and support. Staff reported that senior leaders visited regularly and were approachable, responsive, and supportive. Staff development was encouraged through regular supervision, and leadership opportunities were made available and discussed openly.

Staff described the workplace culture as supportive and compassionate. They felt respected and valued by both their peers and leaders. One staff member shared how, following a challenging incident, colleagues reached out with messages of support, demonstrating a culture of care and solidarity within the team. Staff had access to an employee helpline and wellbeing initiatives, which contributed to a positive working environment.

The provider took equality and inclusion seriously. Staff had a good understanding of human rights and equality principles and described how they used these in practice and policies were in place to support this. Staff were involved in service planning through meetings and supervisions. Local risks were actively discussed, and leaders had made changes, such as reducing bed occupancy, to protect care quality despite wider operational pressures.

There was a clear and stable leadership structure in place. The registered manager had oversight of two services and spent part of their week on-site, where they maintained a strong presence. A Head of Care was introduced into the leadership structure in 2023 to strengthen on-site management. The current Head of Care, a qualified nurse, had recently been appointed following the departure of the previous post holder. Leaders demonstrated the knowledge, experience, and skills required for their roles and acted with integrity and transparency.

Leaders engaged regularly with staff and patients through structured walkarounds and daily contact. Staff said they felt comfortable approaching managers and described them as approachable and responsive. Patients also had regular contact with the registered manager, which helped to build familiarity and trust.

Staff received regular supervision, where development and progression were discussed. Leadership opportunities were actively encouraged, and staff were aware of clear progression pathways. This included access to leadership and management programmes, which supported the development of future leaders within the service.

Although there were only two learning disability (LD) qualified nurses in the team, the provider had ensured that LD-specific training was made available to all staff, including leaders. This helped equip them with the knowledge needed to meet the needs of the patient group and to support safe, high-quality care. Governance systems such as organisational charts, board structures, governance frameworks, and risk registers were in place and accessible, and leaders contributed actively to oversight and assurance processes.

Patients and carers had regular opportunities to provide feedback through weekly community meetings. These forums enabled individuals to express their views on the running of the service and contribute to planning their care and activities for the week ahead. Staff and leaders used this feedback to inform service improvements and to ensure the care remained person-centred.

Staff were aware of the provider’s Freedom to speak up policy and knew how to contact the Freedom to Speak Up Guardians and on-site ambassadors. Leaders promoted a culture of openness, honesty, and transparency, actively encouraging staff empowerment to drive continuous improvement.

An advocate reported that the hospital director consistently kept them updated on safeguarding concerns, enabling effective communication with patients involved. This ensured patients remained at the centre of the safeguarding process and were kept informed about progress, reflecting the leadership’s commitment to transparency and patient involvement.

When concerns were raised, leaders responded consistently and sensitively. Staff reported that investigations were handled confidentially and outcomes, including lessons learned, were shared with the team to prevent recurrence. This approach helped reinforce trust and confidence in the leadership and governance of the service.

Leaders demonstrated a clear commitment to promoting equality, diversity and inclusion (EDI) across the workforce. They had in place a workforce strategy aligned with the principles of the Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES), both of which were reviewed in July 2024. The provider used these benchmarks to identify disparities, monitor progress, and implement targeted interventions to improve staff experience.

Staff from a range of backgrounds, including those with protected characteristics, told us they felt increasingly included and supported in the workplace. The provider ensured policies and procedures were reviewed regularly to address structural and institutional bias. Leaders monitored the impact of actions through staff surveys and equality data analysis. Reasonable adjustments were put in place for staff who required it, for example flexible working arrangements were available to accommodate personal or health-related needs.

The service had clear governance structures in place, with defined roles, responsibilities, and systems of accountability. Staff at all levels understood their roles and how they contributed to delivering safe, effective and sustainable care. There was a clear framework for sharing essential information through regular team and directorate meetings. Staff consistently discussed learning from incidents, complaints, audits and safeguarding alerts, and we saw evidence of actions taken as a result.

Audits were mostly effective in identifying performance issues and driving improvements. However, some concerns, such as environmental hazards, were not identified prior to the inspection, indicating gaps in the audit process.

Managers had access to reliable, timely and relevant information to support oversight of performance, staffing and patient care. This information was shared in accessible formats and used to identify trends, risks and areas for improvement. Leaders submitted notifications and performance data to external bodies as required and used national quality frameworks and standards to inform service development.

Staff used local risk registers and were able to escalate concerns when needed. Risks recorded on the registers reflected concerns raised by frontline staff and were regularly reviewed and updated. Emergency planning arrangements were in place and understood by staff, for example contingency plans for staff illness. Cost improvement plans did not compromise patient safety or quality of care.

Information systems supported the day-to-day work of staff. Staff had access to functioning equipment and IT infrastructure, including secure systems for managing and storing patient data.

Leaders actively engaged with a range of external stakeholders, including commissioners to support continuous improvement and service development. External professional feedback praised the service’s responsiveness and effective multidisciplinary team working.

The provider maintained strong community partnerships, working with local organisations such as Matlock shopping centres, local colleges, garden centres, and coffee shops to support joined-up care and learning opportunities. Patients were encouraged to participate in community activities promoting wellbeing and social inclusion, including visits to ARC Leisure Centre, Matlock Library, local parks, and leisure activities such as cinema and bowling.

The service demonstrated a strong commitment to co-production with service users. An Expert by Experience attended monthly visits to support patient feedback and involvement in decision-making. Patients actively participated in fundraising initiatives, for example during 2024, collectively raising over £6,000 for the Footprints Charity. They supported the fundraising through delivering leaflets to neighbours, organising and taking part in bake sales, and attending a cheque presentation event in January. This engagement fostered a sense of ownership and community involvement.

Senior leaders also collaborated with discharged patients to create signing videos to improve accessibility, which were shared via the Cygnet Signing portal. Overall, staff and leaders demonstrated openness and transparency in their partnerships, using these networks to share learning and implement innovative ideas that improved outcomes for patients.

Since the last inspection, the provider’s primary focus had been on improving the service rating and addressing identified concerns. However, more recently, leaders and staff had begun to place greater emphasis on innovation and quality improvement initiatives. Following a full quality review in June, leaders had been regularly discussing the introduction of a formal quality improvement (QI) project during governance meetings. While the project had not yet formally commenced at the time of the visit, there were clear plans in place, and early-stage discussions reflected a growing focus on structured quality improvement.

While some improvement initiatives were still at an early stage, such as a gardening project led by the occupational therapist, these showed promise in enhancing patient involvement and wellbeing. Staff were increasingly encouraged to contribute ideas and were supported to prioritise time for improvement work.

The service demonstrated a commitment to learning from both local and corporate incidents, with lessons shared openly among staff. There was evidence of reflective practice and collaborative problem-solving to improve care and prevent repeat issues.

Innovation was further supported by research activity within the service. A trainee psychologist was conducting a research project on how psychological formulation affects staff empathy towards forensic patients, involving multiple sites and team-based data collection. This indicated growing engagement with evidence-based practice and external partnerships.