Cygnet Elowen Hospital

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

Well-led – 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 requires improvement. At this assessment, the rating has remained requires improvement. The service was previously in breach of legal regulation in relation to governance. The service had made improvements and was no longer in breach of this regulation.

Leaders had strengthened governance arrangements, improved oversight of risk and performance and demonstrated a clearer understanding of the areas requiring improvement. Staff felt supported by the new leadership team and were encouraged to contribute to service development. However, many of the leadership and governance changes were recent, and we were not yet assured that improvements were fully embedded or consistently effective over time. Leaders could not always demonstrate that learning from incidents was sustained or that actions taken had prevented recurrence.

Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how these applied to their work. Staff felt respected, supported and valued. Governance processes had improved and leaders used information about risk, performance and patient experience to identify areas for improvement. However, further time and evidence were needed to demonstrate that governance arrangements were consistently effective and sustainable.

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 service did not yet have a clear vision and strategy.

The service was still developing a clear and shared direction for the service and its model of care. Staff understood the provider’s wider values and were committed to providing high-quality care, but there was less clarity about how the specialist eating disorder service should operate and the specific patient group it should provide for.

Leaders recognised the need to clarify the service’s referral and admission criteria. During our inspection, we observed an MDT meeting involving professionals where staff actively discussed referral criteria and the suitability of patients being admitted to the service. Staff identified uncertainty about the boundaries of the service, including the support it could provide for patients with trauma-related needs where this was not part of the service’s specialist offer.

Leaders also reviewed the model of care because the existing model was considered too broad and not sufficiently focused on patients’ needs. A revised model was being developed and was due to be completed by October 2026. Leaders were considering how clearer admission criteria and a more defined model could improve patient experience and ensure patients received the most appropriate care.

Staff had opportunities to contribute to these discussions and demonstrated a willingness to shape the developing service. They were able to explain how they worked to provide high-quality care within available resources and understood the financial and operational constraints affecting the service.

However, the service had not yet fully established a clear, shared and patient-focused direction. There remained some uncertainty about the service’s role, admission criteria and the support it could provide. Leaders had recognised these issues and were taking steps to address them, but the changes were not yet fully developed or embedded at the time of our inspection.

The service had made progress following changes to its leadership arrangements. Leaders were knowledgeable about the service, open to feedback and demonstrated a clear commitment to improving the quality and experience of care. We saw evidence of leaders working collaboratively with staff and other professionals to identify and address areas requiring improvement.

The registered manager had recently been registered with CQC and the ward manager had only been in post for a few weeks before our inspection. Both leaders demonstrated a positive approach and were actively working to strengthen the service. Staff spoke positively about the changes in leadership and we saw evidence of improved engagement and multidisciplinary working.

The Responsible Clinician (RC), who has overall responsibility for patients’ medical care and treatment on the ward, was providing interim leadership while the service recruited to the permanent post. They had made a positive contribution to the team and were actively involved in discussions about the service’s model of care and referral criteria. However, a permanent RC had not yet been appointed following the recent departure of the previous postholder.

Leaders had made progress in strengthening staffing, multidisciplinary working, safeguarding and the overall direction of the service. They demonstrated a willingness to listen to staff and patient feedback and to make changes where improvements were needed.

However, many of these leadership arrangements and improvements were still relatively new. The registered manager and ward manager had only recently taken up their roles, the permanent RC position remained vacant and the revised model of care was still being developed. This meant there had not yet been sufficient time to demonstrate that the changes were embedded and consistently improving patients’ experiences. Leaders had made positive progress and the service was moving in the right direction. However, the relative newness of the leadership arrangements and the early stage of several improvements meant we could not yet be assured that the changes would be sustained and embedded.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients, carers and staff had opportunities to raise concerns, provide feedback and influence improvements to the service. Staff were aware of the provider’s freedom to speak up arrangements and could access the Speak Up Guardian as an independent and impartial source of advice. Staff generally told us they felt able to raise concerns and that leaders were approachable.

Leaders encouraged staff to share their views and we saw examples of staff contributing openly to discussions about the service and proposed changes. Leaders were receptive to feedback and demonstrated a willingness to listen and act on concerns raised by staff and patients.

Patients also had opportunities to share their views through ward meetings, care reviews, complaints and discussions with staff. During our inspection, we observed patients confidently expressing their views, including challenging staff when they disagreed with decisions. Staff listened and responded respectfully.

The independent advocate provided mixed feedback. They raised concerns that some requests for information and support on behalf of patients had not always received a timely response. However, leaders were receptive to the feedback provided and engaged with the issues raised. This demonstrated that, while some aspects of communication and responsiveness could be strengthened, patients and their representatives had established opportunities to speak up and be heard.

There was evidence that feedback was being used to inform improvements. For example, leaders were reviewing the service’s model of care and referral criteria and involved staff and professionals in these discussions. Patients and carers were also able to contribute their experiences of the service.

Staff understood that they could raise concerns without fear of repercussions and were aware of routes available to escalate concerns if they felt these had not been addressed.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Leaders had made significant improvements to governance and oversight since the previous inspection. However, these changes were still recent and we were not yet assured that governance arrangements were sufficiently embedded to consistently identify risks, demonstrate learning and drive sustained improvement.

The service had experienced significant changes in its leadership structure. The registered manager had only recently been registered with CQC, the ward manager had been in post for a few weeks before our inspection and the permanent responsible clinician position remained vacant. Leaders were therefore still establishing their roles and responsibilities and developing consistent oversight of the service.

Leaders had taken action in response to previous concerns and had strengthened monitoring in areas including safeguarding, staffing, clinical care, Mental Health Act compliance and patient experience. They could explain the actions taken and demonstrated a clear understanding of the service’s priorities. Staff were involved in discussions about improvements and leaders actively sought feedback from patients, staff and the multidisciplinary team.

However, we were not yet assured that learning from previous concerns was consistently embedded and monitored for effectiveness. Some improvements had only recently been introduced, meaning there was limited evidence to demonstrate that they had been sustained over time or that leaders had tested whether actions had prevented similar concerns from recurring. The developing model of care and changes to leadership also meant the service was still establishing how it would monitor performance and assure itself that improvements were delivering the intended outcomes for patients.

Leaders were open and transparent about the areas requiring further development and demonstrated a strong commitment to improving the service. They had taken practical steps to strengthen governance and had begun to establish clearer systems of accountability and oversight.

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 collaboratively with partner organisations to support joined-up care and respond to patients’ wider health and social care needs. Staff maintained effective relationships with external services and shared relevant information to support continuity of care.

There was evidence of partnership working with organisations including Integrated Care Boards (ICBs), the East Midlands Provider Collaborative, local authority safeguarding services, community services and GPs. Staff worked with these partners when concerns arose and when planning referrals, transitions and discharge to ensure patients received appropriate support.

Staff also worked with families and carers and recognised the importance of maintaining these relationships as part of patients’ care. Where patients required support from services outside the hospital, staff made appropriate referrals and communicated relevant information to support continuity.

Leaders demonstrated a willingness to work with external partners to improve the service. For example, they engaged with partners when reviewing the service’s referral and admission arrangements and considered how the service could better meet the needs of the patients referred to it.

The service had developed a stronger culture of learning and improvement. Staff were encouraged to reflect on practice, raise concerns and contribute ideas about how the service could improve. Leaders were receptive to feedback from staff, patients and external professionals and demonstrated a willingness to make changes in response.

Staff contributed to multidisciplinary discussions about the service and its future development. We saw professionals working together to review practice, share their expertise and consider how care could better meet patients’ needs. Staff also had access to training, supervision and opportunities to develop their knowledge and skills, including in relation to specialist eating disorder care.

The service used a range of information to identify areas for improvement, including patient feedback, complaints, incidents and feedback from staff and external partners. Leaders had taken action in response to this information and were developing improvements to the way care was delivered.

However, we were not yet assured that the service consistently evaluated the impact of changes or demonstrated that learning had been sustained in practice. Some improvements were recent, and there was limited evidence over time to demonstrate that changes had resulted in consistently better outcomes and experiences for patients.