Cygnet Joyce Parker 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

At our last assessment we did not rate this key question. This is the first rated assessment for this service. 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.

This key question has been rated as requires improvement. This meant that management and leadership was inconsistent. Leaders did not always ensure the delivery of high-quality, person-centred care. We found concerns that leader’s governance processes did not always identify or act upon. These included staff not completing risk management plans for all patients, managers not identifying all ligature points and blind spots, staff not involving patients in their care and treatment and staff not providing a full range of activities for patients.

However, leaders were now alert to signs of a closed culture and took action to prevent this. Leaders actively promoted staff empowerment to drive improvement. They encouraged staff to raise concerns and promoted the value of doing so. Leaders were open and transparent, and they collaborated with all relevant external stakeholders and agencies.

The service was in breach of regulations for governance of the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

Leaders ensured there was a shared vision and strategy that staff in all areas knew, understood and supported. The provider developed a 5 year strategy from 2022-2027. The provider's ambition was to provide outstanding services. This ambition was underpinned by clear strategic priorities. Cygnet values were integrity, trust, empower, respect and care. Leaders told us Cygnet Joyce Parker's shared values were focused on civility and kindness. These values were used to change the culture at the hospital.

Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding. Cygnet's mission was to deliver compassionate care and a positive culture by making sure staff had good days at work. Leaders made sure staff felt valued and knew that they mattered. Staff were encouraged to check and challenge each other. Leaders promoted a culture of speaking up and safety.

Leaders ensured any risks to delivering the strategy, including relevant local factors, were understood and had an action plan to address them. Leaders shared a regularly updated action plan detailing improvements identified for the service.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively. However, leaders demonstrated integrity, openness and honesty.

Leaders did not always ensure risks were well managed. Leaders had not identified or always acted on risks within their service. These included potential risks to patients from poor risk management, unidentified ligature points and blind spots and the ongoing lack of activities and therapeutic input.

Leaders ensured support and expertise was provided to support the service transition from CAMHS to an adult acute and PICU service. This included employing a clinical services manager and consultant with acute and PICU experience. Leaders and staff told us they developed links with other Cygnet acute and PICU services and were able to access support and advice whenever they needed.

Leaders at every level were visible and led by example, modelling inclusive behaviours. Staff, the expert by experience, advocates and external stakeholders all told us that leaders at the service were very responsive to any concerns raised. Staff told us that leaders were approachable.

Leaders could access appropriate support and development in their role. Leaders told us they were developing their ward managers to take ownership of their wards and drive improvements. Ward managers completed leadership training. Leaders accessed coaching from Cygnet executives. The hospital director told us they attended monthly regional governance meetings with the regional manager and other hospital directors. These meetings were followed by a peer support session.

Leaders were alert to any examples of poor culture that may affect the quality of patient's care and have a detrimental impact on staff. Leaders worked hard with the staff, especially HCA's, to ensure they understood what a closed culture was and to recognise the warning signs. Leaders shared minutes from the hospital wide morning `flash meetings' with all staff and encouraged staff to raise any issues that were not raised by the ward managers. Leaders recognised staff were struggling with the change from CAMHS to adult services and implemented additional support measures, these included increasing staffing numbers whilst staff adjusted to not having as many staff on shift.

We create a positive culture where people feel that they can speak up and that their voice will be heard.

Leaders actively promoted staff empowerment to drive improvement. They encouraged staff to raise concerns and promoted the value of doing so. There were 4 freedom to speak up guardians (FTSUG) in HCA roles at the service and a national provider level FTSUG. The 4 local FTSUG’s completed training to support them in this role. Leaders told us they facilitated civility training for staff to make sure staff understood what went wrong last time and the impact of being a passive bystander. Leaders were making sure staff were confident to speak out, and if the first person doesn’t listen to take it further and go external if required. We saw new posters on display with external contacts for staff to raise concerns to. Leaders were focused on FTSU with lots of training and awareness raising. There had been an increase in staff raising concerns via the FTSU process with 3 submitted to the national FTSUG and 2 to the local FTSUG’s. There was an accessible and confidential process on Cygnet’s intranet for staff to raise concerns with the national FTSUG.

There was a culture of speaking up where staff actively raised concerns and those who did (including external whistleblowers) were supported, without fear of detriment. Staff described the different avenues available to raise concerns and were confident they would be listened to. However, some staff told us they raised concerns about staffing numbers and although they were listened to, nothing was done.

We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

Leaders acted to continually review and improve the culture of the organisation in the context of equality, diversity and inclusion. Cygnet had an Equality and Diversity policy in place. This policy applied to all staff and included details of laws governing equality and diversity, recruitment processes and dignity at work. Staff had access to Cygnet’s multicultural network and Women’s network.

Leaders acted to improve where there were disparities in the experience of staff with protected equality characteristics. We observed the morning meeting on Brook ward. The team discussed racial abuse, and the ward manager reminded staff to report any incidents of racial abuse, internally and to the police and offered support with this. We observed the hospital wide morning ‘flash’ meeting chaired by the hospital director. The independent expert by experience reported on the equality network resources available to support staff with incidents of racist abuse. Ward managers requested posters that they could display to promote this to staff. told us they were continually advising staff on the need to report any incidents of abuse they experience, including racist abuse. Leaders were supporting a member of staff to challenge the police decision not to take any action against a patient following an assault. The police wrote to all staff advising them on the need to report any crimes they are the victim of.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes.

Governance processes did not always identify or ensure action was taken to address areas of concern. We identified concerns in relation to patient risk management, safety of the ward environments, a lack of activities and staff not always involving patients in planning their care and treatment. Staff were not completing risk management plans for all identified patient risks. The provider’s‘ligature anchor point and blind spot risk assessment’ was completed by one person and did not identify all ligature anchor points and blind spots. We were unable to find an assessment of the ward courtyard areas. We were concerned as previous issues included a reliance on one person to complete audits of restraint incidents and progress safeguarding concerns. Lack of activities remained a concern for patients despite concerns being repeatedly raised from a variety of sources, including the independent expert by experience and advocates.

However, leaders changed governance structures since the CAMHS inspection. Ward managers were now expected to take ownership of their wards and participate in daily flash meetings to report any concerns. There was increased triangulation through meetings, audits and trackers. Leaders implemented improved processes to ensure effective oversight of restraint and safeguarding incidents. Policies were updated to increase patient safety, including an updated emergency procedure that required staff to take the emergency bag to all ligature incidents. Staff raised concerns in daily safety huddles that were escalated in the morning flash meeting. Ward managers completed audits for their wards with senior leaders completing random samples to ensure quality. The hospital director chaired a hospital wide ‘flash’ meeting each weekday morning. We observed the morning flash meeting during our visit. This meeting was attended by ward managers (or the clinical team leader (CTL) in the managers absence), the advocate, the independent expert by experience, clinical service manager, medical director, MHA administrator, general manager and finance manager. Ward managers/CTL’s fed back for their wards on staffing, incidents, safeguarding concerns, admissions/discharges, section 17 leave, observation levels, maintenance issues, patient rights due, section renewals and concerns from the ward safety huddles. We observed the ward morning meetings before the flash meeting and were able to see issues from wards being escalated, apart from 1 issue regarding a patient potentially not accessing section 17 leave on Beck ward not being raised. The provider advised clinical governance was an ongoing improvement initiative. Ward managers were taking more ownership and presenting clinical reports for their wards to the senior management team. The hospital director chaired monthly clinical governance meetings. We reviewed minutes from the last 3 meetings. Attendees reviewed and discussed data for each ward relating to incidents, restrictive practices, safeguarding concerns, patient outcomes and experience, staffing, audits, QI initiatives and training. Staff had access to Cygnets governance handbook which outlined governance structures and processes and staff’s role within these. Cygnet leaders conducted ‘Full Quality Reviews’ of their services. This was completed at Cygnet Joyce Parker in December 2024. The reviewer noted that “The key areas for improvement relate to governance processes, care plan personalisation, family involvement, and activity provisions. The leadership team has committed to addressing these gaps.” These findings aligned with findings from the inspection.

Data or notifications were consistently submitted to external organisations as required. Leaders set up a spreadsheet to track safeguarding referrals and CQC notifications. External stakeholders had no concerns about data and notifications being submitted. The provider submitted 12 notifications in the month prior to the inspection.

We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

Staff and leaders were open and transparent, and they collaborated with all relevant external stakeholders and agencies. Leaders described positive relationships with the local Integrated Care Board (ICB), Local authority and Mental Health NHS trust. Staff were involved with charities and religious institutions within the community. We spoke with 3 local external stakeholders. They told us the service was very engaged with the local health and social care system. They told us leaders at the service were open and transparent and keen to seek support to help drive improvements.

The provider did not always focus on continuous learning, innovation and improvement across the service.

Staff and leaders did not always take the action required to ensure improvement happened. Despite repeated concerns raised since the service opened about a lack of activities for patients from numerous sources, this remained an issue.

We spoke with Cygnets independent expert by experience for the service, who has been trained to level 3 in QI. They told us about the QI initiative submitted to Cygnet central team seeking a corporate sponsor to support- ‘Reducing Violence and Aggression via meaningful activities'. The expert by experience wants this initiative to look at upskilling staff, changing the shift times of activity coordinators to work in the evenings and to assess what staff are doing when ‘floating'. The expert by experience was also looking at a potential QI initiative in relation to racial abuse. Leaders told us about QI initiatives in the service including trialling a peer advocate role in partnership with NHS England. A small team of staff were trained in minds and cultures and developed a project called "kindness is key". Leaders described smaller QI projects, including improving ward rounds to make them more meaningful for patients, improving escalation processes and clarity regarding on call procedures. We spoke with an advocate who visited the service. They told us there had been lots of improvements made and leaders and staff worked hard to make these changes.