Cygnet Brunel

On this page

• 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

At our last assessment we rated this key question good. At this assessment the rating has improved to outstanding.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked 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.

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.

The evidence showed an exceptional 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.

We examined 16 care records during the assessment. All care records evidenced comprehensive assessment of physical health needs and both psychiatric and psychological mental health needs of the patient in a timely manner at, or even before admission. Clinical staff told us they visit all prospective patients prior to admission in their referring settings.

Staff developed detailed multidisciplinary care plans that met the needs identified during assessment. Care plans were personalised, holistic and recovery-oriented with discharge planning evident from the point of admission. Risk assessments, behavioural support plans and MHA and MCA reviews were all completed and current. Care plans were revised with each patient every week. Patient voice, support plans for patient relationships and career goals were highlighted. Daily progress notes for all records examined were current and updated by staff.

The evidence showed an exceptional 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 the patient group. The interventions are those recommended by the National Institute for Health and Care Excellence, specifically NICE guideline252 Rehabilitation for chronic neurological disorders including acquired brain injury Published: 15 October 2025.

Staff ensured that patients had good access to physical healthcare, including access to a broad team of specialists that included doctors, psychiatrists, occupational therapists, clinical psychologists, social workers, pharmacists, speech and language therapists, dieticians and support workers. Staff assessed and met patients’ needs for specialist nutrition and hydration and these needs were clearly identified in care plans. Staff participated in clinical audit, benchmarking and quality improvement initiatives.

Staff were experienced, qualified and had the right training and knowledge to meet the needs of the patient group. All staff interviewed confirmed they received an appropriate induction using a combination of online and face to face learning. All staff interviewed confirmed specialised learning is encouraged, protected time was provided for learning. 100% of records examined showed staff were receiving regular supervision and had an appraisal in the last 12 months.

Staff we spoke to reported satisfaction with induction, describing a structured course of face to face and e-learning with protected and paid learning time. Managers had an induction tracker and were identifying the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Team meetings are held weekly.

100% of staff had received training in the Mental Health Act and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff 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.

Bristol City Council had commissioned an external provider to provide IMHA services for both instructed and non-instructed advocacy at the service. Staff told us there was also a general advocacy service which was commissioned by the provider. Staff told us that an IMHA did weekly drop-in sessions every Thursday and attended ward rounds and managers’ hearings or mental health tribunals where possible. Staff said they introduced the IMHA to every newly admitted patient. Posters for the IMHA were displayed within the hospital.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. The service displayed a notice on the patient information boards near the exit of every ward to tell informal patients that they could leave the ward freely and this information was also read to all informal patients. Patients were able to take Section 17 leave where this had been granted. Staff stored copies of patients' detention papers and associated records correctly and monthly audits are conducted to ensure that the Mental Health Act was adhered to.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. The service held regular and effective multidisciplinary meetings. We observed three handover meetings on three wards and staff in each meeting demonstrated thorough current knowledge of each patient’s physical, psychological needs and preferences at these handover meetings. Staff effectively planned daily activities and appointments for patients based on the needs and patient preferences discussed in these meetings.

The teams had effective working relationships with teams outside the organisation, specifically the local hospital, the GP service across the road and two local dental services that have enrolled 100% of patients. The hospital had 2 bookable minibuses to take patients into the community for activities or visits to primary care services. One of the vehicles was wheelchair accessible.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to 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. There was good evidence of ongoing physical health monitoring. Staff regularly monitored patients’ physical health. Staff told us every patient had a full set of physical observations twice daily which was documented through NEWS2 scores. A physical health nurse supported the team with physical health such as diabetes care and tissue viability. Staff supported patients to attend appointments with dentists and opticians as needed and a gymnasium was available for patients to use with staff supervision.

The evidence showed an excellent 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. The service earned an ‘outstanding’ rating for the second time in June 2025 from Headway, the Brain Injury Association. The service has been recognised for multiple examples of good practice across its neuro services in the first report published by the Quality Network for Neuropsychiatry Services and the Royal college of Psychiatrists.

Staff used recognised rating scales to assess and record severity and outcomes including HATS, ACEIII, Frontal Lobe battery and Westmead (for PTSD Amnesia). Gold standard for ABI, CBT, TBI/ABI compassion focussed therapy, acceptance and commitment therapy (especially in groups), DBT, mindfulness group. Clinical staff are following John Evan's work from Glascow, employing therapies to improve memory and executive function and also building a bespoke family therapy suite to facilitate guided interactions between patients and their families. Clinicians are trialling Eye Movement Desensitization and Reprocessing (EMDR) for patients with neuro degeneration for the first time, noting that EMDR has been used with some success for patients with severe dementia.

The evidence showed an exceptional standard. The service always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions on a decision-specific basis. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

We saw that the consultant psychiatrist had considered patients’ mental capacity and for those patients that lacked capacity, mental capacity assessments and best interest decisions were thorough, decision-specific and detailed. Consent to share information was clearly recorded. In all the patient records we reviewed, we found evidence that consent to share information had been sought and recorded as part of the admission process.