Cygnet Brunel

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 rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. 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 data about outcomes and performance to identify improvements.

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 evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equality, inclusion, engagement, and understanding challenges and the needs of people. The provider’s senior leadership team tried to communicate the provider’s vision and values to the frontline staff in this service. Staff we spoke to knew and understood the provider’s vision and values and how they were applied in the work of their team.

The service used the term ‘rehabilitation community’ to describe its vision and strategy for an inclusive and successful rehabilitation service. The service had established a multicultural network, a woman’s network and continued to support reducing restrictive practice. A TV had been installed in the atrium that looped service staff faces, with their names, hobbies and 2 interesting facts about them. In this way patients learned more about the staff members that supported them. The service held a Summer party in 2025 and staff held an event for the patients to celebrate Nigerian day.

The service had recently changed leadership through internal promotions for two senior positions. These changes had been unsettling for some staff and the service appeared to be adapting to these changes at the time of the inspection.

Service leaders understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organization. However, half of the staff we spoke to complained of favouritism and protection for some staff members. Senior management demonstrated awareness of these staff concerns and admit some emails and initiatives are not always landing well with staff. Service managers were being closely supported during this bedding down period with weekly supervision. The service had a ward manager’s development program and an aspiring hospital manager program. The service had three staff training to be clinical team leaders, one apprentice nurse and provided occupational, psychology and nursing apprenticeships each year to encourage staff and meet succession planning needs.

Management had moved staff between wards to break up perceived staff cliques. Some patients however told us they found the sudden movement of staff disorienting.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard. Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Patients and carers were involved in decision-making about changes to the service and could meet with members of the provider’s senior leadership team to give feedback.

Patients provide feedback directly to staff, through weekly and monthly community meetings, through ward representatives, a suggestion box and a family liaison lead established to call each patient’s family or carer twice a week to obtain their feedback. Suggestion boxes and ‘you say, we did’ noticeboards were visible on all wards. A television has been installed in the gymnasium at patient request and patients have suggested destinations for trips and visits which have been realised. Staff told us appreciatively their rest areas have been refurbished with new equipment by management and staff survey responses have increased 2% in the past year.

There were equality and diversity champions and networks within the service. All staff we spoke to said flexible working agreements were supported to account for personal circumstances such as caring responsibilities and health issues. The provider undertook equality monitoring of staff and published these figures annually. Published figures showed a yearly downward trend for gender pay gap and bonus payments.

The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The service had a clear framework outlining what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information. All handovers and staff meetings observed during the inspection were comprehensive and detailed. Staff demonstrated a good knowledge of patient needs and preferences and had access to the risk register at ward or directorate level. Staff at ward level could escalate concerns when required. Staff concerns matched those on the risk register.

Staff undertook or participated in local clinical audits at ward level on a weekly and monthly basis. The audits were sufficient to provide assurance and staff acted on the results when needed. Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients.

Where cost improvements were taking place, they did not compromise patient care. Staff had access to the equipment and information technology needed to do their work. Staff stated any equipment required for patients was always provided.

Information governance systems included confidentiality of patient records. A senior clinical staff member was the named Caldicott guardian for the local and regional service and patient initials were used for in all correspondence and phone call records.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborate for improvement.

The service leaders actively engaged with external stakeholders including the local authority, the Royal College of Psychiatry quality networks, corporate partners and Headway – the Brian Injury Association. Headway have accredited the service in 2025 as outstanding for a second time in a row.

The service had also been recognised for multiple examples of good practice in the first-ever report published by the Quality Network for Neuro Services by the Royal College of Psychiatrists (QN-Neuro) in November 2025. The report brought together insights from teams, patients, carers and partner organisations, reflecting a collective commitment to improving outcomes and experiences for individuals living with neurological and neuropsychiatric conditions. Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.

The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were given the time and opportunities to participate in research. This led to changes and innovations taking place in the service. Four innovations were taking place at the service. The team was establishing a new anti-racism QI project to manage increased racial incidents and understand patient impulsivity leading to racism. Staff would be trained as mediators to intervene and support each other and patients when a racial incident took place on the ward and wanted to know if this leads to a reduction in their occurrence.

The service had completed an important comparative study in the utility of Free Cognition 30-point assessment tool with the ACEIII (100 point) assessment scale. The clinically significant findings, that the shorter assessment tool was tolerated better with no loss of efficacy will be published in the Neurorehab Bulletin of the British Medical Association/Royal College of Psychiatry and in poster form.

The service was innovating in the area of meeting the patients’ unmet needs around the psychological trauma of acquired brain injury. The Kittwood model suggested treating depression with selective serotonin reuptake inhibitors (SSRI) could meet unmet needs that may have been driving challenging behaviour, which in turn allowed a reduction in antipsychotic medication to facilitate better engagement with rehabilitative occupational and physical therapy.

The service was innovating in the area of family therapy. The family visitation room was being remodelled with a one-way partition mirror to allow direct family therapist intervention during family visits. Three service staff were training to use this modality in 2026. The service is trialling EMDR post acceptance and commitment therapy following John Evan's work around neuro degeneration with severe dementia, applied for the first time to acquired brain injury.