Cygnet Hospital Hexham

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• 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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 9 care records during our assessment.

Assessments were comprehensive and were completed when patients were admitted. Records showed that mental health, physical health and risk assessments were completed promptly.

Care plans reflected the needs identified through these assessments. They were personalised and recovery‑focused, incorporating patients preferences and strengths. Patients and carers told us they were involved in discussions about their care

Care plans were updated when people’s needs changed. Regular MDT meetings, daily huddles and risk assessments ensured staff maintained an up‑to‑date understanding of each patient’s presentation.

We scored the service as 3. The evidence showed a good standard. The service 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 and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the MHA 1983 and the MHA Code of Practice and discharged these well.

Systems were in place to ensure care, treatment and support were delivered effectively. Staff completed clinical audits to assess the service and to implement improvements when these were required. However, audits were not always effective as we identified several issues which impacted safety during this assessment.

Induction training was provided for new staff, including bank and agency staff. This covered the model of care, trauma‑informed practice, psychology‑led training, and bespoke engagement training delivered by the clinical manager.

Training compliance was generally high across all mandatory modules. However, there were some subjects where the providers KPI for the completion of training had not been met. There were clear escalation processes in place for overdue training, including temporary removal from practice until compliance was achieved.

Supervision and appraisal rates exceeded provider targets, with 95–96% compliance over the past 12 months. A comprehensive programme of development opportunities was available to support staff progression. This included management courses, preceptorship, supervision training and clinical forums.

The service demonstrated effective MDT working, with formulation meetings incorporated into patients’ first ward rounds and shared widely with staff. Information from formulations and Positive Behaviour Support (PBS) plans was incorporated into care plans to support consistent practice. Dynamic daily meetings were used to keep care plans and risk assessments up to date.

A range of ongoing quality improvement projects, including environment improvements, enhanced physical health monitoring, and engagement and observation quality improvement work, reflected a culture of continuous improvement. The service also participated in national programmes and accreditation schemes, such as Quality Network for Psychiatric Intensive Care Units (QNPICU) and the Triangle of Care, which supports benchmarking and assurance of effective practice.

We scored the service as 3. 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.

Multidisciplinary working was embedded, with regular MDT meetings, ward rounds and formulation discussions involving all relevant professionals. Staff shared information effectively through structured handovers and daily morning huddles.

Internal relationships between teams working on different wards were in place. Fisher and Franklin wards collaborated to share learning and to deliver a consistent approach.

Effective links with external agencies such as the local authority and advocacy were in place. Carers confirmed they were kept informed, involved in decisions and supported to contribute to care planning.

We scored the service as 3. 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.

Systems were in place to support patients to live healthier lives. Patients consistently told us they received advice on smoking cessation, healthy eating, exercise and general wellbeing.

Activities were offered to patients to encourage healthy lifestyles. This included sports, walking, cooking sessions, mindfulness and sensory groups. Patients and carers reported these activities supported emotional and physical wellbeing.

Staff were trained in physical healthcare. Training records showed 100% completion rate for the Physical Health module for all eligible staff.

We scored the service as 3. The evidence showed a good 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.

Systems were in place to monitor care and treatment. Staff used structured clinical assessments and the provider’s ‘PARA’ risk assessment tool, which was in line with recognised tools used in the mental health sector. Regular reviews were completed to track progress, measure outcomes and inform care planning.

Technology was used to support the delivery of care. This included electronic patient records, incident‑reporting systems and digital access to physical health results. Patients had access to telephones and could use video links to maintain contact with family and friends. Video links were also used to support people to attend MDT meetings virtually when they were unable to attend in person.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff enabled patients to make their own decisions wherever possible. When patients lacked capacity, staff completed decision‑specific assessments in line with the Mental Capacity Act. Patients were informed about their rights and supported to take part in decisions about their care, and records showed a clear person‑centred approach to assessing consent.

Patients told us they were involved in care planning, ward rounds and treatment discussions, and carers reported being included appropriately when consent had been given.

Staff training, supervision and governance processes were used to monitor and provide oversight of consent practice. Consent to treatment documentation was completed appropriately, and audits were undertaken to monitor compliance.

Mental Health Act

Staff were appropriately trained in, and demonstrated a good understanding of, the MHA, its Code of Practice and the guiding principles. Training compliance was high across the service, with 100% of staff on Fisher ward and 97.8% of staff on Franklin ward having completed MHA training.

Staff had easy access to administrative support and legal advice regarding the application of the Act, and they were clear about how to contact MHA administrators when required. The provider had relevant and up-to-date policies and procedures in place that reflected current guidance and supported staff in applying the Act correctly.

Patients had access to independent mental health advocacy (IMHA) an independent mental capacity advocacy (IMCA). Information about IMHA and IMCA services was available, including contact details and referral routes. Staff explained patients’ rights under the MHA in a way that individuals could understand and recorded them appropriately.

Staff ensured that patients were able to take Section 17 leave when this had been authorised, and systems were in place to request a Second Opinion Appointed Doctor (SOAD) where needed. Detention paperwork and associated MHA records, such as Section 17 leave forms, were stored securely and in a way that enabled all relevant staff to access them.

The ward displayed notices informing informal patients of their right to leave the ward freely, in line with the Code of Practice. Care plans included reference to Section 117 aftercare arrangements for those eligible under Section 3 or equivalent Part 3 powers, ensuring aftercare planning was embedded into the patient pathway.

Regular audits of MHA practice were completed by staff.

Mental Capacity Act

The provider had set a key performance indicator (KPI) of 90% for the completion of Mental Capacity Act (MCA) training. This target had been exceeded, with 100% of staff on Fisher ward and 97.8% of staff on Franklin ward having completed the training. Training ensured staff understood the 5 statutory principles of the Act and how to apply them when assessing a patient’s ability to consent.

In the last 12 months, there had been 1 application to the local authority for a Deprivation of Liberty Safeguards (DoLS) authorisation for a patient on Fisher ward. The provider had a MCA policy, which included guidance on DoLS. Staff were aware of the policy and knew how to access it. Staff also knew how to escalate concerns and could seek advice and guidance from the hospital management team and the MHA administrator.

Staff took all practical steps to support patients to make their own decisions. Patients were invited to attend ward rounds and were encouraged to share their views and preferences. Staff routinely assessed and recorded each patient’s ability to consent to their care and treatment. When patients lacked capacity to consent, staff made and documented best interest’s decisions in line with the Mental Capacity Act.

Systems were in place to monitor compliance with the MCA. This included regular audits carried out by the MHA administrator, whose responsibilities included checking that documentation was accurate, complete and legally valid.