Cygnet Hospital Hexham

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• 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

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 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.

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.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff felt empowered to speak out about any concerns. Staff were happy, motivated and felt valued.

The provider’s five core values were:

• Care – Listening to and caring for others
• Respect – Treating people fairly and understanding the value of diversity
• Empower – Giving people the power to make informed decisions
• Trust – Building and maintaining trust
• Integrity – Being trustworthy, fair and ethical.

Staff understood the provider’s values, which were clearly communicated. Expectations of staff behaviours were reinforced during meetings and supervision sessions. Staff were able to contribute to improvements, particularly through governance, learning reviews, and quality improvement activity. Staff were focused on delivering high‑quality, person‑centred care and demonstrated an awareness of how to manage resources effectively.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leadership at the service was compassionate and aligned to the organisation’s values. Leaders were knowledgeable and demonstrated the skills and experience required for their job roles. Leaders had a clear understanding of the wards they managed and were able to describe how teams worked to deliver care.

Managers spent time on the wards speaking with staff and patients and demonstrated good oversight of operational challenges, including staffing pressures, clinical risks and emerging concerns.

Leaders were visible across the service and approachable for both patients and staff. They promoted a culture of learning, inclusivity and psychological safety, and responded proactively when issues were identified.

We scored the service as 3. 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.

An open and transparent culture where people felt safe to speak up was in place. Patients and carers had regular opportunities to share feedback through ward rounds, community meetings, advocacy, and individual discussions. Feedback was used to inform improvements. Managers reviewed themes from complaints, incidents and compliments, and actions were shared with staff to support learning.

Staff described feeling able to raise concerns without fear of reprisal. Freedom to Speak Up Guardians were visible, and staff could escalate any concerns confidentially. Senior leaders were accessible, and both staff and patients reported that they could speak with them directly.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

An inclusive working environment was in place. Staff told us they felt respected and supported, and leaders were committed to ensuring everyone had equal opportunities.

There were named equality and diversity champions, including representatives for LGBT+ and minority ethnic groups. Staff reported that these leads were visible and approachable.

Managers supported flexible working, and we saw examples where staff had agreed adjustments. Staff said these arrangements helped them balance work and personal commitments.

Reasonable adjustments were put in place to support staff with additional needs, including changes to duties or the working environment. Staff described feeling comfortable raising concerns about their needs and said managers responded positively.

We scored the service as 2. The evidence showed some shortfalls. The service 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, or share this securely with others when appropriate.

Established governance structures were in place. These demonstrated clear lines of accountability. Leaders promoted an open culture, and there were systems in place to share learning across the service.

Audits were carried out across key areas, and managers had access to data dashboards. However, governance systems did not always provide reliable assurance. Several risks identified during our inspection had not been highlighted or addressed through routine audits, including issues relating to medicines management, documentation, and environmental safety.

Documentation shortfalls continued despite repeated identification through audit, such as missing observation records. We also raised the use of inappropriate language within records, including references to “firm boundaries”. We assessed the use of this language did not reflect person‑centred practice and was not in line with expectations for respectful and recovery‑focused documentation.

We scored the service as 3. The evidence showed a good standard. 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 effectively with a range of external partners to support coordinated care for patients. Constructive relationships were in place with commissioners, advocacy providers, local safeguarding teams and other agencies. External partners reported being welcomed and able to contribute to service discussions.

Advocacy services were well‑integrated at the service and supported information‑sharing and escalation when needed.

Safeguarding processes showed consistent multi‑agency communication, and learning from incidents was shared to improve practice. Feedback mechanisms, including advocacy input and carer engagement, were embedded practice at the service.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

A learning and improvement culture was embedded at the service. Staff were supported to reflect, raise concerns and contribute ideas.

Sensory‑based interventions, co‑produced environmental changes and tailored activity programmes were in place to improve patient experience. The service contributed to externally published quality improvement work. This demonstrated their commitment to engaging in wider learning.

The service was a Member of QNPICU which supports service and quality improvement through a peer review process and sharing good practice. At the time of our inspection the service was preparing for scheduled external peer review.