Cygnet Hospital Wyke

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 requires improvement. Following this assessment the rating has changed to good.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed.

Staff provided a range of treatment and care for patients based on national guidance and best practice.

The teams on the wards included or had access to 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.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients and carers told us that staff involved them in decisions around care and treatment. Staff had given carers information about how to apply for a carers' assessment from the local authority.

Staff told us they received a high number of calls from family members. Staff gave them a progress update if the patient had given their consent for them to do so and reassured them.



Staff told us there were physical health champions and nurses within the service who made referrals to physical healthcare services when needed. For example, we were told by a staff member on Kingfisher ward that a nurse ran a men's drop-in group and undertook baseline screening of patients' physical health status from admission information. Physical health audits were undertaken each month such as electrocardiogram and bloods results and also recorded on a ward round spreadsheet.



Staff said the service's social worker's obtained consent from patients to involve their families and, if given, they sent out a carer pack to them. There were carer open days ran by the organisation and efforts were made to hold them in areas close to patients' homes. When this was not possible, carers could join calls via social media platforms.



Staff told us care plans, risk assessments and risk management plans were reviewed at least every 2 weeks and updated when required such as after an incident.

We looked at 11 patients' care records. We saw evidence that staff completed a comprehensive mental health assessment of each patient in a timely manner on or soon after admission.



Staff assessed patients' physical health needs and care planned around these accordingly.



Care records were up-to-date, personalised, holistic and recovery-orientated.



We saw evidence that care plans were developed in co-creation with patients and their carers.

Patients who spoke with us said they could seek support and advice about their care and treatment from staff. Staff supported patients to have access to an independent advocate.

Staff told us discussions in supervision sessions were used by managers to identify their training and developmental needs. Staff told us there were opportunities to undertake specialist training for their role. Examples of training offered and undertaken included bloods and electrocardiograms.



Staff were able to demonstrate their knowledge of the Mental Health Act and Mental Capacity Act when they spoke with us.



Leaders told us that there was an audit timetable. Audits included:



• medicines management

• observations

• seclusion documentation

• clinic rooms

• Mental Health Act and

• physical healthcare.

Staff provided a range of care and treatment suitable for the patients in the service. There were therapeutic sessions available either one to one or in groups and there were also a range of social and educational activities such as a breakfast club, maths, English, arts and crafts, an onsite gym, relaxation, pool, board games and music. Patients that could leave the hospital made use of local amenities such as a swimming pool. Staff delivered care in line with best practice and national guidance.

Staff ensured that staff had good access to physical healthcare, including access to specialists when required. These included speech and language therapists, dentists and GPs.



We saw evidence in care records that staff assessed and met patients' nutritional and hydration needs.



Patients had access to a full range of specialists, either within the service or externally. These included psychiatrists, psychologists, occupational therapists, activities coordinators, nurses, healthcare assistants and a social worker.



Staff kept up-to-date with any changes in mental health practice. For example, the head of psychology within the service told us there are bi-monthly service line acute and PICU meetings during which any updates in terms of psychological interventions.



Staff received training in the Mental Health Act and Mental Capacity Act. The provider had policies and procedures relating to the Acts which reflected the most recent guidance. Staff had access to support and advice about the use of the Acts from a Mental Health Act Administrator.



We saw evidence in care records that staff requested an opinion from a second opinion appointed doctor when necessary. Care records also evidenced that staff had read and explained patients' rights to them as required.



On all 3 wards within the service, patient noticeboards contained posters about access to advocacy services and informing informal patients that they had the right to leave the ward freely.

Patients and carers who spoke with us spoke positively about the range of different professionals involved in care and treatment. There were no concerns raised about a lack of joined-up and continuity of care.

Staff told us that they had regular access to team meetings. Minutes from meetings were taken and sent to all staff so any staff members unable to attend were kept up-to-date with essential information.



Staff and leaders told us that they had good, effective working relationships with teams both within and outside of the organisation.

Throughout our assessment, we saw different healthcare professionals working in partnership together well. There appeared to be respect throughout the different disciplines for each other's point of view and clinical insight.



We observed a multidisciplinary meeting in relation to the care and treatment of a patient currently based within the hospital. This was attended by a nurse and 2 doctors based at the hospital and professionals from a mental health trust. Each of the attendees was given the opportunity to provide their input into the patient's current status and thoughts about their future care and treatment.

There were standing agenda items for team meetings to ensure essential information was shared and discussed. This included lessons learned from investigating incidents, complaints and safeguarding concerns.



Staff shared information about patients at effective handover meetings from 1 shift to another. The nurse in charge also completed a checklist during their shift to ensure information about medicines, physical health, observations, seclusion, incidents, security, notifications sent to the CQC, any safeguarding referrals sent to the local authority and any care plans that had been reviewed and updated were recorded.

Patients and carers told us that staff encouraged them to partake in activities which involved exercise and access to fresh air. These included attending the gymnasium or walking. Staff also encouraged patients to attend cooking sessions so they could learn to cook their own food and to make healthier food choices to meet their nutritional needs.

Staff told us they supported patients who wished to stop smoking through smoking cessation programmes. They encouraged patients to partake in exercise, mindfulness and cookery groups. There were physical health leads and nurses within the service who supported patients with their physical health needs.

We saw evidence in patients care records that staff conducted physical health screening such as electrocardiograms, blood glucose monitoring and took patients' blood pressure readings.



We saw evidence in care records that staff care planned for any physical health issues identified. For example, we saw one patient was on a diabetes care plan and staff regularly monitored their glucose levels, their weight, pulse and their body-mass index level. We also saw evidence that staff had referred patients to external healthcare services such as podiatry and dentists.



Staff used a form called the Visual 1 to 6 assessment when patients declined to have their physical observations taken. The form ensured staff assessed the patient's breathing, communication, mobility, orientation to the time, place and people, skin condition and current behaviour.

Patients and carers told us that they received the care and support they needed. Patients told us that their care was regularly reviewed, and they were seen by appropriate teams and professionals to support both their mental and physical health such as psychologists, occupational therapists and GPs.

Quality of life outcomes were assessed by staff and the expert by experience during discussions with patients and their carer and families and use of DIALOG. DIALOG is a scale of 11 questions. Patients rate their satisfaction with 8 life domains and 3 treatment aspects on a 7-point scale.



Clinical outcomes were routinely being monitored due to the action plan in place around medicines safety. This included looking at outcomes and data, what is best practice, e-learning, incidents, meds cards etc. and was monitored via a spreadsheet of reported incidents to monitor trends and medicines errors.

Staff used recognised rating scales to assess and record severity and outcomes. These included the National Early Warning Scores, Health of the Nation Outcome Scores, DIALOG and Global Assessment of Progress. It also used its own Daily Risk Assessment tool to allow for visibility of decision-making around risk as well as the corporate visibility of level of risk that a site carried.



Care plans had occupational therapy-based goals which were monitored each fortnight. There was a budgeting group which included a quiz to assess patients' ability to manage their finances. Staff undertook activities of daily living (ADL) assessments to gauge the effectiveness of ADL based tasks undertaken by patients. The occupational therapy provision was standardised across all the provider's services. Staff had worked alongside other services and private healthcare providers so they could learn from them and benchmark performance against similar services.

Staff explained patients' rights to them in a way they could clearly understand. Staff explained things in a way that enabled patients to make informed decisions about their care and treatment.

Staff told us that there were two advocacy services that supported patients; one was commissioned by the provider and the other was independent. An advocate from the service commissioned by the provider visited the wards twice a week and independent advocacy could normally attend within a day or 2. Advocates could also speak to patients by phone or on social networking platforms. Staff told us that patients were automatically referred to an advocate when they were admitted to the service.



None of the patients at the hospital had 'do not attempt cardiopulmonary resuscitation' orders in place.

During our assessment, we saw staff speaking to patients on the ward, reminding them of their rights either as a detained patient or informal patient.

We saw in care records that patients were regularly reminded of their rights. There was evidence that when patients lacked capacity, staff held best interests meetings with the patient, their family, advocates and members of the multidisciplinary team involved in the patient's care and treatment. Best interests decisions were made and recorded following these meetings.



Care records also contained evidence that staff sought patients' consent to care and treatment. For example, staff had sought consent from a patient to undertake care and treatment of a wound they had sustained. Care records evidenced there were ongoing discussions with patients around consent to treatment and that capacity was assessed. We also saw evidence that patients had access to advocacy.