Cygnet Hospital Wyke

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last assessment we rated this key question requires improvement. Following this assessment, the rating has changed to good.

Staff managed beds well. A bed was available when a patient needed one. Patients were not moved between wards except for their benefit.

Patients did not have to stay in hospital when they were well enough to leave.

The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Staff supported patients with activities outside the service, such as work, education and family relationships.

The service met the needs of all patients, including those with a protected characteristic.

Staff helped patients with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result.

However, 2 of the 6 carers we spoke with said they did not know how to make a complaint if they wanted to do so.

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.

The patients and carers we spoke with said that care and treatment had been arranged around their individual needs and preferences. Staff involved patients and families in decisions about care and treatment.

Staff supported, informed and involved people using the service and their families or carers. Staff told us that people were included in their care and treatment choices with carers being involved where appropriate. There was a social worker within the hospital who supported carers and also sought to facilitate smooth transitions to other placements when the patient was ready to be discharged.

During our tour of the wards, we saw that patients could personalise their bedrooms. Patients had lockers in which to securely store their possessions. There was a multi-faith room onsite and religious leaders such as Imams and chaplains visited the wards to conduct services.

We saw evidence in care records that decisions around care and treatment were made in co-creation with the patient and their carers where appropriate. We saw evidence of discharge planning and that patients were supported to move on with the next steps of their recovery journey.

We observed a multidisciplinary team meeting in relation to the future of a patient's care and treatment. Staff at the hospital were robust in arguing on the patient's behalf about issues relating to the use of clozapine and not to coercing them into making decisions against their will.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups. The hospital offered a good variety of food options including Halal, Kosher, vegan, vegetarian, gluten-free and healthy options such as fresh fruit and vegetables.



Staff made adjustments for patients with specific needs such as mobility or communication issues. For example, patients with mobility issues were placed in bedrooms at ground level and staff could arrange for signers, interpreters or for information to be provided in a variety of formats to support people with communication issues. Staff had also given patients walking aids and shower seats to meet their mobility needs.



There was a People’s Council meeting within the hospital each month which was a patient forum for implementing hospital-wide change. Patients gave feedback about activities, food, what was working well and what could be improved.

The service employed an expert by experience who attends the site each week. They attended sitrep meetings and visited the wards to speak with patients, staff and undertook observations of what was happening on the wards. Their feedback was shared with senior managers within the service.

Work had gone into the carers’ strategy within the hospital. A new carers' lead has been appointed and a review of the information sent out to carers upon admission was being undertaken. This included a document to complete and return providing any information that may be beneficial in planning care and supporting a positive patient experience.

In November 2024, a newly employed social work assistant, had begun contacting the relatives of patients newly admitted to the service when patients had given consent to do this. The purpose of this was to give a general background to the hospital, explain how the multidisciplinary team works and when and how they can attend meetings and contribute towards care and can receive more information and updates.

Patients and carers told us staff worked well in ensuring patients had access to joined-up care. Staff communicated with patients in a way that they could understand the different aspects of their mental and physical health care and treatment.

Staff ensured they shared clear information about patients and any changes in their care. Staff worked alongside the service's social worker to ensure discharge from the service was smooth and carers received appropriate support.



The service had worked with a local NHS trust in relation to multiagency discharge events (MADE) aimed at reducing the length of stay and unblocking obstacles to discharge. Until October 2024, this trust held all 19 beds on Phoenix ward on a block contract and 7 beds on Bennu ward, so the trust had been the hospital's predominant commissioner.



Staff worked with NHS England and various commissioners on the former Adarna ward to try and expedite discharge through a monthly meeting from July onwards. Once the decision was taken to close Adarna ward, these meetings increased in frequency.

We received feedback from 3 commissioners: 2 from a local NHS trust and another from a local authority. Staff provided regular updates about their patients’ progress; interacted well with their patients and explained aspects of care and treatment in a way they could understand.

One commissioner said the hospital manager was excellent at providing feedback about patients and the service. The trust's commissioning and integration team undertook quality visits at the hospital to review the quality of care, ward environment, care records and undertook interviews with patients and staff so they were assured care, and treatment was safe and appropriate.



The commissioner from the local authority said staff were proactive in facilitating discharge appropriately; were able to identify any barriers and acted accordingly to address them. Aftercare services were identified and staff ensured there was a robust plan in place to ensure the discharge was safe.



Feedback from advocates was mixed. One advocate had observed staff members being kind and respectful towards patients on all 3 wards. However, the week after our onsite assessment, the advocate supported a patient in making a complaint about a staff member who had not treated them in a respectful way. The provider confirmed that the staff member had been removed from the ward; been told to have no contact with patients and that the matter would be investigated.



A second advocate had observed improvements on Kingfisher ward. Staff on the ward were more efficient and responsive to requests for updates and handovers. They had concerns about staffing levels on Bennu and Phoenix wards and said they were affecting patients' access to advocacy or for advocates to provide a service in a safely. However, we looked at staff rotas whilst onsite and staffing levels were appropriate to safely meet patients' needs. We were given assurances from the hospital manager around the processes for managing staff levels on the wards.

Care plans reflected people's protected characteristics and we saw evidence of reasonable adjustments being made for people when required. The social worker within the team sought to ensure carers were involved when appropriate and their role included ensuring patients had suitable placements to be discharged to. There was an out of hours doctor who could be at the hospital within 20 minutes if there was an emergency. The service was also located to three nearby acute hospitals if patients needed to be taken to an emergency department.

Patients and carers told us staff provided information in a way they could clearly understand. However, 1 of the 6 carers we spoke of said that staff were not proactive in providing them updates about their loved one's progress.

Leaders and staff told us people could be given information in a variety of ways to meet their needs. These included information in different languages, fonts, braille, easy read and via the use of flash cards.

People had access to interpreters and signers if needed.



We saw evidence in care records that patients had been offered a copy of their care plan and they were written in a way they could clearly understand. They also evidenced that staff regularly reminded patients of their rights.



Patient noticeboards on the wards contained a good level of information including:



• safeguarding

• staffing information

• ‘You said, we did’ posters

• How to complain to the provider, Parliamentary and Health Services Ombudsman and Care Quality Commission

• meal options

• smoking cessation

• local services and helplines

• spiritual support

• activities planner

• advocacy services

• Patients' rights under the Mental Health Act, including informal patients’ right to leave the ward freely.

The need for an interpreter was identified at the point of referral to ensure minimal delays for the patient.



Staff issued patients with welcome packs when they were admitted to the ward and a carer's pack was sent to families and carers. These contained information about the Mental Health Act, contact numbers and how to make a complaint.



We saw evidence in care records that staff had explained aspects of care and treatment options so patients could give informed consent.



Staff maintained the confidentiality of information about patients. At the time of our assessment, 99% of staff had completed their information governance training which focussed on the secure management and handling of personal information and ensuring personal information was kept confidential at all times.

Two of the 6 carers we spoke with said they did not know how to make a complaint about their loved one's care and treatment should they wish to. Patients told us staff gave them opportunities to provide feedback and ideas in relation to how they were treated. Patients knew how to make a complaint.

Staff knew how to handle complaints appropriately. Staff supported patients and carers to give feedback on the service and care and treatment. There were people's council meetings on the wards between patients and staff.



Staff gathered feedback from patients about the quality of their overall experiences via surveys during the patient's stay on the ward and at the point of discharge. Data from the surveys were discussed at governance meetings and used to improve.

During our tour of the wards, we saw posters in patient noticeboards explaining how to make a complaint to the provider or externally to the Care Quality Commission and Parliamentary and Health Services Ombudsman. We also saw evidence that staff had responded to feedback from patients on 'you said, we did' posters.

Managers investigated complaints made by people using the service. In the last 12 months, there had been 22 complaints on Bennu ward and 23 on Phoenix ward.



All complaints had an action plan with a list showing how learning would be cascaded to the staff teams where appropriate. Complaints were shared within team meetings and reviewed within clinical governance monthly each month. Learning was also shared through the hospital lessons learned log when appropriate.



Lessons learned from investigating complaints were used to improve practice within the hospital. Following a complaint that a staff member was falling asleep on night shifts, an investigation was undertaken. Increased random checks of closed-circuit television were completed to ensure that this was not a closed-culture issue. Additionally, random checks of the wards were added to the night duty nurse rota.



Following a complaint from a relative in relation to the communication around their loved one's care, the ward manager met with them to discuss reviewing a communication agreement.



The service had received 67 compliments within the last year. These included the quality of care received, staff attitudes, the admission process and catering team.

Family members that we spoke to told us that they could speak with staff and felt comfortable to do so. They further added that they had not felt the need to complain about the care, support and treatment of their family member, however, would feel comfortable and able to do so should they need to.

Staff that we spoke with told us that patient's family members/carers are invited to meetings regarding their family member via Teams or Zoom if distance of travel would otherwise mean they could not make the meeting.



Staff told us that they have liaised with commissioners for additional funding to allow for patient's to have significant others attend face to face meetings about their care.



Staff told us that on admission should any reasonable adjustments to care and treatment be identified then these would be recorded and incorporated into patient's care plans, such as, the need for a translator or a ground floor placement due to mobility issues.



Staff told us that they are planning face to face meetings or open days for families and carers but are considering locations and logistics for those that live a distance from the hospital site.

Partners told us that they feel the hospital/ward staff identified barriers and acted accordingly. Staff also worked to facilitate safe discharges with a continuity of care when aftercare had been identified.

The social worker team told us that they worked alongside partners commissioners to aid in tackling inequalities and achieve equity of access especially as many current patients were out of area and the distance from the hospital to their homes could be an issue in terms of visits from loved ones.

Patients told us they were given opportunities to say how they wanted to be treated. These included a complaints process, people's council meetings, one-to-one time with their named nurse and speaking with advocates or the expert by experience.



We looked at the results of a patient survey during our assessment.

Patients were satisfied overall with their bedrooms and communal areas of the wards and there were no issues. All 20 patients surveyed felt safe. Patients had mixed views about the standard of the food - a small percentage said the food was bad or 'reasonable'. Over half of the patients found the food good overall. All the patients we spoke with said staff were supportive, helpful and very caring. Most patients said there were always good levels of staff to support them. All patients stated they knew who their named nurse was and that they met with them regularly.

The hospital manager told us that all the policies and procedures used in relation to care and treatment and the running of the hospital had been subject to equality impact assessments. These assessments are used to identify and remove any potential barriers or unfair treatment to vulnerable people, or people with protected characteristics.



Staff told us they recognised people by their preferred pronouns and gender identity.

The provider employed a diverse work force within the hospital, including people from ethnic minority groups, LGBT+ people and disabled people. This helped to ensure that there was a wider knowledge and awareness of any specific considerations that may be pertinent to the patient demographics.

Staff took patients' cultural or religious needs into account when developing their care plans. There were individualised positive behaviour support plans in place for all patients on Bennu ward and for complex patients on Phoenix and Kingfisher wards. The plans included exploring cultural and religious needs as well as a holistic approach to promoting wellbeing and recovery.

All staff on Kingfisher ward had attended a local autistic spectrum disorder induction to give them a greater awareness of how to support autistic people or those with sensory needs. Staff supported neurodivergent people using the service. These included:

• the use of sensory heat maps to highlight low/high stimulus areas on the ward

• the use of accessible/easy read information where needed

• access to a sensory room and sensory grab boxes on the ward and

• access to sensory strategy groups and development of sensory safety plans.

The sensory room had been made available to all wards and the occupational therapist was leading the development of a hospital-wide sensory strategy which the service hoped to introduce in January 2025.

The service operated 3 advocacy provisions for patients, including a generic advocacy service commissioned by the provider, an independent advocacy service and a peer advocacy service. An expert by experience supported patients within the service. This advocacy support amounted to 5 days per week and ensured there were independent mechanisms for any concerns to be raised.

Patients and carers told us they were involved in decisions about their future care and treatment. They were supported to access advocacy and were referred to healthcare professionals to manage their mental and physical healthcare needs.

Staff told us that discharge from the service was planned as a multidisciplinary team and was discussed at regular meetings with the person being consulted at every stage.



Leaders told us there were no patients subject to 'do not attempt cardiopulmonary resuscitation' orders or Respect plans in place at the time of our assessment. They said these would not be in place within the organisation's acute wards and psychiatric intensive care units.

We saw evidence in care records that staff actively discussed and planned for discharge from the service. However, the care records evidenced that some patients were still acutely unwell so discharge from the service was not currently appropriate. We also saw evidence that staff had supported patients in making applications for benefits and applying for bank cards.



We observed a sitrep meeting during our assessment. The ward manager of Bennu ward reported that two patients had been successfully discharged from the ward the previous day.



During our tour of the wards, we overheard staff praising a patient on Phoenix ward whose status had changed from detained to informal. This evidenced that the service removed legal detentions when patients were well enough to manage their own care and treatment.