Improvements at Cygnet but regulator says more work needed to ensure patient safety

Cygnet Health Care CEO Dr Tony Romero talks to HM

The Care Quality Commission has commended the progress made by Cygnet Health Care since its well-led review of the mental health provider in 2019, but said more work was needed to ensure sustainable improvements and the safety of services.

The regulator identified ‘serious concerns’ over Cygnet’s governance and leadership when it undertook the original review in the wake of the Whorlton Hall scandal.

As well as raising concern over the use of physical restraint, high reliance on agency staff and vacant management positions, it said care and treatment did not always follow best practice, clear lines of accountability were not always apparent, and that ‘fit and proper’ person checks had not been carried out for its executive board.

The latest review, which took place from January to March this year, considered additional concerns raised at 13 Cygnet services during subsequent inspections, including ongoing serious incidents, whistleblowing contact and safeguarding concerns.

Across the UK, 80% of Cygnet services are rated good or outstanding and since the last well led inspection, 61 of its services have had their CQC rating either upgraded or retained.

Following the 2019 review, Cygnet appointed four independent advisory board members with a range of experience in human rights, strategic leadership and in health and social care. The CQC said Cygnet had also carried out fit and proper’ person checks for its executive director and three independent directors appointed in the last year. In addition, it found that progress had been made in implementing an outline governance structure.

However, despite the improvements, inspectors said further action was needed to safeguard people using services.

Staff turnover remained high at 30% each year and the regulator said more work was also needed to reduce ligature risks and to review the use of restraint in social care services.

Moreover, it said Cygnet lacked a longer-term strategic plan and that senior leaders could not articulate which groups of people they were planning to support in future, or whether services would have the appropriate facilities and skilled staff to meet their needs. As a result, it said, Cygnet had continued to close and ‘repurpose’ services – at times with short notice and in response to serious concerns.

CQC’s head of hospital inspection Jane Ray said: ‘We carried out this review to check Cygnet were making sufficient progress with the improvements required, following our well-led review in 2019. We found a number of areas where progress had been made and where Cygnet were performing well.  This review took place when Cygnet were dealing with the implications of the Covid 19 pandemic, and we found that they had largely managed the risks associated with this well.

However, she added that action was needed to improve patient safety and working culture, as well as ensure proper engagement and transparency across the wider healthcare system.

‘People should be able to expect high-quality and safe care in all Cygnet services and staff should be supported to raise concerns. While most Cygnet services are providing good care there are some that still need to improve. While we are seeing progress in some services, we are concerned that some others are not providing safe care and are struggling to meet the needs of patients. We will continue to monitor and report on this through our inspection activity and take action where necessary,’ she added.

Publication of the latest well-led assessment coincided with two inspection reports for Cygnet Hospital Beckton and Cygnet Acer Clinic in Chesterfield. The Beckton site has been ordered to make ‘rapid improvements’ and had conditions imposed on its registration after inspectors found instances of inappropriate use of restraint and seclusion alongside high use of agency staff.

Meanwhile, the CQC said ‘significant improvements’ had been made at the Acer Clinic, which has been re-rated ‘good’ overall and allowed to exit special measures.

Cygnet said it took its responsibilities to identify and improve services seriously and was committed to working with service users and other stakeholders to ensure improvements at ‘the minority of services where further work is needed’.

Responding to the well-led assessment, a spokesperson for the company said: ‘We are pleased at the CQC’s recognition of the positive progress Cygnet has made, including that our services have managed the risks associated with the pandemic well. Given the unprecedented challenges all health and social care providers have faced, we are proud of our staff for their tireless work and dedication to keep people safe.’

‘Cygnet’s strategic plan to the end of 2022 focuses on providing services that are person-centred, open, inclusive and empowering and we are currently developing our five-year plan from 2023 onwards. As the CQC has highlighted in its report, we are doing this with strengthened operational leadership capacity, the support of outstanding independent directors and a new governance and quality assurance system that guides the way we engage with people who use our services and improves our oversight of service user safety.’