Concern raised by CQC over Cygnet Health Care

The Care Quality Commission (CQC) carried out a review of Cygnet Health Care - which has hospitals in Bierley, Wyke, Wibsey and Brighouse - in summer last year following a BBC Panorama programme on its Whorlton Hall hospital in Barnard Castle.

At the time of the review a number of Cygnet Health Care’s services were being inspected or subject to the early stages of enforcement action.

During the review CQC inspectors found that a clear line of accountability could not be established across all of Cygnet Health Care’s locations.

The watchdog said the executive board did not have oversight of significant risks identified by regional teams; care and treatment did not always include best practice and training for intermediate life support was not provided to all relevant staff across services where physical intervention or rapid tranquillisation was used.

It also found a high use of physical restraint and seclusion across services compared to similar services in other mental health providers. The number of patient assaults by other patients and self-harm recorded were also higher in Cygnet Health Care compared with NHS providers of similar services. Not all locations had a registered manager in post and the CQC said required checks had not been carried out to ensure that directors and members of the executive board were “fit and proper”.

Dr Kevin Cleary CQC’s deputy chief inspector for mental health and community services, said Cygnet must take “immediate action” to address concerns. He said the CQC would be closely monitoring Cygnet to ensure necessary improvements continue to be made.

A spokesperson said: "Cygnet runs more than 140 services across the UK and we are pleased the report highlights that most of our services inspected by the CQC have been rated as good and some outstanding.

"Many have maintained these ratings over multiple inspections, over many years, showing sustainability in our provision. It also demonstrates that our structure, systems and management have been effective in maintaining sustainable, high quality care across the majority of our services.

"This report recognises our stable and approachable senior executive and leadership team who work together to support the delivery of care. It identifies a culture of openness, a person-centred approach to providing care and a strong emphasis on understanding and improving patient experience. The CQC acknowledge that where concerns have been identified, our senior leaders have taken steps to improve quality, through the provision of additional resource and support.

"This inspection happened in July 2019, since when a number of the services highlighted in the report have improved. However we are not complacent and take on board recommendations where we must improve and are already doing so. This is reflected in conditions being less restrictive and ratings being upgraded in some areas.

"The report documents that this Well Led review was a response to Whorlton Hall and we cannot stress enough that we were horrified and shocked by the footage shown in the Panorama programme. We have a zero tolerance approach to abusive behaviour and took immediate steps to minimise any risk across our portfolio well in advance of this review, including transferring residents to appropriate alternative placements, closing the facility and cooperating fully with external agencies, which we continue to do."

The spokesperson added: "During inspection the CQC saw evidence of clinical, environmental and operational risks being identified and managed appropriately. We have also appointed to the role of Group Medical Director.

"Prior to the publication of this report, Cygnet had already appointed external advisors to review the Group’s governance structures and identify opportunities for these to be strengthened and we are in the process of implementing the appropriate recommended outcomes.

"At Cygnet, we treat some of the most acute patients that other providers may not be able or willing to support. We always aim to de-escalate and advocate least restrictive practices in line with current good practice guidelines. The report recognises it does not take into account the level of need or acuity of individual patients admitted to these wards.

"As an organisation we are keen to learn how we compare with other organisations and we have joined the NHS Benchmarking programme. As part of our transparent culture, we encourage all incidents to be reported to ensure we have visibility across our services.

"The report’s reference to the need for more intermediate life support training refers to one area of practice that had been identified by the organisation prior to the inspection and plans were already in place to address this which have been discussed with the CQC."

The spokesperson accepted Cygnet was not able to immediately show all documents required, but since then "appropriate paper work and actions have been checked and verified by external lawyers".

They added: "We are satisfied we are fully compliant and there are no issues around directors’ capability, experience, or qualifications. We will be submitting this information to the CQC as part of our action plan.

"Our priority is to deliver safe, effective and person-centred care across all of our services to some of the most vulnerable people in society.

"We are pleased this report has recognised that Cygnet’s vision and values support a person-centred approach to providing services. We take on board the findings and our management team will continue to work closely with the CQC and other stakeholders in an open and transparent way to ensure that all recommendations from the report are fully implemented and that the CQC is informed of the progress and continual improvements being made."

Meanwhile, a number of “significant concerns” and regulation breaches were found at the Wyke hospital on Huddersfield Road in an inspection back in June. However, in a follow-up inspection of the hospital, currently rated inadequate, the CQC found improvements had been made.

A spokesperson for Cygnet said it has invested “significantly” in improving the service and new management is in place.