Cygnet Hospital Harrow

On this page

• 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

We looked for evidence on how the service provided was well-led. At the last inspection in 2023, we rated this key question as inadequate. At that inspection, the service was in breach of regulation 17 (good governance). At this inspection, the rating has changed to good. This meant that the service had taken action to improve the effectiveness of its care and treatment, particularly regarding governance and oversight. We found no breaches of regulations in relation to this key question.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and communities.

Most staff understood the strategic direction of the hospital. Significant changes had taken place at the hospital since the last inspection in 2023. The opening of West Ward was part of the hospital redevelopment. A psychiatric intensive care unit was scheduled to be opened shortly in an adjacent area of the hospital.

Staff acknowledged that there had been a lot of changes at the hospital, and this had been unsettling. However, all staff were pleased with the improvements there had been to clinical care.

The service had inclusive leaders with the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

Staff said that the hospital director and medical director were both approachable and engaged well with staff and patients.

Staff told us that the hospital had received enhanced support and investment from Cygnet Health Care after the CQC rated the hospital as inadequate in 2023. Managers said that this support had enabled the hospital to improve.

The ward manager had been in post since the ward opened in October 2024. They were a registered nurse and had previous experience of being a manager. They described their work as being focused on providing supervision, ensuring nursing tasks were completed, ensuring compliance with policies and procedures and attending meetings for senior staff. However, their description of their role did not include engagement with staff and patients. This could lead to the manager becoming out-of-touch with direct service delivery.

At the time of the inspection, the post of clinical services manager was vacant. This meant that the ward manager was directly managed by the hospital director. The hospital director had experience of managing and leading improvements at similar hospitals.

Three of the four patients we spoke with said the ward was well-run.

Freedom to speak up

Quality statement score: 3

The service assigned a senior member of Cygnet Health Care to the role of Freedom to Speak Up Guardian. Information on how to contact the Freedom to Speak Up Guardian was displayed in the nurses’ offices.

Staff said they felt confident in raising concerns about poor professional practice or inappropriate conduct towards patients.

The service assigned a senior member of Cygnet Health Care to the role of Freedom to Speak Up Guardian. Information on how to contact the Freedom to Speak Up Guardian was displayed in the nurses’ offices.

Staff said they felt confident in raising concerns about poor professional practice or inappropriate conduct towards patients.

The service worked towards an inclusive and fair culture by improving equality and equity for people who worked there.

The hospital had set up support networks for staff. These included a multicultural network and a network for lesbian, gay, bi-sexual and transgender staff.

The service employed a diverse team of staff from international backgrounds. Employment practices promoted equality of opportunity. Managers said the service did not discriminate against staff from minority groups. Staff did not raise any concerns about discrimination.

The service had clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support.

During an inspection in May 2023, the provider had the following breach: the provider must ensure governance processes operate effectively, and that local procedures and policies are met. During this inspection we saw the service had improved in this area of work and was now compliant with regulations. There were areas the provider should continue to strengthen in overall governance, such as detailed and consistent recordings of patients being alert after rapid tranquilisation.

Clinical governance meetings were held for the whole hospital. The ward manager from West Ward attended this meeting. The meeting was chaired by the hospital directors. These meetings covered standard agenda items including safety, training and education, effectiveness, the experience of patients and carers and lessons learned from incidents. Each ward was required to submit a monthly clinical governance report. This meant the service now had more effective monitoring of key aspects of service delivery.

The risk register for the hospital included five risks. These were: the risk of ligature incidents, compliance with fire regulations, training for staff, the hospital alarm system and risks relating to building work taking place at the hospital. The risk register included a score for the severity of each risk, actions being taken to address the risk (including immediate mitigation) and timescales for completing those actions.

The role of the expert by experience was fully integrated into the governance processes. The expert by experience visited the hospital once a week, met with patients and facilitated community meetings. They met with the hospital director to give feedback on patients’ and discuss patients’ experiences more broadly. This information was then discussed at the Cygnet Health Care regional governance meeting. This also informed the work of the Cygnet Health Care lived experience advisory group that met four times each year with the Chief Executive and the Director of Nursing.

The service worked well with other agencies including commissioning bed managers, health and social care professionals and the local authority safeguarding team. For example, the service understood the key priority areas for local safeguarding referrals. The service had developed a good relationship with an NHS trust that commissioned the service through a block-booking arrangement. Staff engaged with their professional bodies and undertook specific roles within these organisations.

The service focussed on continuous learning, innovation and improvement across the organisation and the local system.

The consultant psychiatrist was the quality improvement lead for the ward. The ward was undertaking quality improvement programmes to achieve a reduction in medication errors by prescribing doctors, improve the quality of discharge summaries and improving engagement with carers.

The service had appointed a service educator to monitor compliance with procedures and improve professional practice across the hospital.