A review by the Care Quality Commission (CQC) of mental health and adult social care services run by Cygnet Health Care Limited has raised a number of concerns requiring action from the provider.
CQC carried out a provider well-led review of Cygnet Health Care between 2 July and 2 August 2019, after significant concerns were identified regarding the safety and culture of Cygnet Whorlton Hall following the BBC Panorama programme aired on 22 May.
Prior to the well-led review, CQC inspected 47 of Cygnet Health Care’s registered locations in England between May 2018 and April 2019 as part of its planned inspection programme. Whilst the inspections identified several positive factors they also identified some concerns linked to the provider’s leadership and governance arrangements.
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. Prior to publication of this report nine services had been rated inadequate or placed in special measures.
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 structure and processes in place did not support the executive board to effectively identify emerging issues. The provider used different information systems to notify and manage risks across the organisation, so the executive team did not have oversight of significant risks identified by regional teams.
Care and treatment did not always include best practice. Training for intermediate life support was not provided to all relevant staff across services where physical intervention or rapid tranquilisation was used. There was 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.
The executive team did not ensure all locations had a registered manager in post and as of June 2019, 8% of locations did not have a registered manager. Three of these had not had a registered manager for a period of six months.
A freedom to speak up guardian had not been appointed, although a raising concerns policy and external whistleblowing telephone line were in place to support staff to raise concerns. However, analysis of 67 'share your experience' comments received by the CQC about Cygnet services between May 2018 and November 2018 raised concerns regarding culture.
The integration of policies and procedures had not been completed following the acquisition of Cambian Adult Services or Danshell Group. Whilst the majority of policies had been reviewed for safety and rebranded as Cygnet Health Care, only approximately 20% had been integrated into a single Cygnet Health Care Policy. Many policies and procedures had three versions in current use depending on the location and there was no set target for their integration.
The required checks had not been carried out to ensure that directors and members of the executive board were “fit and proper”. Documents provided by Cygnet Health Care did not evidence that references had been sought during recruitment or that insolvency and bankruptcy searches had been carried out although there was evidence that directors’ identity had been checked and disclosure and barring service checks had been carried out.
However, there was a stable senior executive and leadership team in place with a range of skills, who worked together to support the delivery of care and senior leaders took steps to improve the quality of patient care once concerns were identified. Most services across health and social care had been inspected by the CQC and rated as good and some as outstanding.
Dr Kevin Cleary CQC’s deputy chief inspector for mental health and community services, said: “All patients must receive safe, effective and person-centred care. During the well-led review, we identified serious concerns about Cygnet Health Care’s governance and leadership and the impact of this on the quality of care being provided to vulnerable people in some services.
“Cygnet must now take immediate action to address our concerns. They must ensure that effective governance systems and processes are embedded across all services and that policies and procedures are consistent across all services to support staff to provide high quality care and treatment. Clinical and corporate risks must be identified and effectively managed at every level in the organisation including a clear risk escalation process. All checks required by fit and proper persons regulations must be carried out and a freedom to speak up guardian be appointed in all services commissioned by the NHS.
“Since our review Cygnet have commissioned a corporate governance review from an independent person and are taking action to make improvements at a number of locations. We will be closely monitoring the provider to ensure the necessary improvements continue to be made to ensure patients are receiving safe care.”
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