The Care Quality Commission (CQC) has taken action to protect people at Cygnet Hospital Beckton in London, and told the hospital it must make rapid improvements to ensure people’s safety.
CQC undertook an unannounced, focused inspection of the hospital’s psychiatric intensive care unit and the ward for patients with learning disabilities, in March. The inspection was prompted by four incidents of alleged abuse of patients by staff, which Cygnet Hospital Beckton told CQC about.
Following the inspection, conditions were imposed on Cygnet’s registration preventing it from admitting people into the hospital without CQC’s permission.
This inspection sees the overall rating for Cygnet Hospital Beckton move from good to inadequate, and the service has also been placed into special measures. This inspection also sees the individual ratings of whether the service is caring or well-led move from good to inadequate, and the safety rating of the service move from requires improvement to inadequate.
Although two wards for patients with a personality disorder were not inspected at this visit in March, due to the overarching concerns about the hospital, the good rating for this service has been suspended until CQC can be assured this is still reflective of the care being delivered.
Jane Ray, CQC’s head of hospital inspection for mental health, said:
“We were deeply concerned about the safety and quality of care being delivered to people at Cygnet Hospital Beckton. People were sometimes being restrained without an appropriate reason using unauthorised techniques. This is unacceptable. People were also sometimes being secluded without appropriate measures in place to protect them from harm.
“Staff also locked a patient outside in the ward garden for at least 20 minutes following an aggressive outburst in February when the weather was cold. Whilst it was encouraging that Cygnet told us about these incidents and referred them to the local safeguarding team, more needs to be done to prevent these kinds of incidents from happening in the future.
“Nursing and support worker vacancies meant that there was high use of agency staff who might not know the complex individual needs of each of the patients. This had been on the hospital risk register since 2018 and repeatedly raised by the hospital manager but not adequately addressed by the senior managers for the provider. However the hospital manager had ensured there were very few registered nurse vacancies on Hansa Ward which cares for people with a learning disability.
“We immediately spoke with Cygnet about addressing our findings as a priority and told it to submit a report detailing what action it will take to address the issues raised. We have also taken enforcement action requiring it to act immediately to make improvements, and because of the seriousness of our concerns, we are considering whether further action is needed.
“Following the inspection, we received assurances from Cygnet that progress is being made. However, we will continue to closely monitor the care provided at the hospital and will return shortly to check on the progress of the improvements we have told them they must make.”
As well as the conditions preventing Cygnet Hospital Beckton from admitting new patients without CQC’s permission, staff must also undertake prevention and management of violence and aggression training, and senior staff must review and report on all available closed-circuit television images of incidents where staff are using unauthorised breakaway or restraint techniques.
Inspectors found a number of areas of concern:
- There had been four serious incidents between December 2020 and February 2021 which had raised concerns about potential abuse and poor care of patients.
- Inspectors saw evidence of unjustified restraint, use of unauthorised restraint techniques, seclusion without appropriate safeguards and the apparent physical abuse of a patient by staff.
- Staff were not reporting serious incidents in line with the provider’s policies and procedures. Managers learnt of three incidents following complaints from patients.
- Feedback from patients was mixed. Some patients said staff could be rude and some patients felt neglected and ignored. However, lots of the patients’ relatives were very positive regarding staff and their involvement in patients' care and treatment.
- Senior leaders consistently didn’t act on the concerns of the hospital manager, including where suggestions for improvement had been made.
However, inspectors also found:
- It was positive that the leadership informed the local safeguarding team, CQC and the police, following incidents of alleged abuse.
- There had been a relaunch of the least restrictive practice programme to ensure patients did not have unnecessary restrictions placed upon them.
- The hospital manager had identified gaps in the care provided to patients and introduced regular night visits by hospital managers to address this.
- Inspectors saw that staff spoke with patients with respect and responded to patients' frustration, anger and agitation in a calm manner, providing explanations.
Cygnet Healthcare is the organisation that runs Cygnet Hospital Beckton, as well as other healthcare facilities across England. CQC has also recently carried out a review of how well-led Cygnet Healthcare is as an overall healthcare provider.