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Inspectors have warned of an absence of accountability at a mental health provider that was last year at the centre of a televised care scandal.
The Care Quality Commission has identified “serious concerns” over the governance and leadership of Cygnet Health Care following a review of how ‘well-led’ its services are.
“A clear line of accountability from the ‘ward to board’ could not be established”
The review comes in response to a BBC Panorama documentary that exposed staff at one of Cygnet’s learning disabilities hospitals – Whorlton Hall in County Durham – mistreating patients.
Since the programme, which aired in May 2019, the CQC has been reviewing all facilities run by Cygnet and has so far rated nine services as “inadequate” and placed into special measures.
Although most of the 140 services in the provider’s UK portfolio remain rated as “good” or “outstanding”
In July and August 2019, the health watchdog reviewed how well-led the organisation is and it has today published its report.
Inspectors found that “a clear line of accountability from the ‘ward to board’ could not be established across all of Cygnet Health Care’s locations”.
They said there were different information systems being used across the organisation to report risks, which meant Cygnet’s executives “did not have oversight of significant risks identified by regional teams”.
Meanwhile, care and treatment under the organisation “did not always include best practice”, while key training in intermediate life support “was not provided to all relevant staff”.
The report also raised concerns over a “high use” of physical restraint and seclusion across Cygnet’s services compared with similar services in other mental health providers.
The number of patient assaults by other patients and recorded self-harm were also higher at the provider compared with the NHS, noted the CQC.
In terms of nurse staffing, the report highlighted that the percentage of nursing shifts covered by agency across Cygnet increased from 20% in January to 43% in August 2018.
“Being restrained is not just humiliating and dehumanising, it can be life threatening”
However, between August and December 2018 there was a slight reduction to 33%.
The report went on to cite 67 “share your experience comments” believed to be from staff between May 2018 and November 2018, which “raised concerns regarding culture” of the organisation.
Examples included: “managers were absent at important times; ignored the concerns of others and failed to provide enough staff; that in locations, there was active deception by hiding incidents”.
The provider also noted that Cygnet had not appointed a freedom to speak up guardian.
The NHS standard contract requires providers to appoint one or more freedom to speak up guardians to help staff raise concerns in the wake of the Mid Staffordshire hospital scandal.
The CQC therefore actioned the organisation to recruit a guardian for its services that were commissioned by the NHS.
Meanwhile, it was also revealed that 8% of the provider’s locations did not have a registered manager and that three of these posts had not been filled for a period of six months.
In addition, inspectors identified that required checks had not been carried out to ensure that directors and members of the executive board were “fit and proper”.
Commenting on the review, Dr Kevin Cleary, CQC’s deputy chief inspector for mental health and community services, stressed that “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,” he added.
Whilst the CQC has not published a rating for its well-led review, Dr Cleary said the provider must take “immediate action” to address inspectors’ concerns and vowed to monitor the situation closely.
Vicki Nash, head of policy and campaigns at mental health charity Mind, said the review was a reminder of the “poor quality of care too many people receive from mental health services”.
“High self-harm and patient assault rates are unacceptable in any healthcare setting. No matter what happens, at the very least, people receiving treatment and support for their mental health should expect to be kept safe, treated with dignity and compassion,” said Ms Nash.
“It is especially worrying to see the high use of physical restraint and seclusion used in Cygnet Health Care’s facilities. Being restrained is not just humiliating and dehumanising, it can be life threatening.”
“We were horrified and shocked by the footage shown in the Panorama programme”
She called on Cygnet Health Care to act “urgently” to meet the CQC’s recommendations.
“People with mental health problems should not have to use inadequate and dangerous services, nor should mental health staff have to work in them,” warned Ms Nash.
Whilst there were several concerns raised by inspectors, the CQC did recognise that “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”.
The report also highlighted that senior leaders had taken steps to “improve the quality of patient care once concerns were identified”.
It added that systems were in place to “promote honesty and transparency following incidents” and that a “culture of openness was encouraged by leaders and embedded within policy”.
A spokeswoman for Cygnet Health Care said that since the inspection took place last summer, 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.”
She said this was “reflected in being less restrictive and ratings being upgraded in some areas” at the organisation.
“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,” added the spokeswoman.
“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.”
She said the provider was “reviewing our processes for identifying, managing and escalating clinical and corporate risks at all levels – locally, regionally and corporately”.
The spokeswoman added that its use of agency staff had “seen a downward trend” and that in December 2019, “the total percentage of agency hours was 16.8%” across the provider.
Cygnet was also appointing a freedom to speak up guardian, she noted.