On 23 December 2020 the Care Quality Commission published its Quality Report on Cygnet Woodside (copy attached).  Cygnet Woodside is a private mental health hospital that provides assessment, treatment and rehabilitation for adults with learning disabilities and autism.  The hospital received a rating of inadequate and has been placed in special measures.

The Strategic Director of Quality and Nursing at NHS Bradford District and Airedale Clinical Commissioning Group will attend the meeting to update Members on the report and the impact on Bradford residents.

(Michelle Turner - 01274 237707)

On 23 December 2020 the Care Quality Commission published its Quality Report on Cygnet Woodside a copy of which was appended to the agenda.  Members were aware that Cygnet Woodside was a private mental health hospital providing assessment, treatment and rehabilitation for adults with learning disabilities and autism.  The hospital received a rating of inadequate and had been placed in special measures.

The Strategic Director of Quality and Nursing at NHS Bradford District and Airedale Clinical Commissioning Group attended the meeting to update Members on the report and the impact on Bradford residents.

A summary of the inspection included the background to Cygnet Woodside; the rationale for conducting the inspection; how the inspection was carried out and detailed findings from the inspection.

A detailed presentation was provided which included CQC themes and trends; a response to the concerns; safeguarding and safety and future plans.

Members expressed concerns that despite the purpose of scrutiny reports being to provide reassurance it was felt that they almost never had that satisfaction.  They expressed concern that the service had gone from a rating of Good to Inadequate in a short space of time and that issues highlighted in the inspection had not been identified prior to the CQC visit. Concern was also expressed that members of the management team were not in attendance.

In response Members were advised that there had been an immediate response to the concerns and that the new host commissioner role and responsibilities recently published would strengthen the powers of the Local Authority and regular visits would be undertaken.  The Host Commissioner role would provide a central point of contact and would hold partnership meetings including with the CQC and the Safeguarding board.   The Local Authority had also identified a resource for support to be proactive and preventative with independent hospitals and that would include Cygnet.

A number of additional queries and concerns were raised to which the following responses were provided: -

·         There had been long term placements at the facility.  The CQC report did refer to a person staying at the Cygnet Woodside for up to five years.

·         Conduct issues raised in the report may be confidential, however, generally could refer to capability or other concerns.   Those issues would need to be considered on a case by case basis.

·         At the time of publication of the report there were nine people using the facility.  Since that time four people had transitioned to alternative provision.  The CQC and partner organisations were meeting with Cygnet on a weekly basis to look at the safe transfer of those service users remaining and wellbeing checks were being conducted to support those people.

·         The response and work carried out would not be wasted as the service model changed.  The new model would transfer to the local authority which would act as lead commissioner.  The response and work carried out since the inspection would not be wasted and would enhance the future provision.

·         The home first approach was adopted wherever possible to support people in their home settings.

·         There had been many concerns at the hospital during the pandemic.  Many service users did not tolerate staff wearing masks.  Officers had worked with the hospital to mitigate risks and reduce the risk of infection.

·         It was not possible to provide a breakdown of the age and ethnicity of current service users but it was confirmed that they were aged 18+.

·         The CQC report identified access to advocacy and communication between personalised commissioning or social workers who were involved to support service users after the findings.  Positive feedback had been received regarding improvements put in place and how loved ones were supported, from their families.

·         Specialist Autism training was identified in the report and had been delivered.  It was not known if additional specialist support from a Learning Disabilities perspective had been provided.

In response to all the issues highlighted in the report Members were extremely concerned that those issues had not been picked up prior to the CQC inspection.   The monitoring arrangements between CQC visits was questioned and it was stressed that Members needed to have the confidence that a similar situation would not recur at any of the district’s facilities or if they did interventions would be made.

In response it was explained that the new host commissioner role provided the local authority with the power and responsibility to carry out regular visits.  There would also be partnership meetings including the CQC Safeguarding Board to triangulate data. The Local Authority had also identified a resource to support independent hospitals which would include Cygnet.    Assurances were provided that an immediate response was made to all concerns. 

A Member expressed disappointment that she had not had the opportunity to comment on the CQC report and questioned who was speaking up for service users.  She was also disappointed to note that the mandatory autism training for one for one day and that the rate of pay for a support worker was so low. It was queried if the facility, as it moved to its new model of operation would involve the same personnel and if so would they have better training and provide more support and help for service users.  In response it was not possible to comment on future staffing provision but assurances were provided that facility received support to facilitate appropriate discharge and provision for users and that support would be continued.  The possibility of inviting managers of the facility to a future meeting was suggested for Members to gain assurance from that provider.  The oversight of the facility would transfer to the Local Authority in the future. 

A Member with significant experience in mental health referred to a model which revealed how facilities can deteriorate from conscious competence to incompetent complacency and questioned why there were so many agency staff employed.  It was believed that this often evidenced an inability to recruit in places seen as not good places to work.  He questioned if the number of agency staff was because of an inability to recruit or high levels of sickness.  In response it was explained that confirmation from the provider would be required to answer those questions. 

It was confirmed that the CQC visit had been unannounced although it was not possible to confirm if that had been in response to concerns from the Local Authority; family members; staff or other professionals.  It was agreed to discuss with Local Authority colleagues to ascertain where concerns had originated prior to the inspection.

A Member raised the Department of Health review into the Winterbourne View Hospital in 2012 and intentions to ensure similar incidents were not repeated.  Concerns were raised that, because of austerity measures, this had not occurred.   It was explained that the ‘Winterbourne Review’ was regarding out of area placements and measures were now in place.  The Local Authority was responsible agency for safeguarding and moving forward the Host Commissioning Role would strengthen its control.

Members referred to information they required which was not presented in the report under discussion, that there had been no input from the Local Authority and that it should not be down to patients and families to raise concerns.   It was explained that the officers had been asked to provide an update on the response to the inspection and the situation regarding people currently residing at the facility.  It was hoped that they had responded to that request.  There were a number of concerns raised from the report and consideration would be required to ascertain if that information could be shared.  The questions raised at the meeting had been noted and officers would liaise with partners to provide a further report as soon as practicable.

Resolved –

That the issues and themes raised by the Committee including around monitoring and adult safeguarding be added to the Committee’s programme of work for 2021/22 for further scrutiny.

Action: Overview and Scrutiny Lead