The report of the of
the Bradford District and Craven Clinical Commissioning Group and
Bradford Metropolitan District Council (Document
“H”) provided a joint update on the local
arrangements in place for responding to safeguarding concerns from
Cygnet Hospitals Health Care, Bradford.
The Strategic
Director of Health and Wellbeing for Bradford Council was in
attendance, accompanied by the Strategic Director of Quality and
Nursing for Bradford District and Craven Clinical Commissioning
Group, Deputy Director of Nursing, NHS England and Improvement,
Director of Nursing and Patient Experience, Cygnet Healthcare and
the Managing Director, Cygnet Healthcare North.
With the request of the Chair,
the Strategic Director of Quality and Nursing for Bradford
District and Craven Clinical Commissioning Group gave a
detailed synopsis of the report to the committee.
Following an introduction of the report, a
question and answer session ensued:
- As there was no mention in the
report, clarification was sought in regards to whether there was an
independent advocacy support network in place for people with
learning disabilities and, a general insight on the independent
advocacy services for all users was requested
- Yes. An independent advocacy support
network was in place for vulnerable adults who were unable to fully
take part in their own planning process as it was the
responsibility of the Council to offer this service;
- Viable contracts were in place with
external advocacy organisations through immense work in the
development of strong relations over the last six months.
- A co-production steering group was
in place and chaired by an expert through experience. The group was
about working in partnership with patients and service users to
make sure that the agenda was not proven only by professionals, but
in partnership with patients and service users. This was an
important feature as it brought together all of the leads for the
advocacy organisation, for the purpose of reporting on current
themes and trends. This process also gave an opportunity to
challenge needs.
- Every clinical area had contact
information, the advocacy service visited the clinical areas
regularly, at least weekly depending on the size of the hospital
sites and the medical board once a week. Contact numbers for
service users were also available, if users wished to contact the
advocates from outside;
- Further to a report by the
Transforming Care and Commissioning Steering Group, chaired by Sir
Stephen Bubb – 2014 in relation to Winterbourne View Hospital
scandal; concerns expressed by this committee’s
constituents; the public’s concerns of the treatment of
people with learning disabilities, it has always been favoured for
more intermediate level of psychiatric provision and care closer to
home. Therefore, could assurances be given that everything was
being done to ensure the correct safeguarding processes were in
place?
- There were plans to reopen Woodside
hospital as a care in the community facility in November 2021 but
had been pushed later in January 2022. The reopening of the
hospital was to make a significant difference to the services
provided. The services would provide specialist services for people
with a primary diagnoses of mental health problems in addition to a
secondary diagnosis of autistic spectrum disorder. The facility
would be providing specialist services for complex needs;
- In terms of a general overview, what
were the services being provided?
- There were three wards. Each
delivering specialist care services, (1) specialist services for
patients with a primary diagnosis of mental health problems and
secondary diagnosis of autistic spectrum disorder; (2) a
psychiatric intensive care unit; and, (3) services for patients
diagnosed with acute or mental health cases;
- Following the Care Quality
Commission’s (CQC) announced inspection of Woodside Hospital
following allegations of abuse which at the time was subject to an
ongoing police investigation, what reassurances could be
relayed to the committee in terms of the lessons learned and
whether there would be a cultural change within the facility
towards patients?
- There would be a safeguarding lead
in position, trained to an enhanced level of recognising how to
provide the correct specialist care provision. The facility would
also include corporate support for the site, additional
supervision, additional training for all staff, specialist advice,
and to include a dedicated role in corporate safeguarding.
Therefore, the whole supervision and support for the site has been
enhanced to meet the needs of vulnerable adults. In addition, the
site would entail additional roles to support corporate mechanisms
by having access to more specialists than previously. In terms of
advocacy support for the site, there would be continual monitoring
on a corporate level to ensure that patients, service users
obtained as much advocacy as required. If it came to light that
additional services were required, then contracts were in place to
ensure that resources would be made available.
- Woodside Hospital would be visited
regularly and reasons for visits would be to ensure that people
were not at any point at any form risk. However, if something
contentious was to come to light then an investigation would be
initiated in order to establish the correct the mechanisms be put
in place for patients and officers delivering the specialist
care;
- Further to an extract contained in
the report: “Local Authority with a monthly
average of 6.6 safeguarding concerns from Cygnet Hospital Bierley.
From Cygnet Hospital Wyke, during the same time period, the Local
Authority received an average of 7.6 safeguarding concerns each
month. The average s42 conversion rate for Cygnet Hospital Bierley
was 30% and for Cygnet Hospital Wyke it was 41%”.
Therefore, explanation was sought to the information of there being
high profile cases and people being denied access to services. In
such circumstances, concerns or complaints being submitted as well
as the public looking for reassurance, which being in response to
the earlier statement of support for advocacy was very firm
including a welcoming culture for staff to raise concerns?
- The process set in place was a
culture based freedom to speak up within a service area. A
dedicated role had been implemented for staff members to approach a
designated staff member on a confidential basis, anonymously, or
not anonymously if the staff member felt comfortable in coming
forward to address concerns. This was an independent role that
reported directly to the board.
- Outside of Cygnet, an external
service was also provided as well as a whistleblowing
helpline.
- Each service area was now working
towards having an ambassador and this process was being profiled
locally to make sure that all staff were aware of the freedom of
speech culture.
- In the coming year, there would be
additional resources available that would give additional
information and insight to other support for staff.
- Experienced experts were positioned
to lead for the organisation and these roles reported directly to
the board;
- The report touched on Host
Commissioner (HC) arrangements that provided an opportunity to
share intelligence between stakeholders, including commissioners
and strengthen the link with the Local Authority safeguarding team
and Safeguarding Adults Board to triangulate any issues that are
identified. Could a simplified explanation for HC arrangements be
provided to the committee?
- In response, the key role of the HC
in CCG, in respect of inpatient care commissioned for people with a
learning disability, autism or both, was to:
- be the point of contact for
commissioners and for the CQC for issues relating to quality and
safety for units where inpatient care is delivered;
- ensure that placing commissioners
are aware of the key contact in the host CCG should they become
aware of issues of concern
- establish a mechanism for sharing
intelligence between commissioners who are placing individuals (or
considering placing individuals) with a learning disability, autism
or both within the service;
- ensuring interface with the
council’s adult social care safeguarding service, and also
with the local safeguarding adult board (SAB) and with local
partners so that any identified actual or potential safeguarding
concerns are raised with the host local authority and dealt with as
appropriate;
- to work in consultation with
colleagues in contracting and quality teams and be the key point of
contact with the provider for issues relating to quality and
safety, including those that impact multiple commissioners;
- to work with providers and with
colleagues in contracting and quality teams to develop actions that
would deliver required quality improvements, and seek assurance
that necessary improvements have been made; and,
- to work in conjunction with local,
regional and national quality surveillance group (QSG)
arrangements, taking a lead role in co-ordinating the response
required if there are serious and/or multiple concerns identified.
Ensure the QSG has strong and formal links with the local SAB, so
that concerns discussed at QSG can also be discussed with SAB
chairs.
- A recent BBC Panorama programme that
featured undercover filming from inside a Norfolk Hospital for
vulnerable adults and reveals patients being mocked, taunted and
intimidated by abusive staff had also been an influential factor
towards the new policy guidance in regards to the HC;
- Cygnet was currently predicting
important factors to consider which had come about through
conversations with the police;
- With HC, other areas of services
would be accessible for patients who may have had new problems that
required treatment on an immediate basis. HC were specialists that
had access to various other services; and,
- HC role was to ensure that the place
based role in Cygnet as the service provider had undertaken the
correct checks and balances in order to provide the right
care.
During the discussion, the committee and
officers made the following comments:
- For the West Yorkshire region, a
group was set up that played an important role for a significant
programme in undertaking a review of provisions throughout the
region to ensure that the system of keeping people as close to home
as possible was effective and efficient for patients;
- Cygnet tried its best in its overall
goal which was to always ensure that patients were placed close to
home as possible. However, occasionally specialist services were
not available within a locality to enable them to be placed as
preferred. If this was the case, then provisions would be
implemented to ensure regular contact with families and carers
through the means of iPads to FaceTime was made available. It being
paramount that from a provider perspective that it was essentially
critical to ensure the users of Cygnet services had everything in
order to enhance the recovery stage; and,
- This joint report from Bradford
Metropolitan District Council (BMDC) and Bradford District and
Craven Clinical Commissioning Group (CCG) had a responsibility to
understand the ranges of basic responsibilities that set out the
arrangements in place of how the System works together to safeguard
service users in Cygnet, identifying roles, responsibilities and
mechanisms in place to support patients and staff.
The Chair concluded the discussion by stating
that it was easy to say that immense work was being invested into
the system of delivering specialist care and equally for the
committee to praise the efforts of Cygnet due to the implementation
of new processes however, it was important to note that unforeseen
challenges were yet to be met. The system itself was for the
provider to meet the ever increasing challenges and even more
paramount to note that no matter what the circumstances, that no
one slipped through the net, therefore:
Resolved:-
(1) That
a report on the implementation of the new ‘Host
Commissioner’ arrangements be added to the Committee’s
2022/3 programme of work;
(2) That
the assurance against the safeguarding actions taken in relation to
Cygnet be welcomed.
Action: Overview and Scrutiny Lead
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