• CQC calls for “immediate action” from Cygnet 
  • Regulator warns of high number of restraints, seclusions, assaults and self-harm at Cygnet facilities
  • Inspectors could not find “clear line of accountability” and leadership team “”did not have oversight of significant risks”

The firm which runs a mental health hospital at the centre of an abuse scandal has been criticised by regulators for its leadership, care quality and “high use of restraint and seclusion” across its sites.

The Care Quality Commission is calling for “immediate action” from Cygnet Health Care — which ran Whorlton Hall before it closed last year in the wake of a BBC Panorama investigation — following an assessment of its leadership.

Regulators found there “was a high use of physical restraint and seclusion,” and high levels of patient-on-patient assaults and self-harm across services run by Cygnet compared to similar mental health services at other providers.

It also warned the required checks to make sure directors and board members were ‘fit and proper’ “had not been carried out” by Cygnet, which runs more than 140 locations across England, Wales and Scotland, and there was no evidence references had been sought during recruitment or that insolvency and bankruptcy searches were done.

It is quite unusual for the CQC to carry out a “well-led” review of independent providers — this is the third case in the mental health sector, the regulator told HSJ.

The assessment, carried out between 2 July and 2 August 2019, inspectors said they could not find a “clear line of accountability” across the provider’s locations and that, as of June 2019, 8 per cent of Cygnet’s locations did not have a registered manager. Three of these had not had a registered manager for a period of six months.

Cygnet’s executive team “did not have oversight of significant risks identified by regional teams” due to different management systems to manage those risks, inspectors found.

The CQC also found Cygnet did not provide training for immediate life support to all relevant staff in services where physical intervention or rapid tranquilisation was used. 

However, the CQC noted Cygnet had a stable senior executive and leadership team in place “with a range of skills” and senior leaders “took steps to improve the quality of patient care once concerns were identified”. 

The inspection report also highlighted most of Cygnet’s services had been rated by the CQC as “good” and some as “outstanding”.

Immediate action

Kevin Cleary, CQC’s deputy chief inspector for mental health and community services, said Cygnet “must now take immediate action to address our concerns”. Since the inspection, Cygnet has commissioned a corporate governance review from an independent person and has taken action to make improvements. Dr Cleary added the CQC would be “closely monitoring the provider to ensure the necessary improvements continue to be made to ensure patients are receiving safe care”. 

In a statement, Cygnet said “a number of the services highlighted in the report have improved” since the inspection last July but that “we are not complacent and take on board recommendations where we must improve and are already doing so”.

A Cygnet spokeswoman said that following the Panorama programme it “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”.

Cygnet told HSJ that although it could not immediately show the CQC evidence the checks had been carried out, the paperwork had since been checked and verified by external lawyers. It added it had intended to deal with the issue of life support training before the inspection took place. The spokeswoman added the provider “always aim to de-escalate and advocate least restrictive practices in line with current good practice guidelines”.

Special measures

A total of nine services run by Cygnet have been rated either inadequate or placed in special measures, including two services — Whorlton Hall and Cygnet Chesterholme — which have now shut down.

HSJ analysis found the CQC rated six mental health hospitals “inadequate” in the wake of the Whorlton Hall scandal, just months after describing them as “good” or “outstanding”.

Three of these hospitals were run by Cygnet, including Whorlton Hall, which had been rated “good” in December 2017 before being revised to “inadequate” last May.

Update: This story was updated at 12:46 on 14 January 2020 to reflect that Cygnet Health Care runs more than 140 services across England, Wales and Scotland, rather than the 113 figure detailed in the CQC report.