LAST month I wrote about Cygnet, the US-owned private health firm that sells mental health beds to the NHS. 

An inquest jury had just ruled that a patient who collapsed at their Cygnet Kewstoke hospital, dying soon after, received “gross failures” in her care. 

The inquest jury found the “understaffed” Cygnet hospital failed to spot the danger of the patients wildly excessive water-drinking, driven by her poor mental health, which preceded her seizure and death.

Cygnet makes a lot of money from the NHS and local authorities, but has a history of poor care. Since then I have seen even more reports of poor care by Cygnet.

This May the Care Quality Commission published its inspection report on Cygnet Hospital Wyke. Inspectors found the 46-bed mental health hospital in Calderdale, West Yorkshire, was “inadequate” and “did not provide safe care.”

Thanks to management failures, the hospital did not look after medicines properly. Staff filled in medicine records “retrospectively” when “gaps” were discovered, so they couldn’t be sure who took what drugs when. 

Inspectors found that care needed improvement because staff “did not always understand the individual needs of people. They did not always actively involve families and carers in care decisions.”

The hospital environment was also poor. Patients told inspectors “the ward was noisy and chaotic” and “they told us they spent a lot of time in their bedrooms because of this and some patients wore ear defenders.”

The ward was also dirty. Inspectors said “we found food on the floor, staining on furniture, cigarette ends in the lounge and some of the furniture was ripped.” Inspectors put the hospital in special measures — the hospital has had previous periods of poor performance, including being under special measures in 2019.

Last October the Care Quality Commission published its inspection report on Cygnet Hospital Harrow, a 56-bed mental health hospital in London. Cygnet Harrow has four wards, mostly for people with autism who have  other mental health issues. The inspectors rated the hospital “inadequate” in a damning report. 

Some of the long-stay autistic patients were treated particularly badly. Inspectors said Cygnet claimed to be “delivering a specialist service for men with a diagnosis of autism” but “our inspection found that this was not the case.”

The nurses and care staff “were not adequately trained to communicate effectively with people using the service,” they just didn’t have the training to do the job. One effect was that patients told inspectors: “They did not feel they were treated with compassion and kindness.” 

Three patients told inspectors that “staff mimicked them and laughed at them.” Staff did not properly review the use of restraints. This included “a person being taken to appointments wearing handcuffs” by staff.

The wards were also not suitable for autistic people because they were “institutional and noisy.” They were also not “kept adequately clean.” For example, one person in seclusion had “smeared faeces over the walls.” They were left in this mess for 17 hours before it was cleaned.

There were also medical dangers: staff did not monitor the condition of patients given “rapid tranquilisation drugs” properly, even though these can be lethal. Long-stay autistic patients “were not having routine health checks such as appointments with the optician or dentist or an annual health check with the GP.”

Cygnet’s recent history of poor care includes the Care Quality Commission prosecuting the firm last September — a very unusual move. 

The commission fined Cygnet £1.53 million over a patient’s death in London. The commission said Cygnet did not take the right steps to prevent a young woman committing suicide in Cygnet Hospital Ealing, and did not properly prevent the use of ligatures, or observe patients often enough or train staff how to revive patients properly.

Cygnet gets £170m a year from the NHS and local authorities, so it is a big deal. It is owned by US health giant Universal Health Services, which also has a record of poor care.

Both the Care Quality Commission and NHS can take specific action if they think there are general problems at the firm.

In 2020 the Care Quality Commission ran what is called a “well-led review” on the whole firm, following a BBC Panorama exposé of gross abuse of vulnerable adults at Cygnet’s Whorlton Hall hospital. 

The commission looked at all its services and its HQ and found real failings in the overall management of the company. Cygnet was embarrassed and put under pressure by this review. 

The commission ran a follow-up “well-led” review of Cygnet in 2021, when it found that “some progress” had been made but the firm had to do “further work needed to improve safety of services.” 

Given the commission has now prosecuted and fined the firm £1.53m, I asked them if they would now run another well-led review.

Director of mental health at the Care Quality Commission Chris Dzikiti responded: “While we don’t currently have a date for a further well-led review of Cygnet Health Care, this provider is subject to ongoing monitoring and we can inspect at any time should we have evidence that people are at risk or there are concerns about the quality and safety of care. 

“We will use our enforcement powers if necessary to protect people and can take criminal enforcement action to hold providers to account if they do not provide safe care and treatment, as with the prosecution brought against Cygnet Health Care last September.”

NHS England, which has a large, direct contract with Cygnet, can also raise questions of poor performance with Cygnet top management, something it says it has done in the past. I asked if they would, in the wake of the Care Quality Commission prosecution and the poor reports, be pressing Cygnet’s bosses.  

An NHS spokesperson said: “While approximately 75 per cent of Cygnet healthcare providers are rated good or outstanding by CQC, the NHS is working closely with the regulator to monitor, identify and take appropriate action for any NHS service that needs improvement.”   

The fact that the NHS started out by highlighting Cygnet’s 75 per cent good and outstanding services, rather than worrying about their 25 per cent poor or inadequate services makes me think they would rather “look on the bright side” than pressure this private health giant’s poor performance.