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Cygnet Health Care

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Cygnet Health Care is the second largest private provider of mental health services in the UK, with 100 sites and 2,725 beds. The company contracts with a large number of NHS trusts and CCGs. Cygnet Health Care is owned by the US corporation Universal Health Services Inc, a Fortune 500 company with revenue in excess of $11 billion in 2019.

Strategy

Cygnet Health Care was established in 1988. Its website states it has 8800 staff working in 140 services. Services cover mental health needs, autism and learning disabilities within the UK. The company is owned by the US company Universal Health Services (UHS) Inc.

UHS Inc is one of the largest providers of hospital and healthcare services in the USA with more than 90,000 employees. Through its subsidiaries, the company operates 26 acute care hospitals, 328 behavioural health inpatient facilities, and 42 outpatient facilities and ambulatory care centres in 37 states in the US, Puerto Rico and the UK. In the USA, UHS offers health insurance plans through Prominence Health Plan, and manages a network of physicians through Independence Physician Management.

UHS, via Cygnet Health Care, has made several acquisitions in the UK that have been consolidated within the Cygnet group. In 2018, Cygnet acquired The Danshell Group. Danshell owned and operated 25 facilities with a total of 288 beds in the UK. The Danshell facilities focus on adults living with learning disabilities, who may also have a diagnosis of autism.

In December 2016, Cygnet acquired CAS Behavioural Health (formerly known as Cambian Adult Services).

The company now offers 11 distinct service lines: Secure; Acute and PICU; Mental Health Rehabilitation and Recovery; Personality Disorder; Children and Adolescents; Eating Disorder; Learning Disabilities; Autism Spectrum Disorder; Supported Living; Neuropsychiatric; Older Adults; Deafness and Mental Health; and Nursing Homes.

Financials

In the financial year to end December 2019 the Cygnet Health Care Ltd Group of companies reported revenue of £434.2 million (2018: £375.6 million) and a pre-tax profit of £27.6 million (2018: £44.5 million). Post-tax profit was £25.7 million in 2019 (2018:£39 million).

The US parent company is a Fortune 500 corporation with annual revenues in 2019 of $11.4 billion.

Contracts

In 2019, Cygnet Health Care reports that it did business with 257 NHS organisations and local authorities. The company will be listed on framework agreements to supply inpatient beds as well as contracts for outpatient services.

Concerns

Cygnet has been repeatedly criticised by the CQC for unsafe and poor care.

Following an inspection of Cygnet's hospital in Colchester in October 2020, the CQC told the hospital must remain in special measures with improvements still needed. The inspection followed reports relating to the safeguarding of patients and the reporting, investigation and management of incidents. Inspectors found an allegation of abuse had not been reported appropriately and that staff did not always follow correct Covid-19 policy or infection prevention and control guidelines.

An unannounced inspection by the CQC at the company’s CAMHS at the Godden Green hospital in Kent in October 2020 identified serious concerns about environmental risks and staff’s ability to keep patients safe from harm and injury. The CQC had received complaints from other professionals and relatives. Inspectors found a culture of negativity had developed among some staff, with patients referred to as ‘difficult’ and ‘troublemakers’ in records. Cygnet has now decided to close this service and focus on adult patients at this hospital.

In September 2020 the CQC carried out an unannounced inspection of Cygnet Yew Trees, a 10 bed facility for women with learning disability. The CQC reviewed 21 episodes of closed-circuit television footage and found nine that showed staff “abusing patients, acting inappropriately or delivering a poor standard of care”. Managers suspended eight permanent members of staff from working at the hospital. Referrals have also been made to the police. The CQC criticised Cygnet’s management for allowing a culture to develop at this hospital which led to people suffering abuse.

In January 2020, the CQC told Cygnet to take “immediate action” to improve its management following an investigation of the company and its hospitals.  The CQC found that Cygnet-run hospitals were more likely to use seclusion and physical restraint on patients than other NHS providers of mental health care. The incidents of self-harm and assaults by other patients were also much higher. The CQC report also found that checks to ensure directors and members of the executive board were “fit and proper” were not carried out. The full-scale review was triggered by a BBC Panorama report in May 2019 into Whorlton Hall, a centre for people with learning disabilities. As a result of the programme ten people were arrested for abusing patients.

From January to September 2019, mental health units run by the company have been found to be inadequate by the CQC six times. In November 2019, the CQC ordered that the Cygnus Acer Clinic in Derbyshire must stop admitting new patients due to serious concerns over patient safety. CQC inspectors found that clinic patients had opportunities to hang themselves, and the unit had escalating levels of patient self harm, and a huge shortage of trained staff. In 2019 there were two serious incidents, one of which resulted in a patient taking their own life by hanging. The report notes that whilst inspectors were at the clinic in August they witnessed patients congregating in a ward near the reception and banging on the windows to get help from staff, but the staff were nowhere to be seen. Three whistleblowers have contacted the CQC, one prior to the visit and two whilst the CQC inspectors were present.

In October 2019 an inspection report on Cygnet’s Newbus Grange hospital in Darlington, noted how the CQC had found a patient with “unexplained injuries”, and there were opportunities for patients to kill themselves and staff asleep while on duty.  The unit was put into special measures and its 10 patients moved elsewhere.

In July 2019,  the CQC downgraded the hospital at Godden Green to “requires improvement”. The CQC also imposed two requirement notices on the hospital in relation to safe medicines management and making sure they have a permanent registered manager. As a result of the visits restrictions on the provider’s registration were imposed by the CQC, saying it could not admit any young person to the ward without prior agreement with the CQC. This remained in place for a month.

In June 2019, HSJ reported that multi-agency investigation had been launched into Cygnet’s 65-bed hospital in Maidstone, whose 15-bed male psychiatric unit had had a “disproportionate” number of safeguarding alerts for patient-on-patient attacks.

The CQC inspected the Knole Ward at the Cygnet Hospital at Godden Green, in Kent, in July and August 2017 after it was informed of concerns about the safe care and treatment of young people.

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