Good vibrations are bouncing around the communal room at Cygnet St William’s when NR Times arrives.

Partly, it’s down to the surprisingly large quantity of cakes on offer.

A local Headway representative is already tucking in, as is Paul, a friendly patient with a beaming smile.

Manager Alison King and consultant psychiatrist Dr Tony Perini are also in good spirits. But it’s perhaps not just the iced treats fuelling their positivity.

It could also stem from their satisfaction at the progress the facility has made after a year of hard work.

Cygnet St William’s is a 12-bed purpose-built facility for male neuropsychiatric patients in Darlington, North East England.

It has a UK-wide reach, helping to ease pressure on the UK’s neuro-rehab infrastructure.

As the acquired brain injury (ABI) all party parliamentary group report ‘Time for Change’ sets out, neuro-rehab beds across the board are in short supply – with 300,000 ABIs per year versus just 4,600 beds. More than three times that are needed to meet demand.

Despite working in the care sector since 1982, Alison says she’s learned a lot of lessons over the last year.

“One of them is that you can do all the planning you want for the important aspects, and have all the expertise on board, and then a fire that means you have to evacuate can put a spanner in the works. There are so many things you can never account for when you’re setting up a new service and you just have to overcome them as they arise.”

The fire, from an adjacent property, came just a few weeks after its first residents were welcomed. Thankfully no harm and little damage was done.

The hospital takes referrals of men affected by brain injuries and neurological conditions where challenging behaviour is the leading impairment.

They may have been detained under the Mental Health Act and have a forensic history.

Presenting comorbidities could include psychiatric disorders including psychoses, complex epilepsy, post-ictal psychosis and organic personality disorder.

For Tony, a standout challenge has been in establishing credentials to build vital relationships with CCGs.

“It’s not easy but if you’ve got the right ethos and the right sort of attitude and you’re doing what you say you’re doing, then you can gradually become a provider of choice.

“You’ve got to prove yourself as a new service, and initially may be tested on the most complex cases that others have declined to take on. It’s about making sure CCGs understand exactly what we do.”

The service is part of Cygnet Health Care, one of the UK’s largest independent providers of inpatient and residential mental health care.

Having assembled a well experienced interdisciplinary team, a crucial achievement has been the forming of relationships with GPs.

Alison says: “Getting the GP service on board was difficult initially.

“Our patients weren’t registered with GPs and so we had to work with the CCG to show the benefits of our patients being with a local GP, albeit on a temporary basis, and that took us a long time to get it worked out.

“We had to give them an understanding of what we are about and what we will provide.

“We arrange a lot of the appropriate medications ourselves, so we don’t require them from the GPs, but anything we do need, they’ll prescribe it and we’ll buy it ourselves.”

Tony says: “We all want to do the best for our patients and get the best out of the system and resources available to us that we can, so we are all working from a common place.

“We now have a good relationship with our local NHS colleagues and we’ve had dealings with the local hospital quite a bit.

“Establishing a relationship with primary care is very important because we are taking on individuals who potentially could have a quite rapid deterioration.

“Some are into their 80s and may get physical illnesses, which GPs are much better at diagnosing than psychiatrists with a few years away from general medicine.

“Without GP input, the risk is that you might either under react and miss things, or over react and over treat. So we are very pleased to have primary care there to advise us.”

Being transparent and accepting of scrutiny has been integral in forming vital links with other members of the healthcare ecosystem, meanwhile.

Alison says: “It helps that we invite external professionals in to have a look around and see what we’re doing here and how well it’s working.”

Tony adds: “A big part of us proving our credentials has been our policy of being open and honest. If we haven’t done something, or if something could have been done better, we will say so, and say ‘we’ve already identified this and it’s something we are going to address’.

“As an independent facility, you are under close scrutiny from the Care Quality Commission, but we are rightly also scrutinised by care managers and case managers because these are very complex cases we are working on.

“So we have regular meetings with them, and very clear targets from them which we have to deliver. “Contracting based on outcomes is good for them and for us in setting out what is realistic and what is ideal.”

On staffing, Alison says: “We discovered with the patients we had at first that individual’s needs were higher than expected. For example, we had more cases with physical complexities than we had factored into our planning. So we had to adapt to that by adding extra support and nursing staff.”

With new patients now being referred on an ongoing basis, to add to some of the unit’s longer-term residents – the longest duration for a resident to date has been eight months – the centre continues to grow its reputation.

Onsite, Alison has worked hard to establish a close-knit team with no bureaucracy and everyone encouraged to voice concerns. This approach, says Tony, enables them to deliver the best service to patients.

“We have genuine respect for each other here and we all want to strive to do the best for our patients. If this comes from the top downwards, it creates a good place to be. We want to be the best we can be – and I think Alison has managed to build the foundations for that in a very short period of time.

“Also, in the wider Cygnet group, the training is very good. Some is e-learning and some face to face, often at quite a large cost to the company. But it’s something we are all benefitting from. We want to retain staff and support them in their development.”

As part of the facility’s ongoing progress, plans are underway to better support patients approaching discharge back into the community.

Alison says: “We are just acquiring the building at present, but the plan is to create a three-bedroom transitional unit where individuals go from being in the existing centre.

“As they move towards leaving us, it will be a stepping stone for them to live more independently, living with support workers. It will be close to the existing building and we hope to get work underway this year.”

Further developments include the addition of a wider range of therapies, with music therapy and visits from animals among several new interventions
being introduced.

Alison is particularly excited about the animals.

“I saw the impact they could have when I used to work with elderly patients,” she says.

“We managed to find a local farm which can bring ponies in and they can visit the bedrooms – even going up in our lift up to the rooms on the first floor.

“Some of the patients we have here have lived around animals for a lot of their lives and it’s hard when you aren’t around animals anymore. Seeing animals can help to bring a bit of normality back. They have a very calming impact, and people’s eyes light up when they see them.”

Tony adds: “We’re always looking at things which will benefit our patients and have worked hard on creating the right setting. It’s is a great foundation from which we can build further.”

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