Bere Clinic

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question as good at this assessment the rating has remained good.

Staff assessed the physical and mental health of all young people on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for young people based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of young people on the ward. Staff from different disciplines worked together as a team to benefit young people. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service assessed the needs of young people before and on admission. A clinician completed an initial assessment using referral information, community CAMHS records and, where possible, a discussion with the young person and their family. A preadmission checklist ensured key clinical, safeguarding and social information was gathered before a bed was offered.

Within 72 hours of admission, the full MDT completed an assessment. This covered psychiatry, physical health, nursing, diet and occupational therapy. Findings were shared at the first MDT meeting.

Physical health assessment was thorough. All young people had baseline observations, a 12-lead ECG and blood tests including electrolytes, liver function, glucose, magnesium, phosphate and bone profile. The service used a paediatric early warning score throughout admission. Staff understood the physical risks specific to eating disorders, including refeeding syndrome, cardiac arrhythmia and hypoglycaemia.

Psychological and social needs were assessed using validated tools, including the RCADS and the EDE-Q. Social circumstances, education, family dynamics and cultural background were included in the nursing and social care assessments.

Assessments were well documented and formed a clear basis for care planning. However, they did not always lead to sufficiently individualised care plans. This is covered in the next section.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well

Care and treatment followed NICE guideline NG69 and NHS England Tier 4 CAMHS guidance. CBT-E was available for young people where indicated. The choice of therapeutic model was matched to the young person’s presentation and preference. The rationale was documented.

Physical and nutritional treatment followed NICE guidance. Refeeding plans were prescribed by the medical team and reviewed by the dietitian. The nasogastric feed protocol was standardised and developed with pharmacy and dietetics. There were no significant errors in nasogastric feed administration in the 12 months before the inspection.

We reviewed six care plans. The findings were mixed.

Four of the six were generic. They included standard risk statements and broad goals. They did not reflect the individual needs, preferences or culture of the young person. There was little evidence of co-production with the young people.

Two plans were of a much higher standard. Both contained detailed PBS plans developed with the young person. Goals were in the young person’s own words. Triggers, preferred activities and agreed de-escalation strategies were clear. These plans show what the service is capable of. They should be used as an internal benchmark.

Mental Health Act

Staff received Mental Health Act training and had a good understanding of the Act, the Code of Practice and its principles. They had easy access to administrative support and legal advice. Staff knew who the Mental Health Act administrators were.

The provider had relevant, up-to-date policies. Staff had easy access to them and to the Code of Practice. Young people had easy access to information about independent mental health advocacy.

Staff explained young people’ rights under the Act in a way they could understand. They repeated this as needed and recorded that they had done so. Staff made sure young people could take Section 17 leave when it had been granted.

Staff requested a second opinion from an appointed doctor when necessary. Detention papers and associated records were stored correctly. The service displayed a notice telling informal young people they could leave the ward freely.

Staff audited Mental Health Act compliance regularly. There was evidence of learning from those audits.

Staff requested a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records, for example, Section 17 leave forms, correctly and so that they were available to all staff that needed access to them.

The service displayed a notice to tell informal patients that they could leave the ward freely.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

MDT working was a strength of Bere Clinic. Weekly MDT meetings were attended by psychiatry, nursing, psychology, education, dietetics and occupational therapy. All young people were discussed at every meeting. Records confirmed consistent attendance.

Staff from different disciplines could describe each patient’s current presentation, formulation and treatment plan. This showed good communication and shared understanding. Nursing staff told us the MDT was inclusive and that their contributions were taken seriously.

Referral pathways in and out of the service were clear and well managed. The service followed NHS England Tier 4 CAMHS guidance. Transition planning started early. The service communicated with community CAMHS teams and, where relevant, with adult eating disorder services. Feedback from community teams about communication at the point of discharge was positive.

Families were routinely invited to care reviews. However, at the time of our inspection, there was no family therapist in post. The service was actively recruiting to this role.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service helped young people develop the skills and confidence to manage their health after discharge. Occupational therapy ran a structured programme covering life skills, leisure and community access. The OT team assessed each patient’s functional baseline on admission and set measurable goals linked to daily living.

The dietetic team provided nutritional education for young people and their families. Sessions were tailored to the young person’s stage of treatment. Families told us this was one of the most valued parts of the service. It helped them feel confident about managing nutrition at home after discharge.

All young people of school age had educational provision. The service had dedicated teachers who liaised with home schools throughout admission. Individual education plans were developed and reviewed at MDT.

Physical activity and outdoor engagement were built into the therapeutic programme, matched to each patient’s physical status. This is consistent with current evidence for treating young people with eating disorders.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service used validated outcome measures at admission and discharge for all young people. The main tool was the BERRI assessment. The BERRI is an online assessment tool used to cover mental health, behaviour, emotional wellbeing, relationships, risk and attachment Outcome data was reviewed at clinical governance meetings quarterly. The team used this data to assess programme effectiveness and identify trends.

Data from the 12 months before the inspection showed improvement in mean discharge scores compared with admission, across psychological and physical outcomes.

Physical outcomes were tracked closely throughout admission. Weight restoration, electrolytes and vital signs were reviewed at MDT. The escalation protocol for physical deterioration was clear. It was used twice in the preceding 12 months. Both cases were managed well, with positive outcomes.

The service submitted data quarterly to the NHS England Tier 4 CAMHS benchmarking programme. Senior staff could describe their benchmarking position and how they used it to improve practice.

Patient and family feedback was collected at discharge and during admission. Feedback was broadly positive about staff relationships and the programme structure. Young people and families consistently raised concerns about bedroom temperatures and the lack of a de-escalation space. These match what we found during inspection, suggesting the service was aware of these problems and it was on the risk register.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service had a clear, current approach to consent. Policies were reviewed annually and reflected the Mental Capacity Act 2005, the Children Act 1989 and Gillick competence for young people under 16. Where young people were detained under the Mental Health Act 1983, Part IV consent provisions were applied, documented and reviewed at required intervals.

Staff understood consent clearly. They could explain the difference between consent, assent and parental responsibility in a CAMHS inpatient context. They gave relevant, accurate examples of these principles in practice. Consent and capacity training was included in induction and refreshed annually.

Consent documentation was generally good. For informal young people, records showed ongoing consent. Any change in a patient’s engagement with treatment was noted and reviewed at MDT. For detained young people, T2 and T3 forms were accurate and reviewed at required intervals.

Best interests decisions were documented, time-limited and reviewed regularly. Independent mental health advocacy was available to all eligible detained young people. Staff could show that young people had been told about this right at the point of detention and at subsequent intervals.