Bere Clinic

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive this means we looked for evidence that the service met people’s needs.

At our last assessment we rated responsive as good. At this assessment the rating has remained good. Staff managed beds well. A bed was available when a patient needed one. Young people were not moved between wards except for their benefit. Young people did not have to stay in hospital when they were well enough to leave. The design, layout, and furnishings of the ward supported young people’ treatment, privacy and dignity. Staff supported young people with activities outside the service, such as work, education and family relationships. The service met the needs of all young people – including those with a protected characteristic. Staff helped young people with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result.

We have not awarded this service a score for Responsive.

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

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Bere Clinic placed the young person at the centre of care planning and treatment decisions. Care was not delivered to a standard model. Staff understood why eating disorder treatment requires a highly individual approach, and this was evident in practice.

One young person had autism alongside their eating disorder. The service adapted the therapeutic programme to meet their sensory needs. Staff adjusted the young person’s bedroom environment, modified the group programme and agreed an individual mealtime support plan. The young person said this made a big difference to their admission.

At admission, a person-centred assessment gathered information about the young person’s clinical presentation, interests, values, communication preferences, cultural background, religious practice, education and family. This was used to shape their therapeutic programme.

When a young person’s presentation changed, the care plan was updated and the treatment approach adjusted. Staff gave examples of adapting their approach to specific individual needs.

However, as noted in the Effective and Caring sections, four of six care plans were generic and did not capture the individual’s voice, goals or preferences in writing.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service provided integrated care drawing on a full multidisciplinary team. Psychiatry, nursing, dietetics, psychology and occupational therapy were available to all young people and coordinated through a weekly MDT.

Young people were allocated a named nurse and an identified care team. This gave the young person and their family a consistent point of contact. Families valued the named nurse arrangement.

Discharge planning started early. It normally included direct liaison with the receiving community CAMHS team. Discharge meetings were held in advance, attended by the young person and their family where possible. Discharge summaries were shared with the community team and GP before the young person left.

For young people approaching 18, the service worked with adult eating disorder services to plan the transition. Staff understood the specific risks of this transition and took steps to ensure continuity of care.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service provided clear, timely information in a range of formats. Information was shared at referral, on admission, throughout treatment and at discharge.

On admission, young people and families received an information pack. This covered the treatment approach, ward structure, patient rights (including under the Mental Health Act), how to raise concerns, how to access advocacy, and contact details for the named nurse and service manager. An easy-read version was available. Staff routinely offered verbal explanation alongside written materials.

Clinical information, including about diagnosis, treatment options and medicines, was explained at a level suited to the young person’s age and capacity. Staff were aware that young people with eating disorders may be fearful about information relating to weight and nutrition. They adapted their communication accordingly. Families said they received clear information throughout.

The service signposted young people and families to local and national support resources, including peer support organisations and eating disorder charities. This was part of discharge planning and was tailored to each young person’s circumstances.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and

The service had an embedded culture of listening to and involving young people and their families. Young people told us they felt heard and that their involvement in decisions about their care was genuine. This was consistent across the families we spoke with.

Goal setting was collaborative from the start. Care reviews were held with the young person present where possible. The review process was explained in advance. Staff helped young people who were distressed or reluctant to take part.

Families were invited to care reviews. They had direct access to the named nurse and could request a meeting with the responsible clinician at any time.

The service held weekly community meetings and a monthly patient forum. Young people raised topics and concerns at these. We reviewed the minutes and found that feedback from young people had led to changes in ward practice. For example, young people raised concerns about staff not starting mealtimes on time. The service discussed the barriers at clinical governance and was working to resolve the issue.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

The service was commissioned to provide specialist CAMHS eating disorder inpatient care within NHS England Tier 4 guidance. Referrals were assessed on clinical need. There was no evidence that any young person was disadvantaged because of a protected characteristic.

The service accepted referrals from a wide area. Distance from home could challenge family involvement and community care continuity. The service offered remote attendance at care reviews for families who could not travel and maintained regular contact with community teams. One family attended all reviews by video call. A nurse supported the young person in person during those meetings.

Staff were aware that eating disorders in young people from Black, Asian and minority ethnic communities are often not identified. Young people from these communities may present later in their illness. Staff could describe how the service worked to ensure it was culturally appropriate and treated all young people equally once referred.

Waiting times were monitored and reported to commissioners quarterly. Most referrals were admitted within contracted timescales. Delays were documented and reviewed. The service kept in contact with referrers and community teams during the waiting period to monitor risk.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The service collected outcome data using validated measures at admission and discharge for all young people. This was reviewed at clinical governance monthly.

Young people from minority ethnic backgrounds, LGBTQ+ young people and young people with neurodevelopmental conditions all reported positive experiences. There was no evidence of differential treatment or of any patient feeling disadvantaged because of a protected characteristic.

Cultural and religious dietary requirements were accommodated. Interpreting services were available at short notice. Information was provided in different formats and at appropriate reading levels. All staff had completed equality and diversity training.

The service participated in the NHS England Tier 4 CAMHS benchmarking programme. Senior staff could describe their benchmarking position and used it to identify areas to improve.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Planning for the future started at the point of admission. The service positioned each admission as a bridge back to the young person’s life outside the clinic.

A provisional discharge date was agreed with the young person, their family and the community team as soon as clinically possible. Discharge planning was reviewed at each MDT and updated as the young person’s presentation changed.

The service confirmed community CAMHS appointments, dietetic follow-up and school reintegration plans before discharge. Where needed, a period of day programme support was arranged as a step between inpatient and community-based care.

Educational continuity was a specific focus. Dedicated teachers liaised with home schools throughout admission. Young people studying for GCSEs and A-Levels were supported to continue their studies. Where young people had missed significant school time before admission, a graded return to education plan was developed with the young person, their family and the school.

Young people developed a personal relapse prevention plan before discharge. Plans were co-produced and covered early warning signs, coping strategies, who to contact and what to do in a crisis.