Bere Clinic

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated well-led as good. At this assessment the rating has remained good. Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected analysed data about outcomes and performance. They used this to identify improvement.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service had a clear vision and set of values. The vision – to provide compassionate, evidence-based care to help each young person recover and live a full life – shaped how staff described their work, how decisions were made and how the service engaged with young people, families and partners.

Staff at all levels and across all disciplines could describe the service’s values in their own words. There was a genuine shared sense of purpose. New staff described being quickly absorbed into the team culture and identifying with its values from the start.

The hospital director and clinical lead had created a culture of psychological safety. Staff felt comfortable raising concerns, sharing ideas and admitting mistakes without blame. This was evident in team meetings, supervision records and conversations with staff during the inspection.

The service operated within Elysium’s governance framework. The service’s local values aligned with the wider organisational values. Senior Elysium leaders visited regularly.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The service was led by a capable and experienced team. The hospital director had substantial CAMHS inpatient experience and a deep understanding of eating disorder care. Their clinical credibility and commitment to the service were evident throughout the inspection.

Leadership was described by staff as compassionate, inclusive and visible. At the time of our inspection, there was no ward manager in post. The service was recruiting to this role. The hospital director covered this gap by being present on the ward daily. They were known personally by virtually every member of the team. Staff said they felt genuinely valued, not just as operational resources.

The leadership team consulted staff before making significant changes. Frontline staff at all grades said they felt involved. Team meeting minutes showed that staff contributions had directly shaped decisions.

In an emergency, the clinical lead was available to cover shifts outside standard hours and at weekends. This gave the service oversight of weekend working.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service had a genuine, embedded freedom to speak up culture. A freedom to speak up guardian was in post and well known to staff. Staff across all grades said they felt able to raise concerns without fear of consequences. They could describe specific examples of concerns they had raised and how these had been acted upon.

The service tracked themes from concerns raised and used them to inform governance and quality improvement. Concerns about conduct or systemic issues were escalated promptly and addressed within a defined timeframe. Staff who had raised concerns said the process was positive and that they received feedback on outcomes.

The freedom to speak up culture was reinforced in supervision, team meetings and induction. The hospital director modelled openness by acknowledging areas for improvement and inviting challenge. Staff said this was one of the most significant factors in making it feel safe and worthwhile to speak up.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service had a genuine commitment to workforce equality, diversity and inclusion. The staff group reflected a range of backgrounds and identities. Leaders made deliberate efforts to ensure recruitment, development and day-to-day working life were equitable and inclusive.

All staff completed equality and diversity training as part of mandatory requirements. Compliance was 100% in the preceding 12 months.

Staff from all backgrounds said they felt respected and included. There was no evidence of bullying or differential treatment. Staff described diversity of perspective as a clinical and organisational asset. This was particularly noted in relation to the diverse patient group, where staff with cultural proximity to specific patient experiences were able to contribute meaningfully to clinical discussions.

A whistleblowing policy was in place. Staff knew where to find it and how to use it.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Governance arrangements were well structured. The service held monthly clinical governance meetings attended by the hospital director, clinical services manager and leads from occupational therapy and education. Agenda items covered a consistent set of quality and safety domains.

The governance meeting reviewed incident rates, safeguarding activity, mandatory training, supervision compliance, complaints, patient outcome data, physical health monitoring, medicines audit results and workforce metrics. Action plans were monitored to completion with named owners.

The service kept a live risk register, reviewed at each governance meeting. Risks above a defined threshold were escalated to the provider and the commissioner’s quality team. At the time of inspection, the register included the pressure of available rooms across the service and the absence of a ward manager. Both had been escalated to provider level and were being addressed.

Staff said the electronic record keeping system supported their work. Systems were in place for fire safety and ligature risk management. Staff could access ligature risk information easily. They understood the high-risk areas on the ward and had received relevant training.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The service had built productive partnerships across commissioning, clinical, education and voluntary sector organisations.

The relationship with the lead commissioner was positive. Regular contract monitoring meetings were held at which the service shared quality and performance data openly.

Clinical partnerships with the local acute paediatric unit were well established. The protocol for managing physical deterioration and emergency transfer was familiar to both teams, had been used in practice and was described positively by staff at both sites.

The service was an active member of the Royal College of Psychiatrists Quality Network for Inpatient CAMHS (QNIC) and the NHS England Tier 4 CAMHS improvement collaborative. QNIC peer review and benchmarking had informed several service improvements over the preceding two years.

The service had links with local eating disorder peer support organisations. Family support groups run by voluntary sector organisations were signposted at discharge. Several families had engaged with these successfully.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Learning, improvement and innovation were embedded in the service’s culture and practice. The service drew on incident analysis, outcome data, patient and family feedback, audit findings, peer review and national guidance to set improvement priorities with named leads and timescales.

The service had a good track record of implementing changes and sustaining them. Improvements in the preceding two years included standardising the nasogastric feed protocol and introducing annual nasogastric tube competency assessments. Both were evaluated using measurable outcomes.

Learning from serious incidents was thorough. Root cause analyses identified systemic as well as individual factors. Learning was shared through safety briefings and incorporated into training. One outcome was a structured post-incident debrief process for staff and young people after any physical intervention.

The clinical service lead received safety alerts with lessons learned from incidents across the organisation.