ABBI Clinic Manchester

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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated Good.

Good: 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 maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

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.

Staff completed a comprehensive assessment of each patient’s mental health upon admission, and the consultant psychiatrist assessed all patients prior to them joining the service. Once admitted to the service the patient and their named nurse would jointly complete a risk assessment and care plan. There were three separate risk assessments for each patient with a focus on physical health, mental health and eating habits.

Staff ensured that patients received a full physical health assessment as required. This was completed by the specialist GP following referral from the team. Staff were made aware of any physical health needs for the patients they were working with. The specialist GP completed a review of patients and requested blood through the patient’s GP where appropriate.

Staff developed a comprehensive care plan for each patient that met their mental and physical health needs. We reviewed 5 care records and found that care plans were personalised, holistic and recovery orientated. They included identified needs, patient goals and outlined the planned interventions. Care plans were current and updated when necessary.

We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

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 provided a range of care and treatment suitable for the patients in the service. There were group sessions facilitated by the cognitive behavioural therapist and therapy assistant, as well as one-to-one sessions with a member of the psychology team. Patients also accessed one-to-one review sessions with their named nurse as well as reviews with the consultant psychiatrist and specialist GP when needed. Patients also accessed one-to-one and group sessions with the dietician.

Staff delivered care in line with best practice and national guidance. The group work used a combination of MANTRA (Maudsley Model of Anorexia Nervosa Treatment for Adults) and CBT-E (Cognitive Behaviour Therapy for Eating Disorders), which were both specialist therapies for the treatment of eating disorders. MANTRA aimed to help patients find alternative and more adaptive ways of coping. CBT-E used the principles of cognitive behavioural therapy to support patients in identifying and altering their thoughts, feelings and behaviours in relation to their eating disorder. These therapies were offered in both a group and one to one setting. This approach alongside the multidisciplinary provision including the nutritional support met the recommendations of the NICE guidelines.

Staff made sure patients had support for their physical health needs, from their GP. The specialist GP was the main link with the GP, providing regular updates and a handover of care.

Staff took part in clinical audits. These included audits of patient files and patient experience. Managers used results from audits to make improvements. The audits generated change including the introduction of a discharge letter session which allowed therapists a session after discharge to ensure patient summaries were completed and sent out in a timely manner.

The service had a full range of specialists to meet the needs of each patient. The team comprised the consultant psychiatrist who was the nominated individual, a mental health nurse, a dietician, a specialist GP, 3 psychological therapists and a therapy assistant. There was also a full-time operations coordinator. There was recruitment underway for a registered manager and an occupational therapist.

Managers made sure staff had the right skills, qualifications, and experience to meet the needs of the patients in their care. Records showed all staff had experience and knowledge of working with people with an eating disorder. Managers gave each new member of staff a full induction to the service before they started work. There was an induction policy in place and all staff had an induction checklist to follow and complete.

Managers supported staff through regular, constructive appraisals of their work. There was an appraisal policy in place. All staff who had been in post for over a year had up to date completed appraisal records.

Managers supported staff through regular, constructive clinical supervision of their work. The supervision policy stated that staff should receive one-to-one supervision every three months. Records showed this was happening with 100% compliance for clinical supervision and 89% for management supervision.

Managers provided staff with the opportunity to attend regular team meetings and gave information to those who could not attend. Monthly meetings took place which covered training, quality, service development, incidents, complaints and feedback. However, there were no standard agenda items, which meant staff were not regularly updated on important areas such as incidents and complaints. Information such as lessons learnt and other useful information was also shared through the quality bulletin.

Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. This was discussed in individual supervision and team meetings.

Managers made sure staff received any specialist training for their role. For example, a staff member had recently completed CBT-E training (enhanced cognitive behaviour therapy developed for patients with an eating disorder). Where appropriate staff also shared their learning with the wider team.

Managers recognised poor performance, could identify the reasons and dealt with these. This was discussed through staff supervision and one-to-one meetings.

We do not always work effectively across teams and services to support people.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people.

Staff held regular multidisciplinary meetings to discuss patients and improve their care. Whilst not all staff were able to attend due to non-working days, the mix of disciplines that attended the meeting meant they were able to give updates from each discipline. Staff reported that they had identified an alternative day for the meeting to ensure all staff were able to attend.

Staff made sure they shared clear information about patients and any changes in their care. This was clearly documented in the patients care notes. It was easily identifiable on who had made these changes and there was a clear picture from the notes of the patient’s treatment and journey.

Morning huddle meetings had been introduced, to review the patients attending that day. These took place on the days that groups took place. These were typically led by the clinical lead. However, when the clinical lead was not in work these meetings did not take place. This meant that information was not shared consistently.

Feedback from carers we spoke with was that they would benefit from additional support and information about how to support their loved one at home and when they were discharged from the service.

The team at the service had effective working relationships with additional teams outside the organisation involved in the patients care, for example with community eating disorder teams. For patients who did not have other specialist teams involved in their care, the main external professional was the patients GP.

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

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.

Staff supported patients to live healthier lives by providing opportunities to take part in programmes and giving advice.

Patients we spoke with shared that they received support through the dietician for tailored support around the food they ate and how this was carefully increased and adapted to meet their needs during treatment.

Staff encouraged patients to live healthier lives and provided psychoeducation around different aspects of movement, eating and wellbeing.

Staff supported patients with activities outside of the clinic such as work and family relationships. This included information to employers about the treatment patients were engaging in.

We do not always routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record the severity of patient conditions as well as care and treatment outcomes. At admission, patients completed the outcome measures and these were reviewed at weeks 4, 8 and 12. The outcome measures used were Clinical Impairment Assessment, DASS (Depression, Anxiety and Stress Scale), EDSIS (Eating Disorders Symptom Impact Scale), EDEQ (Eating Disorder Examination Questionnaire), PARDI (Avoidant restrictive food intake disorder questionnaire) and RCADS (Revised children anxiety and depression scale). This meant the service were exploring holistically the needs of the patient and the progress they were making in their recovery.

Staff used technology to support patients effectively. This included the remote access for the groups. All patients had access to a shared online Google Drive folder where all of the resources for sessions were stored. Patients told us they found the Google Drive folder helpful to access the resources.

There was no way of uploading self assessments and outcome measures to the electronic care record, which meant staff were manually inputting the results or summarising in the notes. This meant the record did not include the outcome documentation completed by patients and was not contemporaneous. The service were planning to move to a new electronic care record where patients could input the outcomes directly to the system.

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

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.

We reviewed 5 patient care records.

Staff involved patients in planning their care and gave them access to their care plans. Patients were able to discuss and develop meal plans with the dietician. They were also involved in the therapeutic approach they accessed and were able to discuss alternative treatment approaches where appropriate.

Staff were trained in the Mental Capacity Act and understood their role in relation to assessing capacity. Capacity was considered within the initial assessment and throughout their care.

Staff made sure patients understood their care and treatment. Patients told us they felt they were “in charge of their treatment and care” and found that the combination of group work and one to one sessions was helpful as they were able to gain peer support within the groups, as well as the opportunity to explore their individual treatment with a professional.

Staff involved patients in decisions about the service, where appropriate. Patients shared that the patient participation group allowed them to give feedback on the service as well as more specific areas such as session content. Patients shared they felt heard during these sessions and could see when changes had been made based on feedback.