ABBI Clinic Manchester

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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.

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

Requires improvement: This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of Regulation 17 Good Governance in relation to staff and directors files, oversight and mitigation of environmental risks and lack of clear framework of what must be discussed at a team and senior level.

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 have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

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.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. The aim of the service was that patients felt seen, heard, and cared for at every stage of their recovery journey. The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. This was shared on the providers website and discussed at staff inductions.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. Minutes showed that service development was discussed at the team meetings.

Staff could explain how they were working to deliver high quality care within the budgets available. The service had recently expanded to offer an outpatient service to meet the psychological needs of patients and provided one to one therapy sessions.

We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

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.

Leaders had the skills, knowledge and experience to perform their roles. The responsible clinician who was also the medical director had extensive experience in the sector of eating disorders.

Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care. The service had recently started to offer outpatient services to meet the needs of patients.

Leaders were visible in the service and approachable for patients and staff. The responsible clinician completed all initial assessments, to ensure they understood the needs of the patients they were supporting and were able to identify the most appropriate treatment for them.

Leaders involved expert by experiences in governance meetings. Feedback from the expert by experience included “The clinic is deeply committed to having an Expert by Experience as part of the team, recognising the value that lived experience brings to service development and patient care. I have been included in discussions regarding updates and proposed changes, ensuring that decisions are informed by a broad range of perspectives and experiences.”

Leadership development opportunities were available, including opportunities for staff. Both directors completed an operational excellence course delivered by Salford University.

We create a positive culture where people feel that they can speak up and that their voice will be heard.

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.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Patients could provide feedback through the co production meetings, feedback box, surveys and one-to-one meetings with staff.

Staff could feedback through the staff survey, team meetings and supervision.

Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. ‘You said we did’ posters were displayed in the service to demonstrate how the service responded to patients feedback.

Feedback including from complaints and compliments were shared through the monthly quality bulletins.

Patients and carers were involved in decision-making about changes to the service. An expert by experience was involved in the governance meetings. Patients provided feedback in the co-production meetings and minutes showed that changes were made a result of the feedback.

We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

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

The service did not have equality and diversity champions within the service. The service only employed 9 staff at the time of the inspection. This meant it would be difficult to assign staff additional roles and responsibilities. However, staff told us that they felt valued and supported in their role.

Staff were able to apply to work flexibly e.g. flexible working agreements to account for personal circumstances such as caring responsibilities and health issues. Some staff were part-time and some staff provided virtual treatment and were home workers. The service accommodated this by having team meetings and multidisciplinary meetings with the facility for remote access.

The provider undertook equality monitoring of staff as part of their recruitment process to ensure it was diverse in its make-up and representative of the patient group. The staff team was a diverse staff team.

We do not always have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We do not always act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

We scored the service as 1. The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was not a clear framework of what must be discussed at a team and senior level. Minutes of meetings showed there was not a standard agenda for team meetings, leadership meetings and peer meetings. Agendas did not consistently include essential information, such as learning from incidents and complaints. This meant that these topics were not discussed at each meeting. We reviewed 6 sets of team meeting minutes and found incidents or complaints were only discussed in 2 of the meetings.

Staff had implemented recommendations from reviews of incidents, complaints and safeguarding alerts at the service level. Following learning from a delayed discharge letter, a log and oversight from an independent team member was introduced to provide additional oversight in addition to the clinician.

Leaders did not ensure that environmental risks were assessed consistently. Staff completed annual environmental risk assessments of the care environment. Within the assessment, hazards were identified. However, the rating of these hazards was not consistent. The service had a location statement for the defibrillator displayed in the service. The statement was past its review date. This meant that the statement had not been recently reviewed.

Staff undertook or participated in local clinical audits. The audits were not sufficient to provide assurance, and staff did not always act on the results when needed. For example, there was a monthly HR audit that took place, however this did not identify gaps in the staff records.

We reviewed 4 staff records and found these were incomplete. Four records did not include evidence of qualifications. Two did not include proof of identity. Three did not include health screening. One did not include evidence of professional registration. One did not include a photograph. One did not include references. The provider explained that the gaps identified during the inspection arose from a temporary administrative access issue, not from an absence of the underlying records. The provider was able to produce these documents following the on-site inspection once the service’s administrator returned from leave. However, we were concerned that the administrator was the only individual able to access these records.

The service were not evidencing that they were meeting Regulation 5 and Schedule 4 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were 2 directors employed by the service and there were no staff files in place to show they were meeting this requirement. However, this information was provided following the on-site inspection.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. This included the community eating disorder teams.

Staff maintained and had access to the risk register. Staff could escalate concerns when required. Staff concerns matched those on the risk register. This included the use of a communal shower room for conducting the weights of patients.

The service had plans for emergencies – for example, adverse weather or a flu outbreak.

Staff did not always have access to effective information technology systems. The electronic care record had a glitch where patients could access their care records when completing self assessments, this had been resolved at the time of the inspection. 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.

Information governance systems included confidentiality of patient records. Staff had individual access to the electronic care record system.

Managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. A quality bulletin was completed on a monthly basis which included complaints, compliments and incidents. Dashboards captured patient information for monitoring.

We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

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 shared information and learning with partners and collaborated for improvement.

Leaders engaged with external stakeholders – such as commissioners and other services for people with an eating disorder. The service had met with the local MP to discuss the service and gaps in the provision for people with an eating disorder. The MP had then written to the Mayor for Greater Manchester to raise awareness of this.

The medical director was part of the Lancashire South Cumbria Foundation Trust pathway development group and was a member of the Royal College of Psychiatry Faculty of Eating Disorders to ensure most up to date practice was being delivered locally.

Internationally, the service were working with a Canadian team to support the development of services in Toronto. The service were passionate about sharing their knowledge and expertise with others with the aim of improving services for people with an eating disorder.

Patients and staff could meet with members of the provider’s senior leadership team to give feedback. Senior leaders were based in the service and were approachable to patients and staff. The medical director completed all assessments of new referrals. This meant patients met senior leaders from the point of accessing the service and felt able to provide feedback.

Stakeholders told us how the service were embracing changes in technology and have been involved in a study funded by the Greater Manchester Business Hub to assess the person centredness of AI care planning. Stakeholders also told us how they had received positive feedback from patients and that the service focused on outcomes with patients.

We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Staff had opportunities to participate in research. The medical director was part of the writing group for The Royal College of Psychiatrists Report 170, which mapped and provided evidence-based guidance on eating disorder pathways nationally.

The medical director was a member of the Eating Disorders Clinical Research group, Kings College London. The service was a participant site for their national project on outcomes.

The medical director was part of a working group developing the National Strategy for Eating Disorders.

The medical director was a member of the Greater Manchester Autism and Eating Disorders Group, contributing to a guidance paper.

The service accepted psychology student placements from the university of Manchester.

Innovations were taking place in the service. The service were working with a digital eating disorder treatment app to provide community support for patients who did not require daycare but were on a waiting list or had no access to care.

Staff participated in national audits relevant to the service and learned from them. The service contributed to the National Eating Disorders Audit 2025.