National Review of Eating Disorder Services Implementation Group: final report

5. National Review of Eating Disorder Services Implementation Group

As outlined above, the Implementation Group met for the first time in August 2021 where members agreed on priorities and actions for the year ahead.

Members agreed to focus on the following wide-ranging work areas:

• Developing quality standards in eating disorders for Scotland
• Develop a skills and competency framework and training strategy
• Agree on a national eating disorder dataset and plan for consistent data collection across Scotland

5.1 Working Groups

5.1.1. Training & Skills

The National Review outlined Education and Training as a key recommendation:

Recommendation 12: Education and training

A comprehensive training plan will be developed which will aim to equip the entire healthcare workforce which might see people with eating disorders and their families, to deliver high quality care for people with eating disorders in all settings ranging from early intervention to highly specialist care, and from community to in-patient. In addition, there should be appropriate education and awareness training for other relevant professionals, such as youth workers, counsellors and sports coaches. Training should be appropriate to the role that each professional has with respect to prevention, identification, signposting, treatment and support of people with eating disorders.

The Working Group's terms of reference and outcomes were:

• To provide a directory of what eating disorder training is currently available
• To identify gaps in training and what is needed to fill those gaps

The Working Group began work by mapping what training and education were being provided across a variety of professions in Scotland. The Group discovered that there has been a lot of training developed and available. However, the training provided, and its accessibility, varies depending on local interests and needs. Therefore, it is crucial that there is national coordination to ensure that professionals across Scotland have equitable access.

In conclusion, the Working Group recommends that a skills and competency framework is developed, in partnership with NES and EEATS, for all staff, including third sector, who may see or work with people who have eating disorder symptoms or diagnosis. The initial focus should be on developing medical expertise in eating disorders within Scotland to ensure safe medical treatment for all patients with eating disorders, regardless of where they are seen. This should include physical health monitoring.

In addition, a training strategy should be delivered in partnership between, the National Network, NES, EEATS, and the third sector that translates the NHS skills and competency framework into a framework suitable for non-healthcare/NHS professionals and supports appropriate training and awareness in schools, further education, third sector mental health workers and fitness sector. Where possible, and appropriate, resources already developed could be adapted and used. For example, training has already been created by Beat and the Royal College of Psychiatrists and could be rapidly implemented if desired.

Lastly, it is crucial that the National Eating Disorders Network should develop and host national remote training for all types of healthcare and other professionals.

5.1.2. Quality Standards

The Working Group has the overall vision to produce quality standards for eating disorder care and treatment across Scotland. These must take into consideration all relevant eating disorder guidance and policies.

The Quality Standards outline a national minimum level of service so that local services can deliver person-centred, safe and effective care. Standards are realistic, fit for purpose, apply across all settings, and focus on improving personal outcomes.

The Quality Standards are near completion and will be consulted on Spring 2023, and will be published later in the year.

Currently the Quality Standards cover the following overarching areas:

• Standard 1: Leadership and governance
  • NHS boards demonstrate effective leadership, governance and partnership working in the management and delivery of eating disorder services.
• Standard 2: Service structure
  • NHS boards deliver a range of services which are safe, effective and person centred. High-quality treatment and support is delivered by multi-disciplinary teams working in partnership.
• Standard 3: Access to care
  • All individuals have equitable, consistent, and timely access to effective eating disorder health care and services. Services should be flexible and responsive to individual need.
• Standard 4: Supporting people with co-occurring considerations
  • All individuals with co-occurring considerations have equitable, consistent, and timely access to eating disorder services and ongoing effective treatment and support.
• Standard 5: Assessment and monitoring
  • All individuals have a holistic assessment and where clinically appropriate receive ongoing monitoring and management.
• Standard 6: Transitions
  • Clear transitions protocols are in place to support safe and coherent care.
• Standard 7: Discharge
  • Discharge from service is planned, collaborative, and based on individualised goals of treatment.
• Standard 8: Education and training
  • NHS boards demonstrate commitment to the education and training of all staff involved in eating disorder services, appropriate to roles and workplace setting.
• Standard 9: Shared and supported decision making
  • All individuals receive inclusive information to facilitate informed choice and shared and supported decision making.

5.1.3. Data Improvement

Currently, we still know too little about who receives care and support and, crucially, who does not for an eating disorder. The Working Group was therefore focused on identifying what data we currently collect and from where, and ultimately, designing a

plan for data collection and ongoing analysis across Scotland.

To drive forward this work, the Group has engaged with Public Health Scotland, to understand what data is currently held on eating disorders, and NHS Boards to understand what data is collected locally and how this is used.

In addition, a workshop was held at Beat's National Event on 27 September 2022 where 5 questions were discussed:

1. What data do we have?

2. What data should we collect?

3. What about the CAPTND data set, and would it be good to start for ED?

4. Who should be involved in developing the ED dataset?

5. What other data will be required?

Ultimately, much of the data we require is collected at a local level, however, due to NHS Boards using different systems and not all data being digitised, this makes comparing this data difficult, which does not allow us to understand a clear picture across Scotland. Due to these challenges, any chances to have data collected will need to be taken forward over a number of years and stages to ensure that NHS Boards can deliver this data.

It is hoped that a future data set will include: an annual audit of the prevalence of all eating disorder diagnoses; nationally agreed measures to evaluate service delivery and outcomes; and collation of Significant Incident Reviews to report annually to the National Eating Disorder Network. It would also be beneficial for future data sets to include data from the third sector to understand the support that people access that is not NHS specialist care.

In addition, for those planning and delivering support and treatment, it is vital to understand what happens to people turned away from specialist services. This includes whether they are given access to other forms of support outside the NHS, or whether their condition deteriorates to the point of needing more intensive care in the future.

The Working Group is aiming to meet in Spring 2023 to finalise an Eating Disorder Data Set.