National Review of Eating Disorder Services Implementation Group: final report

Annex A

1. Updates on National Review's Recommendations

The National Review published 15 recommendations that covered the short, medium and long term:

• Short term recommendations are numbers: 1, Covid-19 response; 2, implementation planning; 4, lived experience panel; 6, self-help resources; and 13, families and carers.

• Medium term recommendations are numbers: 3, co-ordination of national activity; 8, primary care; 9, medical care; and 12, education and training.

• Longer term recommendations are numbers: 5, public health; 7, early intervention; 10, specialist care; 11, workforce planning; 14, in-patient care; and 15, research.

1.1 Recommendation 1 - Covid-19 response (Short-term)

Emergency funding should be provided to rapidly meet the urgent needs of eating disorder patients and services as a direct result of an increase in the number and severity of eating disorder presentations related to the Covid-19 pandemic. Funding should prioritise physical health stability, risk reduction, support inpatient discharge and prevent admission to hospital.

Updates and Next Steps

We Provided NHS Boards with Emergency funding of nearly £4.5 million in 2021/22 to help rapidly meet the urgent needs of eating disorder patients and services as a direct result of an increase in the number and severity of eating disorder presentations related to the Covid-19 pandemic. Funding aimed to prioritise physical health stability, risk reduction, support inpatient discharge and prevent admission to hospital.

In 2022-23, we allocated funding of £46 million via the 2022-23 Mental Health Outcomes Framework to improve the quality and delivery of mental health and psychological services for all. The funding was aimed at continuing to delivering improvements in CAMHS, psychological therapies, eating disorders, and neurodevelopmental services, as well as ongoing innovation and service reform. This Framework brings together the 2021-22 Outcomes Framework and key elements of the 2021-22 Recovery and Renewal Fund, which included the dedicated eating disorder funding.

This funding was allocated to:

• Support clearing long waits for CAMHS and meeting the waiting times standards.
• Implementing and delivering local elements of the national CAMHS service specification, including improvement in provision for those with eating disorders, by March 2026.
• Supporting improvements in both neurodevelopmental services for children and young people, and eating disorder services.

1.2 Recommendation 2 - Implementation Planning (Short Term)

An Implementation Group should be set up by Scottish Government. This short-term group will be responsible for the implementation of these service review recommendations, planning for and setting the strategic direction, vision and ethos for improvement and service delivery over the next 10 years. This group should report directly to Scottish Government.

Updates and Next Steps

The National Review for Eating Disorder Services Implementation Group was established in August 2021, and was active until September 2022.

The Group's Terms of Reference and membership list can be found here.

1.3 Recommendation 3 – Coordination of National Activity and Data Collection (Medium Term)

A National Eating Disorder Network should be established and funded by Scottish Government. This permanent Network will take over from the work of the Implementation Group to support the implementation of the recommendations on an ongoing basis. It will also be responsible for the coordination of national functions including training, national level service development, setting quality standards, and coordinating research and innovation networks for eating disorders.

Updates and Next Steps

The National Review of Eating Disorder Services Implementation Group created an Outline Specification for the establishment of a National Eating Disorder Network in Scotland.

The Implementation Group agreed the Network should have the following aims:

• Establishing an online resource/website with signposting, educational material, and providing access to online self-help/management programmes, as well as providing a platform to host any Scottish information gathering, research and sharing activity. Including providing a space to share knowledge, learning and best practice with the existing north and south Networks to ensure that work is joined up and priorities aligned.
• Implement the Eating Disorder Quality Standards.
• Outline what eating disorder services should be available in Scotland, and the staff that are required to support these services. This includes recommending any pilots of new services.
• Facilitating the collation of national data, with the aim of providing, on an ongoing basis, annual audits of the prevalence of all eating disorder diagnoses, analysis of nationally agreed datasets to measure service delivery and outcomes, collation of Significant Incident Reviews to report annually to Scottish Government.
• Work with Public Health Scotland and other relevant agencies to build, implement and evaluate a public health strategy for Scotland that makes eating disorder prevention everyone's business.
• Support and lead on training for healthcare and other stakeholder professional, taking forward and expanding on the work of the Implementation Group. Ensuring that training offers are advertised and available nationally.

We are currently taking forward planning to establish this Network in 2023.

1.4 Recommendation 4 - Lived Experience Panel (Short Term)

There should be a lived experience panel set up who will advise the Implementation Group and work alongside the National Eating Disorders Network. The lived experience panel should include patients, families and loved ones, and third sector representatives and there should be diversity in the panel, for example, including all eating disorder diagnoses, men with eating disorders, LGBT representatives and people from ethnic minorities. The panel will advise on all eating disorder national changes.

Updates and Next Steps

The National Review of Eating Disorder Services Implementation Group drafted and published an Outline Specification for the establishment of a Lived Experience Panel for those who have been impacted by an Eating Disorder in summer 2022.

Funding was then awarded in FY 2022/23 to Beat, the UKs Eating Disorder Charity, to establish and facilitate the Panel, with recruitment to beginning in early 2023.

The Panel will provide advice and evidence from the perspective of lived experience in order to inform the ongoing delivery of the recommendations of the National Review of Eating Disorders Review and support the work of the National Eating Disorder Network.

1.5 Recommendation 5 - Public Health (Long Term)

The Scottish Government should fund and support development of a comprehensive public health strategy for Scotland that makes eating disorders prevention everyone's business.

Updates and Next Steps

The National Review of Eating Disorder Services Implementation Group has identified that this recommendation will be taken forward by the National Eating Disorder Network.

The Network will work closely with Public Health Scotland, and other relevant organisations to make sure that eating disorder prevention is everyone's business.

1.6 Recommendation 6 - Self-help Resources Available to All (Short Term)

Scottish Government should provide funding to the Third Sector to build platforms and a range of community services to enable the Scottish public to have free access to evidence-based self-help/management programmes and supports, including peer support networks.

Updates and Next Steps

We provided over £400,000 in financial year 2021/22 to Beat, the UK's Eating Disorder Charity, to provide a wide range of support options to families and carers affected by eating disorders, as well as support for children, young people and adults. Through this funding over 6,000 people were provided with support.

In financial year 2022-23 we are providing Beat, the UK's eating disorder charity, with over £600,000 to provide a range of support services for those impacted by an eating disorder. This includes expansion of their helpline, and specialist support for those impacted by binge eating disorder, and a variety of peer support groups and support programmes.

Through this financial year's funding over 8,000 people have received support from Beat.

We will continue to develop our response to this recommendation to ensure that all those who require support can access this in the right way for them.

1.7 Recommendation 7 - Early Intervention (Long Term)

Key Stakeholders and Healthcare professionals should be able to identify the signs and symptoms of all eating disorders including at early stages and know how to support and sign post people into treatment.

Updates and Next Steps

Through the funding allocated to Beat in financial year 2022/23, we have introduced Beyond the Symptoms Training for GPs and Healthcare professionals training to support them to identify when a patient has an eating disorder, and confidently intervene early.

Further actions in relation to this Recommendation will be taken forward by the National Network once established.

1.8 Recommendation 8 – Primary Care (Medium Term)

Awareness, detection and early, effective treatment of eating disorders at primary care is important. There should be an ongoing training programme for all primary care clinicians to ensure consistent high standards are maintained in identification and management of patients who may have eating disorders, and their families. There should be increased support from specialist services when primary care is asked to assist with physical monitoring or support, for instance when patients live far away from specialist teams.

Updates and Next Steps

We know that it is vital that we continue to support work to build capacity in primary care settings given the increasing demand, complexity of presentations and impact on secondary care services.

We will continue to build on the investment we have already made, by including Mental Health and Primary Care in the Mental Health Outcomes Framework, which will give Integration Authorities flexibility to improve existing pathways

Through the funding allocated to Beat in financial year 2022/23, we have introduced Beyond the Symptoms Training for GPs and Healthcare professionals training to support them to identify when a patient has an eating disorder, and confidently intervene early.

In addition, we are currently developing Eating Disorder Quality Standards which are due to be consulted on in Spring 2023. The Standards cover areas such as service structure and governance arrangements.

Lastly, as described above in Recommendation 3, we are currently taking forward planning to establish a National Eating Disorder Network in 2023. Included within the Network's remit will be further developing specialist eating disorder services and the links between primary and secondary services.

1.9 Recommendation 9 - Safe Medical Care (Medium Term)

Medical aspects of care should be prioritized, with clear lines of responsibility and leadership from suitably trained medical experts. We recommend named eating disorder medical leads for every health board/region with oversight over the medical care of every patient with an eating disorder, who report data to the National Eating Disorder Network. This can be done in collaboration with General Practitioners, Acute Medicine and Paediatrics according to the local context of who has appropriate training in managing the medical aspects of eating disorders.

Updates and Next Steps

We are currently developing Eating Disorder Quality Standards which are due to be consulted on in Spring 2023. The Standards cover the safe medical care of patients, monitoring arrangements and shared and supported decision making.

In addition, as described above in Recommendation 3, we are currently taking forward planning to establish a National Eating Disorder Network in 2023. Included within the Network's remit will be the facilitation of the collation of national data relating to eating disorders.

1.10 Recommendation 10 - Investment in Specialist Eating Disorder Services (Long Term)

The Scottish Government should commission and fund equitable provision of high-quality accessible specialist community-based services for eating disorders across Scotland for all ages, which see all types of eating disorders across the range of severity.

Updates and Next Steps

We are currently developing Eating Disorder Quality Standards which are due to be consulted on in Spring 2023. The Standards cover a range of areas, that include access to care and service structure to ensure that individuals have access to a range of support options that work for them.

Once these Standards have been published we will support Boards to implement these.

In addition, as described above in Recommendation 3, we are currently taking forward planning to establish a National Eating Disorder Network in 2023. Included within the Network's remit will be to understand further what services should be available across Scotland and the staff required to support these services.

1.11 Recommendation 11 – Workforce (Long Term)

A comprehensive workforce plan will be developed that aims to build the workforce to be able it to meet the service standards over the next 10 years. This plan should emphasise staff retention and training within eating disorders services as well as recruitment.

Updates and Next Steps

We are developing and will publish a Mental Health Workforce Plan in Spring 2023, helping to plan, attract, retain, employ and nurture our mental health workforce, this includes the workforce that is required to care for those impacted by an eating disorder.

As described above in Recommendation 3, we are currently taking forward planning to establish a National Eating Disorder Network in 2023. Included within the Network's remit will be understanding the workforce requirements of any new eating disorder services, and their training needs.

1.12 Recommendation 12 - Education and Training (Medium Term)

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 inpatient. 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.

Updates and Next Steps

The National Review of Eating Disorder Services Implementation Group highlighted key areas where training needs to be improved, and mapped out where training was already available. In addition, members of the Working Group have started to trial and evaluate SPOT - Online Training for Schools which has been developed by Beat.

Through the funding allocated to Beat in financial year 2022/23, we have introduced Beyond the Symptoms Training for GPs and Healthcare professionals training to support them to identify when a patient has an eating disorder, and confidently intervene early.

As described above in Recommendation 3, we are currently taking forward planning to establish a National Eating Disorder Network in 2023. Included within the Network's remit will be understanding the workforce requirements of any new eating disorder services, and their training needs which will build on the work of the Implementation Group.

1.13 Recommendation 13 - Families and Carers (Short Term)

Families and carers should be given a high level of support from the start of their loved ones eating disorder, and for as long as they need it. Experts by experience (both patients and families) should be involved in service design and implementation as well as quality improvement.

Updates and Next Steps

We provided over £400,000 in financial year 2021/22 to Beat, the UK's Eating Disorder Charity, to provide a wide range of support options to families and carers affected by eating disorders, as well as support for children, young people and adults. Through this funding over 6,000 people were provided with support.

In financial year 2022-23 we are providing Beat, the UK's eating disorder charity, with over £600,000 to provide a range of support services for those impacted by an eating disorder. This includes expansion of their helpline, and specialist support for those impacted by binge eating disorder, and a variety of peer support groups and support programmes.

Through this financial year's funding over 8,000 people have received support from Beat.

As described above in Recommendation 3, we are currently taking forward planning to establish a National Eating Disorder Network in 2023. Included within the Network's remit will be establishing an online resource/website with signposting, educational material, and providing access to online self-help/management programmes to ensure that families and carers can access appropriate support.

We will continue to develop our response to this recommendation to ensure that all those who require support can access this in the right way for them.

1.14 Recommendation 14 - Inpatient Eating Disorder Services (Long Term)

Inpatient eating disorder provision is currently variable and inequitable across Scotland particularly for adult men. Inequitable access to inpatient care has significant impact on community services. Where there are inequalities, Health Boards should work together to ensure there are equitable access to services. We recommend a further, smaller review specifically of national inpatient provision across all ages in 5 years' time, after community service improvements have been implemented.

Updates and Next Steps

We are currently developing Eating Disorder Quality Standards which are due to be consulted on in Spring 2023. The Standards cover a range of areas, that include access to care and service structure to ensure that individuals have access to a range of support options that work for them, which includes inpatient services when required.

In addition, as described above in Recommendation 3, we are currently taking forward planning to establish a National Eating Disorder Network in 2023. Included within the Network's remit will be outlining what eating disorder services should be available in Scotland, and the staff that are required to support these services, this includes inpatient services.

1.15 Recommendation 15 - Eating Disorder Research in Scotland (Long Term)

Scottish Government should consider funding eating disorders research through NHS Research Scotland. Specific calls for eating disorder research should be made to support research which would fill gaps in knowledge and understanding of eating disorders in the Scottish population, and their treatment in Scotland. Particular note should be taken of gaps in the research base that SIGN identifies.

Updates and Next Steps

As described above in Recommendation 3, we are currently taking forward planning to establish a National Eating Disorder Network in 2023. Included within the Network's remit will be to establish a platform to host any Scottish information gathering, research and sharing activity. Including providing a space to share knowledge, learning and best practice with the existing north and south Networks to ensure that work is joined up and priorities aligned.