National Specification for the Care and Treatment of Eating Disorders in Scotland - Consultation Analysis Report

12. Outcome 8: Education and Training

This chapter presents the analysis of Q29-Q31 about Outcome 8: Education and Training.

The vast majority (95%) of those answering Q29 agreed to some extent that Outcome 8 will improve the experiences of people accessing eating disorder treatment; 45% strongly agreed, and 50% agreed. Each subgroup recorded very high levels of total and strong agreement.

Very high levels of total agreement (95%) that Outcome 8 will improve the outcomes of people accessing eating disorder treatment were also recorded; 44% strongly agreed, and 51% agreed. All individuals and other organisations who answered agreed, as did 92% of healthcare respondents.

Q31. Reading the “Outcome in Action”, which is intended to describe how “Outcome 8 - Education and training" will be delivered, do you have any other comments about the Outcome?

Training content and format

Over three fifths commented on Q31, with the most prevalent theme being training format and content. There were calls for staff to be trained in a multitude of issues, including:

• New developments, up-to-date research and evidence-based treatment.
• Early detection, management and containment of eating disorders.
• Practical aspects of supporting someone with an eating disorder.
• Individualised care.
• ARFID and BED.
• Neurodiversity and co-occurring considerations.
• The dental effects of eating disorders.
• The impact of trauma and relationship with food.
• A range of therapeutic models and skills- including trauma processing.
• The role and rights of carers.
• Research literacy and data analysis skills.
• Cultural competency and inclusive care.
• Staff wellbeing and tackling stigma and discrimination in the workplace.

Others requested training to be delivered via TURAS, embedded within professional competency frameworks, or aligned with MEED, SIGN guidelines, and The Matrix. One healthcare respondent proposed devising a minimum standards framework for eating disorder training paralleling the trauma skills framework.

One healthcare respondent felt remote training would be the best use of staff time. The Scottish Physiotherapists in Mental Health and UK Physiotherapy Network Group suggested that where a uniprofessional within an MDT requires specific training unique to their role, they are supported to attend training with a peer from a different trust.

“I would suggest that services should not just be trained in 'trauma-informed care' but should also have at least some clinicians who are trained and experienced in trauma processing work. This is essential given the very high comorbidity of PTSD alongside eating disorders.” – Healthcare respondent

“The physiotherapy ED network, and national physiotherapy leads in Mental Health group have created a mental health competency framework for staff working with people with eating disorders, which has specific learning needs identified at different grades and areas (CSP 2023). This may be of interest for future reference.” – Mental Health Physiotherapy, NHS Ayrshire and Arran

Training reach

Several respondents commented on the reach of eating disorder training or felt that the Specification should also consider training and education outwith specialist eating disorder services. They suggested this should include mental health teams, primary care teams and GPs, those referring or signposting to eating disorder services, reception and administration staff, third-sector organisations, carers and families, dental professionals, and all eating disorder staff, whether or not they are public facing. A healthcare respondent also advocated under and postgraduate education/training to encourage students into eating disorder-focused roles.

“Training for dental professionals would be good as they may be in a position to identify eating disorders before other Health Care Practitioners. The corollary is also true for HCP to be offered training in dental effects of some eating disorders." – Healthcare respondent

“Our volunteers sought clarity and questioned if training courses also includes reception and administration staff, as they usually are the first staff member that they disclose to.” – See Me

Training delivery

Some respondents agreed with the proposal that those with lived experience be involved in devising and delivering training, or advocated a greater focus on this within the Specification. Edinburgh Carers Council also suggested carers input into training and education packages.

“There needs to be much more focus on learning from the experience of lived experience and less on textbook knowledge. There must be a focus on refreshing with new information and research but also on education about different ways to deliver treatment and on individualised care.” – Individual

“Staff education should involve individuals with a lived experience of eating disorders in training, ideally lived experience of having gone through the NHS systems of treatment for individuals with an ED. Staff should be more educated on the role and rights of carers in treatment and recovery from eating disorders and with input from carers. There is currently carer awareness training being developed by NHS Education Scotland and the Carers Trust... This training may be sufficient for eating disorder services but there could also be an opportunity to input into the development of the training modules to ensure that it is appropriate. Any training for staff may want to reference the Mental Welfare Commission’s good practice guide on Carers and Confidentiality – Edinburgh Carers Council

Other suggestions for training delivery and providers included staff working directly with people with eating disorders, staff from the proposed all age service, NES, and opportunities promoted by the EEATS initiative. One healthcare respondent felt that as well as protected time for in-house training and supervision, there must also be sufficient provision for training for specialist therapeutic interventions from NES, or other professional bodies and centres of excellence. A small number also identified regional and national networks, including a National Managed Clinical Network, as important for knowledge sharing, peer learning and support, developing training packages, and supporting research and evaluation.

“NES have a range of training offers which could be further developed to support the needs of the workforce including enhanced and specialist psychological therapies and interventions. NES notes the suggestion that the National Eating Disorder Network would be in a position to deliver training in collaboration with training and education providers and would welcome a conversation around how this would be implemented.” – NHS Education for Scotland

Other themes

Several mentioned the benefits of training or expressed support for the recommendations at Outcome 8, with some describing this as crucial to achieving the proposed Outcomes.

However, barriers to training access were also highlighted by some, including lack of resource, capacity, operational cover, and protected learning time to enable staff to attend training. Suggestions for enabling staff to attend training included that organisations develop service-level training plans and incorporate training into staff job plans, supporting staff to attend training as a core business task rather than additional workload; and that the Specification outlines a minimum number of hours of training expected of staff.

One healthcare respondent requested learning and skills acquired through training to remain within the NHS and proposed learner contracts indicating clear reciprocity of sustainable benefit to learner and employer over a reasonable timeframe following training completion. NES also stressed the importance of monitoring the provision of post-training supervision support. They explained that evidence shows that selecting appropriate staff and post-training supervision support maintains the implementation of training in practice. They called for organisations to include the development of supervisors within their training plans as it can take years for clinicians to reach supervisor status in particular interventions.

“Training and supervision are vital, but it should never take time away from spending time with patients and learning from them what is right for them, and also what has been helpful and unhelpful for them, past and present.” – Individual

“I would like to see an actual minimum number of hours specified here. At present, many staff are often overwhelmed with standard NHS requirements to use up their CPD allocation on things such as violence and aggression courses, information governance, etc. which have little or nothing to do with eating disorders. It will help staff if they have a specific requirement in terms of number of hours for eating disorder specific CPD hours per year, which they can use as a guideline for discussions and planning with management teams.” – Healthcare respondent