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

1. Introduction

Background

The National Review of Eating Disorder Services was commissioned by Scottish Government in 2020 and published its final report and recommendations in March 2021. The National Review of Eating Disorder Services Implementation Group was established in August 2021 to take forward the early planning of the recommendations made by the Review. A working group, consisting of experts in eating disorders who have academic, lived and clinical experience was formed to develop the National Specification for the Care and Treatment of Eating Disorders in Scotland.

The National Review’s extensive engagement was used as the basis for drafting the National Specification which outlines a national baseline of eating disorder service provision for the delivery of person-centred, safe, and effective care. The National Specification applies across all levels of service provision from community outpatient teams to more intensive services, including inpatient and day services and the independent sector.

A public consultation on the draft National Specification ran between 27 October 2023 and 9 February 2024. Across 39 questions, the consultation sought the views of individuals and stakeholders on the Specification overall, the impact of the nine Outcomes on the experiences and outcomes of people accessing eating disorder treatment, and on the proposals for implementing and monitoring the Specification. A list of the consultation questions is in Appendix A and the online version can be accessed here: Care and treatment of eating disorders - national specification: consultation.

Respondent profile

In total, 52 consultation responses were received. Most were submitted via the online consultation platform, Citizen Space. Those received in an alternative format, for example, an email or PDF document, were reviewed separately by the research team.

To aid analysis, respondents were grouped based on their characteristics as shown below. While both individuals and organisations responded to the consultation, an additional classification question allowed analysts to identify individuals with a healthcare background, and create one category for healthcare respondent which includes both individuals and those responding on behalf of a healthcare organisation.

Analysis approach

The Lines Between was commissioned to provide a robust, independent analysis of the responses to the public consultation. The main purpose of consultation analysis is to understand the full range of views expressed, and where possible using closed questions to quantify how many people held particular views. This report provides a thematic analysis of responses based on the analysis approach outlined below.

Public consultations invite everyone to express their views; individuals and organisations interested in the topic are more likely to respond than those without a direct or known interest. This self-selection means the views of respondents do not necessarily represent the views of the entire population.

Reflecting the large number of people who took part, it is impossible to detail every response in this report; a few organisations shared lengthy submissions reflecting their specific subject matter expertise. These responses are referenced where possible. Full responses to the consultation, where permission for publication was granted, can be found on the Scottish Government’s consultation website.

Quantitative analysis

The analysis of responses to each question begins with a summary of the closed question data illustrating the range of opinions held by respondents.

Not all respondents answered every question. Some may not have answered as they hold no strong view on the question, or it may not relate to their area of knowledge or expertise. Where those who did not answer a closed questions expressed a view in their open comments, this has been noted in the qualitative analysis. To allow comparisons across sub-groups, the tables in this report present the results of the closed questions based on those who answered each question and broken down by type of respondent. For clarity, each closed question shows:

• The number of respondents who answered each question out of the total sample of 52 (column “n=”).
• The number of respondents from the total sample of 52 respondents who selected each response, and the corresponding percentage (grey rows).
• The number and percentage response among those who answered each question, broken down by individual and organisation responses and by type of organisation (rows including and under “All answering (%)”.
• To maintain confidentiality, results for advocacy organisations, professional bodies and academia and other organisations have been combined in the tables

Please note that numbers in the tables may not add to 100% due to rounding.

Qualitative analysis

Qualitative analysis identifies the key themes across responses to each question. The research team developed a draft coding framework based on a review of the consultation questions and a sample of responses. During the coding process, new codes were created if additional themes emerged.

When reviewing the qualitative analysis in this report, we would ask the reader to consider:

• Where differences between types of respondent were evident in qualitative responses, these have been noted. If no specific differences are highlighted then a theme was raised by a mix of respondents.
• In a small number of instances where alternative format responses contained information that did not align with specific questions, analysts exercised judgment about the most relevant place to include this material for analysis purposes.
• Respondents frequently left comments under one question which were more relevant to another question. For example, while Q7 invited comments on the overall Specification, many respondents expressed their views on the individual Outcomes within the Specification. In other instances, respondents repeatedly raised the same issues or suggestions at multiple questions, regardless of the specific focus of the question. These views are all included in this report, but analysts exercised judgment about the most relevant place to include each theme to avoid repetition.
• Analysis of the quantitative responses indicates a high level of support for the Specification. While many respondents expressed support at the closed questions, they caveated their support in open comments by highlighting concerns or queries raised about specific proposals or the implementation of the Specification.
• Due to space constraints, it is not possible to fully detail the content of the Specification within this report. Further information can be found in the online version which can be accessed here: Care and treatment of eating disorders - national specification: consultation.
• Where appropriate, quotes from a range of participants are included to illustrate key points and provide useful examples, insights and contextual information.

Weight of opinion

This report presents the themes identified in responses from most to least commonly mentioned. All themes, including views shared by small numbers of respondents, are covered; an insightful view expressed by a very small number of participants is not given less weight than more general comments shared by a majority. Similarly, all responses have an equal weighting. We recognise this means a response from an individual has the same weight as the response from an organisation which may represent many members, but this approach ensures all views are presented.

Qualitative analysis of open-ended questions does not permit the quantification of results. However, to assist the reader in interpreting the findings, a framework is used to convey the most to least commonly identified themes in responses to each question:

• The most common / second most common theme; the most frequently identified.
• Many; 25 or more comments; a common but not the most prevalent theme.
• Several respondents; 10-24 comments, a recurring theme.
• Some respondents; 5-9 comments, another theme.
• A few / a small number of comments (3-4), a less commonly mentioned theme.
• Two/one respondents; a singular comment or a view identified in two responses.