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

5. Outcome 1: Leadership and Governance

This chapter presents the analysis of responses to Q8 to Q10, which focused on Outcome 1 – Leadership and Governance. Where respondents commented on these questions about the overarching themes, their comments have been included in the previous chapters. The same approach applies to all subsequent Outcome-specific chapters.

Nine in ten (90%) of those answering Q8 agreed that Outcome 1 would improve the experiences of people accessing eating disorder treatment; 32% strongly agreed, and 59% agreed. All individuals and other organisations agreed to some extent, as did 84% of healthcare respondents.

Over three quarters (78%) of those answering Q9 agreed that Outcome 1 would improve the outcomes of people accessing eating disorder treatment; 24% strongly agreed, and 54% agreed. All other organisations agreed to some extent, as did around three quarters of individuals (73%) and healthcare respondents (76%).

Q10. Reading the “Outcome in Action”, which is intended to describe how the “Outcome 1 - Leadership and Governance” will be delivered, do you have any other comments about the Outcome?

Monitoring and evaluation

Two thirds of respondents left a comment in Q10. While support for monitoring, evaluation, research, and regulation was expressed in most open questions, it was Q10’s most prevalent theme. In addition to the comments on this issue outlined in Chapter 3, where there were requests for more detail around plans for monitoring, evaluation, benchmarking, and regulation, in Q10, there were also calls to:

• Address barriers to information sharing, data collection, and review, such as issues with electronic record-keeping systems, limited clinician capacity, and lack of administration and assistant support.
• Provide clarity around how the National IT recording system proposed at Outcome 1 is progressing. One healthcare respondent felt that a database provided by the Scottish Government would help ensure that all health boards know what data to report on and are collating the same information.
• Include staffing levels in monitoring activity and ensure sufficient availability of supervisors who can consider adherence to evidence-based treatment.

“Effective data collection, benchmarking, adverse event reporting/learning, and communication more broadly, will require unified IT administrative and clinical systems across all NHS Boards. At the moment we do not have this (even across Eating Disorder Managed Clinical Network areas), compromising the care of patients who move between Board areas and contributing to the risks inherent in transitions.” – Healthcare respondent

Effective leadership

Views on effective leadership and governance were the next most common theme. While some agreed with the Specifications’ focus on leadership and the rationale for this, others identified barriers or limitations to effective leadership. For example, one healthcare respondent felt that the lack of a national steering group or network for adult eating disorder services is a significant gap in national governance structures.

For this to work, we also need to think about how to recruit and retain specialist staff who are trained and experienced in the treatment of eating disorders. At present, many clinicians in these roles are overwhelmed with paperwork and management responsibilities which significantly impede the time and capacity available for focusing on leadership in developing eating disorder services.” – Healthcare respondent

Other respondents advocated further details regarding leadership plans within the Specification. One healthcare respondent, for instance, felt the Outcome considers governance structures too broadly. They advocated increased focus on the specific leadership and governance structures required by the eating disorder pathway in each implementing organisation and clarity on how these fit within overall leadership and governance structures. Another healthcare respondent queried who appropriate leaders would be and what governance would look like. They suggested current successful leadership and governance models could be used to enhance and expand service models. They also felt clinical psychologists may be in a good position to adopt leadership roles, given their training covers the age spectrum, learning disability, neurodiversity and neuropsychology.

There were calls for the Specification to include, or provide more detail on, leadership at different levels including:

• Leadership approaches for uniprofessionals working within multi-disciplinary teams.
• Supervision structures to ensure well supported staff.
• A National steering group or Managed Clinical Network, with diverse representation from clinicians, service users, carers, third-sector organisations, researchers, and NES representatives. It was felt this would encourage collaboration towards implementing the Specification and promote consistency on issues related to Outcome 1 including: lines of accountability; adverse events processes; best practice guidance; quality assurance and improvement; resilience planning; data collection, monitoring and analysis; and coordination of clinical research.
• Leadership at the Scottish Government level in resourcing and clear implementation and action plans covering operationalising the Specification and the practical, financial, and leadership that services can expect.
• Alignment with other mental health pathways, guidelines, reporting, and IT.

“Uniprofessional leadership and links to local and national networks must be provided for isolated staff working in multi-professional teams to maintain development and core uniprofessional skills.” – Mental Health Physiotherapy, NHS Ayrshire and Arran

Other themes

Additional information about the overarching theme of partnership working provided in response to Q10 included the need to:

• Consider information sharing and partnerships with General Practice more in the Specification. One professional/academic organisation suggested partnerships here could be strengthened by Interface Groups, particularly at times of transition.
• Strengthen communication with CMHTs.
• Strengthen pathways between specialist and non-specialist services supporting people with co-occurring conditions.
• Outline plans for funding of Third-sector organisations as important partners.

Some respondents agreed with the commitment at Outcome 1 to include people with lived experience at leadership and governance levels and involve them in service design, delivery, and evaluation, as described in Chapter 3. Edinburgh Carers Council also called for families and carers to be involved in Outcome 1 so leaders could better understand the role and contribution of carers.

‘Involving people with living/lived experience at both multi-disciplinary team and leadership level to meaningfully shape service design and delivery’. (This) point is so needed for the recovery of people with ED. BEAT is a wonderful charity, but they can't do all the work. People with lived experience and support from peers can make a huge difference.” – Healthcare respondent

Some welcomed the proposal to adopt a rights-based approach, with two individuals indicating that this can be missing within current practice. A variety of singular points were made on this theme. Edinburgh Carers Council proposed understanding the role and rights of carers to be included as a bullet point under ‘What does this mean for staff’ on page 17. See Me called for greater elaboration of what human rights treaties would be incorporated into the Specification and suggested alignment with the current Human Rights Bill workstream. SupportED called for details around tangible measures to ensure people understand their rights, especially in in-patient care. One individual explained they had to fight hard within NHS services for their right to veganism and advocated that services better uphold people’s moral and philosophical rights.

An advocacy organisation suggested adding a bullet point to the ‘what does this mean for the person receiving care’ section stating that ‘there will be a process in place to support escalation of concerns in the event of significant deterioration’.