Care and treatment of eating disorders - national specification: consultation

Outcome 1: Leadership and Governance

Outcome Statement

Organisations demonstrate effective leadership, governance, and partnership working in the management and delivery of eating disorder services.

Rationale

Effective leadership and governance are critical to ensuring safe, person-centred, and high-quality health and social care services. Individuals accessing eating disorder services should have confidence that their care and support is of the highest quality.Services should understand people’s needs and experiences by undertaking meaningful consultation and facilitating codesign.

People accessing services should benefit from partnership working at a local, regional, and national level. Effective planning and partnership work should be underpinned by arrangements and information sharing that facilitate the delivery of high-quality, equitable care.

Public health and clinical leadership should support effective planning and continuous quality improvement. To allow for effective planning and management, organisations must ensure the effective collation, analysis, and review of eating disorder data, such as local and national epidemiological and improvement data.

Outcome in Action

1.1 Organisations can demonstrate robust governance arrangements, with clear lines of accountability, covering all aspects of the patient journey.

1.2 Organisations can demonstrate a commitment to quality planning and assurance through:

• effective data collection, including data on health inequalities
• involving people with living/lived experience at both multi-disciplinary team and leadership level to meaningfully shape service design and delivery
• local and national benchmarking against agreed outcomes, and
• clear alignment of strategic policy objectives and implementation strategies, and routine monitoring of patient outcomes to inform interventions.

1.3 Organisations can demonstrate a commitment to international human rights conventions by:

• taking a rights-based approach to service planning and delivery, and
• routinely informing people of their rights and providing comprehensive training to staff on upholding people’s rights, which is updated when necessary and appropriate to their role and setting.

1.4 People are given meaningful opportunities to participate in the design and evaluation of eating disorder services, and organisations can demonstrate where this feedback has resulted in change.

1.5 There are clear and structured risk management and adverse events processes, which include:

• accountability and responsibility arrangements for reporting any risks, including monitoring people at risk
• accountability and responsibility arrangements for reporting adverse events
• a consistent approach to reporting adverse events
• a documented escalation process for adverse events, and
• organisational learning from adverse events.

1.6 Information management structures and governance processes are in place to support:

• the use of a national IT system for reporting, benchmarking, and performance to improve patient safety and quality of care, where appropriate, and
• the routine sharing, with fully informed consent, of identifiable personal healthcare data between care providers, and the effective collation of anonymised data in support of care governance.

1.7 There are agreed pathways and processes, developed with people with living/lived experience, to ensure:

• accessible and responsive care, including self-referral options
• timely management options are consistently available
• information is shared appropriately between public health and primary care, secondary care, laboratories, third sector, local authority, and independent healthcare sector services
• there are resilience plans for service disruption
• there is clear communication of medical monitoring and test results and onward referral for management and support as necessary
• prioritisation of those most in need
• individuals with co-occurring considerations such as pregnancy, diabetes, mental health concerns, and autistic individuals are adequately and appropriately supported, and
• appropriate signposting to additional areas of support, including the third sector, as necessary.

1.8 There are systems in place to ensure that all medical equipment used in the provision of eating disorder care have:

• planned preventative maintenance, and
• a mechanism for routine checks and testing, and rolling replacement schedules.

1.9 Organisations support and encourage service evaluation, audit, and research to develop and share best practice.

1.10 There is regular review and audits of clinical environment and resources, making sure these are accessible for those with protected characteristics, sensory, and communication differences.

What does this mean for the person receiving care?

You can be confident that:

• you will receive a safe, equitable, and high-quality service that is personalised to meet your needs
• services committed to quality improvement, have effective leadership and governance, and are engaging effectively with people with living/lived experience of eating disorders and using services
• you will be given meaningful opportunities to participate in decisions about how services are shaped
• information about you and your care will be shared with your consent, where appropriate, and in line with national guidance, and
• that while you wait for access, there will be a process in place to support escalation of concerns in the event of significant deterioration while waiting.

What does this mean for staff?

Staff:

• understand and can access care pathways, standards, and guidance relevant to their role
• actively participate in the multi-disciplinary team and are supported by their organisations to understand their role
• are aware of how to report and escalate adverse events
• are proactive in raising and responding to identified concerns which may impact on patient safety and care, and
• are encouraged and supported to work collaboratively with allied services.

What does this mean for the organisation?

The organisation:

• has governance arrangements in place to determine roles, responsibilities, and lines of accountability, including adverse event management
• supports a culture where concerns can be raised and appropriately acted upon
• ensures co-ordinated person-centred pathways for access and delivery of care are developed and implemented
• performs routine monitoring of outcomes to inform health interventions and improve service delivery
• monitors and responds to areas of concern
• engage with staff, patients, and carers to identify areas for improvement
• record and monitor data
• undertake quality improvement and assurance activities to ensure performance against the Specification
• has planned preventative maintenance, quality assurance checks, and a rolling replacement schedule in place for all equipment and peripherals, and
• encourages research and clinical excellence where research is undertaken and has processes in place to monitor people awaiting services, including how risk and reassessment are managed.

Practical examples of evidence of achievement (Note: this list is not exhaustive)

• Documentation describing lines of accountability, roles and responsibilities, and escalation of adverse event reporting.
• Documentation describing monitoring and reporting systems for local strategic aims and objectives, quality improvement, and service delivery objectives.
• Care pathways and local and national standard operating procedures demonstrating multi-disciplinary working.
• Improvement work, including action plans, data collection and review of data, such as feedback from service users, staff members, national benchmarking, and evidence of timeliness of processes.
• Documentation describing preventative maintenance, quality assurance checks, and rolling replacement schedules for equipment and peripherals.
• A management system for reporting, reviewing, and learning from all types of adverse events.
• Evidence of research activity.
• Evaluation of clinical effectiveness against national or local standards.
• Evidence of codesigned service plans, innovative engagement with local communities, and good communication with service users.