Care and treatment of eating disorders - national specification: consultation

Outcome 2: Service structure

Outcome Statement

Organisations deliver a range of services which are safe, effective, and person-centred. High-quality treatment and support are delivered by multi-disciplinary teams working in partnership.

Rationale

Patient safety is fundamental to the delivery of eating disorder treatment and care. The service structure and underlying protocols and pathways play an essential role in the delivery of safe care. The aim of the Specification is to reduce and prevent gaps in care via the provision of clear protocols and service agreements and to change service structure to improve patient safety where possible. This includes implementation of the recommendations of all age eating disorder services across Scotland (National Review of Eating Disorder Services, 2021). It is recommended that the National Eating Disorder Network develop specific guidance on the development of all age services to make sure that the developmental needs of younger populations, and associated assessment of risk and specialist intervention, are not lost in the merging of services.

International clinical practice guidelines recommend that most individuals with an eating disorder should be treated in outpatient care (Hay et al., 2019). This is led by the need for efficient use of healthcare resources, patient preference, and greater adherence to outpatient treatment in clinical trials (Freeman, 1992; Gowers, et al., 2007). However, when individuals cannot be managed in the community due to physical or psychiatric risk, there is a need for a range of more intensive service structures inclusive of day patient, intensive outreach, and inpatient treatment.

Stakeholders in the National Review of Eating Disorder Services (2021) described variability in the availability of services. This Specification aims to reduce this variability while acknowledging the diverse population needs of Scotland including remote and rural locations where different models of service delivery, such as regional multi-disciplinary teams and services, may be more appropriate.

Clinical consensus indicates that the optimal model of service delivery for people with an eating disorder is a dedicated, multi-disciplinary eating disorder services (NHS England, 2019).

Outcomes in Action

2.1 Organisations ensure a range of services, with varying intensities of provision, are developed. These should be based on individual assessment and clinical risk, and available to all people who have been assessed as requiring treatment and support.

2.2 Organisations ensure that they provide an all-age specialist eating disorder service which can meet the full range of developmental needs of children, young people, adults, and older adults.

2.3 Organisations ensure a range of options in the delivery of care are offered which are person-centred and responsive. These include:

• inpatient care
• outpatient care
• day services
• outreach including intensive outreach services
• digital and online technology, and
• freely available evidence-based self-help materials.

2.4 Different models and intensity of service provision are integrated with transparent pathways and protocols to enable safe provision of treatment at points of transition and to support individuals to experience their care as connected, coherent, and recovery-focused.

2.5 Clear protocols are in place to manage:

• risk and safety, and
• unattended appointments.

2.6 Assertive and proactive follow-up protocols are in place that are designed to prevent inappropriate discharge and support engagement in treatment and care.

2.7 Organisations ensure that services are delivered by multi-disciplinary teams who work in effective partnerships with other agencies and the third sector.

2.8 Where health boards have smaller populations, creation of regional specialist eating disorder multi-disciplinary teams may be appropriate. Appropriate protocols should be developed to ensure seamless information exchange (within the parameters of information governance and informed consent) and consistency in care and treatment.

2.9 As a minimum, essential outpatient care should include:

• psychiatric assessment and review
• SIGN recommended psychological interventions
• medical monitoring
• medication, and
• dietetic intervention.

2.10 An ideal staffing mix for a comprehensive eating disorder all age service should include:

• administrative staff
• dietitians
• family therapists
• medical professionals (e.g. clinical nurse consultant, GP, physician, paediatrician)
• nursing staff
• occupational therapists
• peer support workers
• physiotherapist
• psychiatrists
• applied psychologists (including assistant psychologists)
• psychological therapists
• social workers, and
• support workers.

Where appropriate, people are supported to access speech, language or communication assessment and support, and art and creative therapies.

What does this mean for people?

You:

• will receive safe and high-quality eating disorder treatment from a multi-disciplinary team
• can be confident that while the majority of eating disorder treatment is provided on an outpatient basis, you can access a range of higher intensity eating disorder services if required, and
• will have an opportunity to feedback on the service you have received without any negative impact on your care and treatment.

What does this mean for staff?

Staff:

• are well supported in a multi-disciplinary eating disorder team
• receive appropriate training and receive effective clinical supervision appropriate to their role and workplace setting, and
• understand and can access care pathways, standards, and guidance as appropriate

What does this mean for the organisation?

The organisation:

• develops an all age range specialist eating disorder service
• routinely assesses service capacity to implement the Specification, and develops associated staff training plans to meet the need for evidence-based care
• participates in national reporting of routine outcomes
• can access higher intensity specialist eating disorder service provision including day services, intensive treatment services, and inpatient, and
• has clear protocols in place to manage risk and safety, and transition between services.

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

• Development of an all age eating disorder service.
• Regional specialist eating disorder multi-disciplinary teams in health boards with smaller populations.
• Cross-health board protocols to facilitate seamless information exchange and consistency in care and treatment.
• Details of staff mix and referral pathways.