Eating disorder services review: summary recommendations

Recommendations

The following 15 recommendations will ensure that Scotland meets the Vision, using the principles articulated above, within 10 years.

Short term recommendations are numbers: 1, Covid-19 response; 2, implementation planning; 4, lived experience panel; 6, self-help resources; and 13, families and carers.

Medium term recommendations are numbers: 3, co-ordination of national activity; 8, primary care; 9, medical care; and 12, education and training.

Longer term recommendations are numbers: 5, public health; 7, early intervention; 10, specialist care; 11, workforce planning; 14, in-patient care; and 15, research.

Recommendation 1: Covid-19 response

Emergency funding should be provided to rapidly meet the urgent needs of eating disorder patients and services as a direct result of an increase in the number and severity of eating disorder presentations related to the Covid-19 pandemic. Funding should prioritise physical health stability, risk reduction, support inpatient discharge and prevent admission to hospital.

Ownership: Scottish Government providing funding, individual health boards responsible to Scottish Government.

In Summary: This urgent funding is to enable rapid expansion of medical, nursing, dietetic and therapist time and additional support workers (including third sector) over the next 12 months.

Recommendation 2: Implementation planning

An Implementation Group should be set up by Scottish Government. This short-term group will be responsible for the implementation of these service review recommendations, planning for and setting the strategic direction, vision and ethos for improvement and service delivery over the next 10 years. This group should report directly to Scottish Government.

Ownership: Scottish Government, Scottish Government's appointed chair of Implementation Group

In Summary: Once the recommendations are accepted by the Scottish Government, the Implementation Group should take forward the task of planning the implementation of the recommendations with all stakeholders. This should be informed by the data provided in the Appendices. The Implementation Group should provide clear plans and timelines for developing quality standards in eating disorders for Scotland, a skills and competency framework, finalise the costing of the changes recommended and agree a national eating disorder dataset and plan for consistent data collection across Scotland.

Recommendation 3: Coordination of national activity and data collection

A National Eating Disorder Network should be established and funded by Scottish Government. This permanent Network will take over from the work of the Implementation Group to support the implementation of the recommendations on an ongoing basis. It will also be responsible for the coordination of national functions including training, national level service development, setting quality standards, and coordinating research and innovation networks for eating disorders.

Ownership: Scottish Government, Implementation Group with stakeholders, all Health Boards

In Summary: Responsibilities will include implementation, data collection and analysis, and supporting training at undergraduate and postgraduate as well as specialist levels. In addition, the National Network would host a national website as a focal point to provide and share information and support online training and awareness.

Recommendation 4: Lived Experienced Panel

There should be a lived experience panel set up who will advise the Implementation Group and work alongside the National Eating Disorders Network. The lived experience panel should include patients, families and loved ones, and third sector representatives and there should be diversity in the panel, for example, including all eating disorder diagnoses, men with eating disorders, LGBT representatives and people from ethnic minorities. The panel will advise on all eating disorder national changes.

Ownership: Implementation Group then National Eating Disorders Network, Scottish Government

Recommendation 5: Public health

The Scottish Government should fund and support development of a comprehensive public health strategy for Scotland that makes eating disorders prevention everyone's business.

Ownership: Scottish Government, National Eating Disorders Network and Public Health Scotland

In Summary: A comprehensive public health strategy should include working with parents, schools, higher education institutions, sport and fitness organisations, the food industry, the fashion industry, healthy eating programmes, mental health organisations, and other relevant organisations to promote and support a positive body image culture in Scotland. A further aim would be to reduce influences that lead to poor body esteem and poor body image, poor attitudes to food or dieting, and promote development or perpetuation of eating disorders. Public Health Scotland and the National Eating Disorders Network should work together to ensure clear strategies and consistent messaging in relation to obesity, fitness and eating disorders across the health, education and other ministries within Scotland.

Recommendation 6: Self-help resources available to all

Scottish Government should provide funding to the Third Sector to build platforms and a range of community services to enable the Scottish public to have free access to evidence-based self-help/management programmes and supports, including peer support networks.

Ownership: Scottish Government, the National Eating Disorder Group, Public Health Scotland and the Third Sector

In Summary: This will include third sector provision of evidence-based self-help packages, peer support networks, emotional and practical support to families and carers.

Recommendation 7: Early Intervention

Key Stakeholders and Healthcare professionals should be able to identify the signs and symptoms of all eating disorders including at early stages and know how to support and sign post people into treatment.

Ownership: Implementation Group, National Eating Disorders Network, Key stakeholder organisations, healthcare professional organisations.

Recommendation 8: Primary care

Awareness, detection and early, effective treatment of eating disorders at primary care is important. There should be an ongoing training programme for all primary care clinicians to ensure consistent high standards are maintained in identification and management of patients who may have eating disorders, and their families. There should be increased support from specialist services when primary care is asked to assist with physical monitoring or support, for instance when patients live far away from specialist teams.

Ownership: Implementation Group, healthcare professional organisations, Eating Disorder Education and Training Scotland (EEATS) and NHS Education Scotland (NES)

In Summary: There should be collaboration between specialist services and primary care to develop training and care standards for eating disorders. Professionals in primary care should not be required to hold medical responsibility for significant or severe eating disorders. There may be a role for primary care to provide some aspects of care in conjunction with specialist teams where this is appropriate (for example, in rural areas) but primary care must be adequately supported to do this.

Recommendation 9: Safe medical care

Medical aspects of care should be prioritized, with clear lines of responsibility and leadership from suitably trained medical experts. We recommend named eating disorder medical leads for every health board/region with oversight over the medical care of every patient with an eating disorder, who report data to the National Eating Disorder Network. This can be done in collaboration with General Practitioners, Acute Medicine and Paediatrics according to the local context of who has appropriate training in managing the medical aspects of eating disorders.

Ownership: National Eating Disorder Network, All health boards

Recommendation 10: Investment in specialist eating disorder services.

The Scottish Government should commission and fund equitable provision of high-quality accessible specialist community-based services for eating disorders across Scotland for all ages, which see all types of eating disorders across the range of severity.

Ownership: Scottish Government, Implementation Group, National Eating Disorder Network, All health boards

In Summary: Self-referral to specialist eating disorder teams should be available to all. Teams should take an 'all age' approach to treatment. The National Eating Disorders Network should lead in developing nationally agreed standards and SIGN concordant eating disorder care. Where needed to enable equitable delivery of care, the creation of regional specialist teams utilising telehealth may be appropriate.

Recommendation 11: Workforce

A comprehensive workforce plan will be developed that aims to build the workforce to be able it to meet the service standards over the next 10 years. This plan should emphasise staff retention and training within eating disorders services as well as recruitment.

Ownership: Scottish Government, Implementation Group, National Eating Disorders Network, All health boards.

Recommendation 12: Education and Training

A comprehensive training plan will be developed which will aim to equip the entire healthcare workforce which might see people with eating disorders and their families, to deliver high quality care for people with eating disorders in all settings ranging from early intervention to highly specialist care, and from community to inpatient. In addition, there should be appropriate education and awareness training for other relevant professionals, such as youth workers, counsellors, and sports coaches. Training should be appropriate to the role that each professional has with respect to prevention, identification, signposting, treatment and support of people with eating disorders.

Ownership: Scottish Government, National Eating Disorder Network, Eating Disorder Education and Training Scotland (EEATS) and NHS Education Scotland (NES)

In Summary: The development of a skills and competency framework and training strategy is needed to ensure that there is appropriate training for all professionals to the level they need based on their role with respect to people with eating disorders. There should be a particular focus on early intervention, medical aspects of care, and support; and training should range from undergraduate healthcare training to specialist training.

Recommendation 13: Families and carers

Families and carers should be given a high level of support from the start of their loved ones eating disorder, and for as long as they need it. Experts by experience (both patients and families) should be involved in service design and implementation as well as quality improvement.

Ownership: Specialist eating disorder teams, the National Eating Disorder Network and the Third Sector

Recommendation 14: Inpatient eating disorder services

Inpatient eating disorder provision is currently variable and inequitable across Scotland particularly for adult men. Inequitable access to inpatient care has significant impact on community services. Where there are inequalities, Health Boards should work together to ensure there are equitable access to services. We recommend a further, smaller review specifically of national inpatient provision across all ages in 5 years' time, after community service improvements have been implemented.

Ownership: The Scottish Government, Implementation Group and National Eating Disorder Network, all Health Boards

Recommendation 15: Eating disorders Research in Scotland.

Scottish Government should consider funding eating disorders research through NHS Research Scotland. Specific calls for eating disorder research should be made to support research which would fill gaps in knowledge and understanding of eating disorders in the Scottish population, and their treatment in Scotland. Particular note should be taken of gaps in the research base that SIGN identifies.

Ownership: Scottish Government, NHS Research Scotland, National Eating disorders Network, Health boards and eating disorder clinicians.

In Summary: We recommended co-production of funded research that would directly improve the treatment and welfare of people with eating disorders and their families. Developing a strong research culture in Scotland would ultimately improve standards across all services.