Care and treatment of eating disorders - national specification: consultation

Outcome 3: Access to Care

Outcome Statement

All individuals have equitable, consistent, and timely access to effective eating disorder health care and services. Services should be flexible and responsive to individual needs.

Rationale

The need for early identification and intervention has been reinforced by the SIGN Guidelines for Eating Disorders (2022). It highlighted the potential accumulation of harm that can take place during an untreated eating disorder and that our current NHS systems and pathways can compound delays in accessing treatment.

This has also been reiterated by stakeholder feedback to the National Review of Eating Disorder Services (2021) that identified several areas of concern around access to care in Scotland. Specifically:

• stakeholders drew attention to how long it can take to access specialist eating disorder care
• individuals reported experiencing barriers to accessing the right treatment
• stakeholders highlighted a predominant service focus on Anorexia Nervosa, meaning individuals with other eating disorders could find it difficult to access appropriate treatment.

There is therefore a clear need for this Specification to be underpinned by the values highlighted in the Scottish Government’s Mental Health Strategy (2017) including a focus on early intervention and equal access to the most effective, evidence-based, and safest care and treatment for individuals experiencing a range of eating disorder presentations.

Outcome in Action

3.1 Organisations ensure equitable and consistent access to services, treatment, and care regardless of a person’s:

• age
• gender
• ethnicity
• geographical location, or
• economic circumstances.

3.2 Eating disorder services are accessible to individuals with the full range of eating disorders including OSFED, BED and as part of a multi-agency pathway for ARFID, and access is equal and consistent irrespective of the episode of presentation.

3.3 Individuals with a primary diagnosis of BED are seen in specialist eating disorder services and not weight management services.

3.4 Organisations should reduce barriers to care and promote a culture that enables outreach, proactive engagement, and enhances accessibility.

3.5 Specialist eating disorder services are supported to accept self-referrals and referrals from any relevant professional, including counsellors, school nurses, and the third sector.

3.6 Each service has clear accessible information in a range of languages and formats that includes:

• accessible contact details that are easy to find
• clear instructions on how to contact the service or submit an online self-referral form, and
• ‘first line advice’ while individuals wait to be seen.

3.7 A range of methods of self-referral are available for those unable to access online referral forms. Clear and accessible guidance on alternative methods of referral should be available.

3.8 People have access to services and treatment as soon as they are needed with immediate access to treatment and support, where appropriate. This includes people who present:

• early in the development of the illness
• early in help-seeking, or
• early in recurrent episodes of illness or relapse.

3.9 Organisations ensure that decisions on accepting a referral (including self-referral) should be based on a holistic assessment and review of an individual’s circumstances, needs, and preferences and not based solely on clinical measurements such as BMI.

3.10 Individuals with an eating disorder should receive SIGN concordant treatment in specialist eating disorder services within appropriate timelines:

• maximum of four weeks from receipt of a referral for routine cases, and
• within one week from referral for urgent cases.

3.11 All eating disorder services are accessible and safe for individuals in larger bodies including access to specialist equipment for monitoring physical health and the clinical environment.

What does this mean for the person receiving care?

You will:

• be able to see the right person in the right place at the right time
• be able to self-refer to specialist eating disorder services, if think you might have an eating disorder, and
• be seen by people with appropriate skills, knowledge, and competencies.

What does this mean for staff?

Staff:

• in collaboration with those with living/lived experience, develop an action plan to reduce barriers to accessing specialist services and implement associated mechanisms, including the use of self-referral, and
• have the skills and capacity to deliver timely evidence-based interventions for the full range of eating disorders.

What does this mean for the organisation?

The organisation:

• develops an all-age range specialist eating disorder services
• assesses service capacity to embed the national specification, and develop associated staff training plans to meet the need for evidence-based care
• undertakes regular audits of referral data to understand representation aligned with prevalence rates and local population demographics, with associated action plans to reduce inequalities, and
• participates in national reporting of standardised waiting time data.

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

• An annual audit of eating disorder referrals to a local specialist eating disorders team using standardised data collection.
• Comparison of referral data nationally and with prevalence rates and local population demographics.
• Identification of potential areas of health inequalities (e.g. lack of males being referred) and an action plan developed, in partnership with individuals with living/lived experience including individuals from that particular demographic, to reduce inequalities.
• An easily accessible website with clear information on service criteria and accessible first link advice.
• Information is available in a range of languages relevant to the local population and in accessible formats.