Specialised adult eating disorder inpatient service: Consultation

NHS England are currently undertaking a consultation to update the Adult Eating Disorder Inpatient Service Specification. The current guidance, which is almost a decade old, does not take account of the gaps in the current system, particularly for those with complex eating disorders. There has been a move and development of categories of eating disorders with both Avoidant Restrictive Food Intake Disorder (ARFID) and Binge Eating Disorder (BED) now described in the ICD-11 and DSM-5 whereas they were under the categories of ‘atypical and unspecified eating disorders’ in the ICD-10 and previous versions.

Why now?

The NHS Long Term Plan sets out that by 2023-24 all appropriate specialised mental health services would be managed by NHS Led provider collaboratives. There are 12 NHS led Adult Eating Disorder inpatient services across the country providing this specialist service.

As at 1 April 2025, these Provider Collaboratives will transition to the oversight of NHS Integrated Care Boards who will assume responsibility for decision making and commissioning for Eating Disorder services in England

The current system appears to have an over reliance on inpatient care and through the limited access to care was appearing as a ‘postcode lottery.’ The new guidance seeks to plug some recognised barriers within the service including the number of male beds available for example. The guidance states that some intensive services in the UK have not admitted any males for several years or cap the number of male beds they have which is not acceptable in light of the percentages of males with a diagnosed eating disorder as being up to 25% in community samples vs the 5% of admissions being male.

Changes to the guidance

There are various changes which are proposed and being currently consulted on.

It was recognised that there was insufficient inclusion of co-morbidities as the guidance did not address the frequent co-occurrence of conditions such as personality disorders or those who are autistic with the prevalence of eating disorders. There was a concern raised in the stakeholder engagement working group (which consisted of clinicians, other professionals, parents, families and patients) that there was a health inequality from the service towards those who are neurodivergent. The new specification contains specific provisions for this including individualised care plans to meet the needs of neurodiverse patients as well as ensuring communication is clear and accessible and clinical environments do not cause sensory overload.

Other examples of outcomes requiring change following the initial stakeholder engagement meetings was as follows:

·         The role of families being underestimated – the revised specification includes clear requirements for the involvement of parents and carers in Multi-disciplinary meetings and treatment planning

·         The lack of robust data to monitor the effectiveness of the treatments being provided at the Adult Eating Disorder inpatient service – the revised specification addresses this by introducing standardised metrics for data collection and outcome measurement as well as annual reviews of these metrics.

·         Lack of collaboration with other clinical services – the revised specification emphasises the need for collaboration between Adult Eating Disorder services and other clinical services

·         The need for enhanced training both in terms of complexity of eating disorders and also in terms of accessibility and comprehensive nature of the training – the revised specification includes explicit references to the training resources available and mandates the provision for all staff in terms of training programmes in the treatment of eating disorders

The consultation

Following this comprehensive consultation with the stakeholder working group, the Patient and Public Voice Assurance Group raised concerns that there was a lack of direct or individual responses from former service users, carers and the public. To address this, NHS England have opened a public consultation on the matter which was originally open until 18 November but has now been extended to 6 December. There is an online survey available here Service specification for specialised adult eating disorder inpatient service - NHS England - Citizen Space for those who wish to share their views.

We will provide further updates following the publication of consultation report and service specification. We at Weightmans recognise that this guidance will have an impact on our clients and so if you would like to know more or have any questions about this, then please do not hesitate to contact one of our legal experts who can advise on this further.