Adult eating disorder services

Adult eating disorders

Eating disorder services should be multidisciplinary and include care in the community as well as intensive day patient or inpatient treatment for people with a high level of risk. They should provide effective evidence-based treatment that meets the needs of people across the full range of eating disorder diagnoses (NHS & National Collaborating Centre for Mental Health, 2019).

There are two main services supporting people with eating disorders in Cambridgeshire and Peterborough:

  • Personalised Eating Disorder Support (PEDS) offers support for people with anorexia, bulimia, and binge eating disorder where they do not meet the criteria for the NHS secondary care eating disorder team. They also support people at risk of these eating disorders, who experience symptoms affecting their quality of life (Personalised Eating Disorder Support, 2023).
  • Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) adult eating disorder services provide assessment and support to adults (over 18s) with moderate to severe eating disorders across the local region (including Cambridgeshire, Peterborough and Norfolk). They provide support to people within the community and have 14 inpatient beds (Ward S3).

The Exemplar (approved by the Clinical Commissioning Group in 2019) aimed to produce a seamless system delivering accessible evidence-based eating disorder services, removing referrals and thresholds, ensuring early intervention, integrated working and robust physical heath monitoring. This is delivered via three pathways (link powerpoint);

  1. Community
  2. Stability and support
  3. Medical Monitoring: Specialist Health Care Assistants (SHACs) based within GP practices in Cambridgeshire and Peterborough carry out medical monitoring of people with mild-to-moderate eating disorders.

Referrals and caseload

The number of open referrals and caseload of adult eating disorder services have substantially increased since April 2019. In July 2023, the 76% of the caseload was made up of open referrals, compared to 86% in April 2019.

Figure 27: Caseload and referrals to eating disorder services (age 18 to 64), Cambridgeshire and Peterborough ICS, April 2019 to April 2023. Image source: Workbook: Eating Disorders Services (england.nhs.uk)

Note: Caseload is a measure of referrals that have had at least one attended contact and are still open at the end of the month.​ Open referrals is a count of all referrals, including those yet to be seen

During the period August 2021 to July 2023, the majority of new referrals to eating disorder services were from general practice.

Contacts

The proportion of people referred to adult eating disorder services who have 2+ contacts recorded within the past four weeks shows an increasing trend since January 2022, with over a third having 2+ contacts (‘contacts’ are defined as anything clinically meaningful or to support the mental health of the person referred) in July 2023.

Figure 28: Proportion of referrals to eating disorder services (age 18 to 64) with two or more contacts recorded within the past 4 weeks, Cambridgeshire and Peterborough ICS, August 2019 – July 2023. Image source: Workbook: Eating Disorders Services (england.nhs.uk)

In July 2023, 42% of all consultations in adult eating disorder services were done via video consultation. Since September 2021 there has been a substantial increase is seen in the number of telephone and video consultations, alongside a large decrease in the number of face-to-face consultations.

Figure 29: Consultation types in adult eating disorder services (age 18 to 64), Cambridgeshire and Peterborough ICS, April 2019 – July 2023. Image source: Workbook: Eating Disorders Services (england.nhs.uk)

Impact of the COVID-19 pandemic on services

All eating disorder services saw an increase in referral rates since the start of the COVID-19 pandemic, but the largest increase was in adult community eating disorder services.

Figure 30: New referrals (all ages) to community eating disorder services. March 2018 – February 2022.

Note: blue windows represent periods of national lockdown due to COVID-19. This is a statistical processes control (SPC) chart, where the horizontal black line represents the mean over the baseline period, and the dotted lines on either side of the mean are the control limits (the threshold between normal variation in the data and variation that is beyond the range that we would expect). CAMHS ED stands for Child and Adolescent Mental Health Services Eating Disorder services (which support children and young people up to the age of 18).

Increases in referrals to inpatient services were seen towards the end of the first national lockdown. Referrals remained higher than the pre-pandemic baseline until July 2021, after which referrals to Ward S3 were below baseline.

Figure 31: New referrals to inpatient eating disorder services. March 2018 – February 2022.

Note: blue windows represent periods of national lockdown due to COVID-19. This is a statistical processes control (SPC) chart, where the horizontal black line represents the mean over the baseline period, and the dotted lines on either side of the mean are the control limits (the threshold between normal variation in the data and variation that is beyond the range that we would expect). The Phoenix provides support to children and young people aged 13 to 18, whilst Ward S3 (adult services) supports over 18s. Referrals into inpatient services include those from outside the local area and represent a different population to the Cambridgeshire and Peterborough.

A detailed analysis of referrals to community and inpatient eating disorder services in Cambridgeshire and Peterborough comparing the 2 years prior to the pandemic (March 2018 – February 2020) to the earlier stages of the pandemic (March 2020 – February 2022) found that:

  • Since the start of the COVID-19 pandemic, there was an increase in referrals to community and inpatient eating disorder services. The increase in referrals was greatest in less deprived areas for children and adults.
  • By Spring 2022, inpatient services had returned to pre-pandemic levels of referrals, whilst community services were still seeing a higher rates of referrals. This has continued into 2023.
    • Increases in the number of referrals to children’s services occurred in all districts, which has continued into 2023.
    • Increases in the number of referrals to adult services occurred across all districts, with the greatest increases seen in Cambridge and East Cambridgeshire.
  • For children and young people, there were increased referrals across all ages (from 11+) during the early stages of the pandemic, though this increase was greatest across the late teenage years.
  • Increases in adult referrals during the early stages of the pandemic were primarily from young adults aged 19 to 25.

What do local people think?

A survey of 37 local professionals (from acute services, primary care and eating disorder services) suggested that reasons behind the increase in referrals included a loss of control during lockdowns, greater isolation and people’s routines being restricted. However, several people felt that the rise in referrals was accelerated, rather than caused by, the pandemic.

A survey of 6 local people (1 with lived experience of an eating disorder, 5 of whom were carers/loved ones of someone with an eating disorder) about what could be done to support people with an eating disorder and their loved ones highlighted the importance of:

  • Early education around eating disorders and potential warning signs, including in schools and targeted at parents/carers.
  • Better education for medical professionals.
  • Rapid referrals into eating disorder services.
  • Early support for families around how to support their loved ones, such as support groups for carers.
  • Community support post-discharge.
  • Screening for autism in people diagnosed with eating disorders.

Education around eating disorders for professionals and parents/carers is currently being provided locally by Personalised Eating Disorder Support (PEDS).

Additional Resources

References

Full list of references is included at the end of this chapter.

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