Agenda item

The Committee has asked for a general update on the Eating Disorder Service. Eating disorders are serious, often persistent, mental health disorders associated with high levels of impairment to everyday functioning and development, and a high burden on families and carers. They can be associated with life-long physical, psychological, educational and social impairment and in some cases can be fatal.

Discussion

The new All Age Eating Disorder Service had been commissioned in late 2017 and had been fully operational since April 2018, with the service being fully staffed. It was fully compliant with National Institute for Health and Care Excellence guidance. Referrals to the service were higher than anticipated, which suggested that the new service was much needed. The provision of a single Kent and Medway service enabled a full range of professional expertise to be provided. Between October and April 2018, there had been 49 referrals to the service in Medway, which included 12 children. The contract was structured so as to enable full monitoring of activity in Medway.

Committee Members raised a number of questions which were responded to as follows:

Level of detail in report – A Committee Member expressed their disappointment in relation to the level of detail provided in the report. In particular, they would have expected details of the referral process, a breakdown of patient numbers by age and sex and information on how the service was being publicised. The Director of Operations at NELFT said that the focus had been on establishing the service and ensuring that it functioned as intended. Recruitment had been successful, with all roles having been filled. The service had been building knowledge and skills in the community. One particular challenge was that patients tended to present late once their eating disorder had escalated. Work was taking place with schools, higher education establishments and GPs to look at how to promote the service.

It was agreed that a report and presentation containing this information would be provided to a future meeting of the Committee and that a written briefing would be circulated to the Committee in the interim.

Transfer to new service and work with other services – In response to a Member concern that the rollout of the service had not been as seamless as had previously been suggested, the Director of Operations said that the rollout had gone as planned but that there had been a particular staffing skill related challenge as the previous provider had not provided a children’s service. This provision required the recruitment of staff with the correct knowledge and skills. In a well-run service, it would be expected that the number of patient discharges would be similar to the number of referrals. Current referral and discharge figures were misleading as many of the people entering the service had a relatively high level of need, particularly for child patients as there had not previously been a dedicated children’s service. The provision of a single service covering the whole of Kent and Medway enabled it to provide a multi-disciplinary team across a number of specialisms, such as cognitive behavioural therapists, dieticians, physical health experts and psychiatrists. It was considered that the service had sufficient capacity for Medway patients.

It was clarified that the 49 referrals quoted in the report were referrals to the service within Medway. The total number of referrals for the whole of Kent and Medway was around 500. Everyone under the care of the service received a leaflet setting out how to access care when they experienced a crisis. An out-of-hours crisis team was available. All patients were assessed and provided a care plan. Work was undertaken with acute hospitals as patients often also had physical health needs.

Patients in crisis and referrals – It was requested that a figure be provided for the number of patients treated who were considered to be in crisis and also whether the service was able to make specialist residential referrals when needed. The Committee was advised that referrals could be made to a range of specialist provision and that this depended on the needs of the patient. Initial stabilisation of a patient was often undertaken at the local acute hospital ahead of specialist referral. Details of this would be included in the further report and presentation due to be brought to the Committee.

Inpatient Admissions - In relation to Health and Care Information published figures from April 2014 that showed an 8% rise in inpatient hospital admissions in the previous 12 months and that this trend was continuing, it was questioned what the extent was of this trend and what the implications were for the service. The NELFT Director of Operations said it was recognised that patients were presenting at a later stage, which resulted in them being more severely affected and being in need of a higher level of care. The service undertook community education and was developing early intervention approaches to reduce the number of patients in need of crisis care. There was a need to develop training capacity in this area. Further details would be provided in the next report to the Committee.

Ongoing support, sources of referral and waiting times – A Committee Member asked what ongoing support and counselling was available for patients and carers once they were discharged from the service. The Member also asked for details of waiting times and the waiting list to access the service. They also expressed concern that the number of patients referred by Child and Adolescent Mental Health Services was just two while there had been no referrals from local authority social care. It was also requested that the next report to the Committee provide details of community engagement undertaken to promote the service. The Committee was informed that the vast majority of referrals were currently coming from GPs. Training was being undertaken to raise the profile of the service with other organisations and professions. One challenge was that many of the people presenting to the Eating Disorder Service were not previously known to any other service providers. The service was delivered from all existing NELFT sites across Kent and Medway rather than from a dedicated facility. This facilitated close working with other NELFT services. Work also took place with the Kent and Medway NHS and Social Care Partnership Trust to link with other adult mental health services.

The next report and presentation to the Committee would focus on how the service was meeting National Institute for Health and Care Excellence guidance and the partnership working with organisations, such as KMPT.

The Director of People - Children and Adults services added that the Council was working with NELFT to support awareness raising amongst children’s and adult social care services. Work was taking place with NELFT and schools in relation to emotional health and wellbeing, although eating disorder was not an area that local schools had highlighted as being of particular concern. Where patients had multiple illnesses or conditions, this would be jointly managed by the various services supporting the patient. A small number of eating disorder patients were eligible for ongoing social care services. Work was undertaken with KMPT to manage co-morbidity for patients who had other mental health conditions. This was particularly important given that the mortality rate for patients with eating disorders was relatively high.

Decision

The Committee noted and commented on the update provided and agreed that a further report and presentation should be brought to the Committee and requested that a briefing note be provided to the Committee in advance of this.