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. 2023 Aug 1;48(4):1-9.
doi: 10.1192/bjb.2023.57. Online ahead of print.

The alarms should no longer be ignored: survey of the demand, capacity and provision of adult community eating disorder services in England and Scotland before COVID-19

David Viljoen  1   2 , Emily King  1   3 , Sophie Harris  1   4 , Jonathan Hollyman  1   5 , Kate Costello  1   6 , Eimear Galvin  1   7 , Melissa Stock  7   8 , Ulrike Schmidt  9 , James Downs  10 , Murali Sekar  8   11 , Ciaran Newell  12   13 , Sam Clark-Stone  14 , Amy Wicksteed  15 , Caroline Foster  16 , Francesca Battisti  17 , Laura Williams  5   16 , Roshan Jones  1   18 , Sarah Beglin  19 , Stephen Anderson  20 , Thuthirna Jebarsan  21   22 , Viviane Ghuys  21 , Agnes Ayton  1
Affiliations

The alarms should no longer be ignored: survey of the demand, capacity and provision of adult community eating disorder services in England and Scotland before COVID-19

David Viljoen et al. BJPsych Bull. .

Abstract

Aims/method: This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance.

Results: Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016-2017 and 2019-2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18-25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS.

Clinical implications: This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.

Keywords: Adult community eating disorders services; Ignoring the Alarms report; commissioning guidance; referral rates; workforce levels.

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Conflict of interest statement

None.

References

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    1. McManus SM, Meltzer H, Brugha T, Bebbington P, Jenkins R. Adult Psychiatric Morbidity in England. Results of a Household Survey. National Centre for Social Research and the Department of Health Sciences, University of Leicester, 2007.
    1. Parliamentary and Health Service Ombudsman. Ignoring the Alarms: How NHS Eating Disorder Services Are Failing Patients. PHSO, 2017.
    1. House of Commons Public Administration and Constitutional Affairs Committee. Ignoring the Alarms Follow-Up: Too Many Avoidable Deaths from Eating Disorders. House of Commons, 2019.
    1. NHS England. Access and Waiting Time Standards for Children and Young People with an Eating Disorder: Commissioning Guide. National Collaborating Centre for Mental Health, 2015 (https://www.england.nhs.uk/wp-content/uploads/2015/07/cyp-eating-disorde... [accessed 23 Aug 2022]).

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