EATING DISORDERS C A M H S C O M M I S S I O N I N G E V E N T 1 6 J U N E 2015
WHO ARE WE? Andy Roberts National Service and Commissioning Advisor, NCCMH Rachel Bryant-Waugh National Clinical Advisor, NCCMH Consultant Clinical Psychologist and Joint Head of Feeding and Eating Disorders Service, GOSH National Collaborating Centre for Mental Heath Eating Disorders Guidance: Access and Waiting Times
CONTEXT An early focus of the Children and Young People s Mental Health Transformation Programme announced as: Developing evidence based community Eating Disorder Services for children and young people NHS England commissioned the NCCMH to: develop guidelines on access and waiting times guide commissioners in the design and delivery of ED services AR and RBW part of Technical Team
OVERVIEW Eating disorders and their impact Current service organization and delivery Challenges to delivering optimal care Guidance for commissioners Standards Quality assurance Transformation
EATING DISORDERS Anorexia nervosa Extreme restriction of food intake; low weight; fear of weight gain; possible vomiting, laxative misuse, excessive exercise Bulimia nervosa Regular binge eating with compensatory behaviours vomiting, laxative misuse, restricted intake, medication misuse Binge eating disorder Regular binge eating in the absence of compensatory behaviours - accompanied by shame and distress The largest group Atypical eating disorders Do not meet full diagnostic criteria for AN or BN, or may be ARFID (avoidant/restrictive food intake disorder)
THE IMPACT OF EATING DISORDERS Burden on families Relationship difficulties Isolation Peer problems Missed school Exam difficulties Anxiety social emotional physical educational family Growth delay, malnutrition, Cardiac problems Low mood Mistrust Eating disorders can have a fatal outcome
CURRENT SERVICE ORGANIZATION AND DELIVERY GP monitoring, primary care interventions and onward referral Generic CAMHS and CAMHS ED mini-teams Specialist out-patient ED services some with day and/or home treatment options In-patient care in generic child and adolescent units or is specialist ED units (often private sector) In-patient admission to paediatric wards as needed
CHALLENGES TO DELIVERING OPTIMAL CARE Eating disorders myths and stigma Barriers to identification, early intervention and engagement Inadequate liaison between healthcare providers and with local authorities and education Transition difficulties between services and geographical variability in distribution of services Commissioning for severity
GUIDANCE FOR COMMISSIONERS Background No decision about me without me Delivering with Delivering Well The Child and Adolescent Mental Health (CAMH) service Tier 4 review Tiered model/thrive model of service/need Planned introduction of a minimum data set for MHLD NHS England guidance to commissioners (dated 26 th May 2015) The Five Year Forward View Future in Mind Achieving Better Access to Mental Health Services by 2020
GUIDANCE FOR COMMISSIONERS The Autumn Statement, 2014 announced additional funds of 30 million per year to transform services in England for the treatment of children and young people with eating disorders up to the age of 18. These funds have been confirmed as recurrent, allowing CCGs and providers to plan services with confidence Young people, parents and carers need to be involved at every stage of the commissioning process to ensure services are developed that meet their needs
GUIDANCE FOR COMMISSIONERS Needs Assessment Incidence (per 500,000 all age population?) Current service provision (including Paediatric care) Service Design Supporting severely ill and developing preventative work Balanced service across a range of needs All eating disorder services for children and young people are able to meet the Access and Waiting Time Standards All children and young people with an eating disorder are able to access NICE-concordant treatment, at every stage of the care pathway Links to Paediatrics Incidence will dictate the optimum size of the team and therefore the area they will serve and how they are configured
STANDARDS Standards need to support the development of services that provide swift access to evidence based care, provided by appropriately trained and qualified clinicians with multi-disciplinary representation Have to improve accessibility by encouraging all children, young people and carers to understand eating disorders and seek help at the earliest opportunity All professionals working with children and young people also need to understand eating disorders and what to do
QUALITY ASSURANCE Use of measures as part of the treatment process is vital MHLDDS A Quality Network for eating disorder providers will produce transparent, accessible data and benchmarking, which will allow them to assess and increase the quality of care they provide Quality Improvement/Accreditation Networks successful delivery of NICE-concordant treatment within the Access and Waiting Time Standards provision and take-up of education and training across the care pathway the routine collection of and response to outcome data
TRANSFORMATION Led by the views of children, young people, parents and carers Transformation not a transactional change Staff recruitment Workforce development Outcomes focussed
COMMISSIONING FOR EATING DISORDERS To improve outcomes for children and young people with eating disorders we need a comprehensive response to the full range of needs, which will require collaborative commissioning from NHS England, CCG s, Local Authorities and Education