NHS Tayside Eating Disorders Service


NHS TAYSIDE

EATING DISORDERS SERVICE
OPERATIONAL GUIDANCE
Author:
Dr Paula Collin
Consultant Clinical Psychologist and Lead Clinician
NHS Tayside Eating Disorders Service / Review Group:
Relevant Stakeholders
Review Date: August 2016 / Last Update: August 2013
Document No: 1 / Issue No: 1

UNCONTROLLED WHEN PRINTED

Signed: Executive Lead
(Authorised Signatory)
Date:

TEDS Operational Guidance Page1 of 9

15/11/2018

NHS Tayside Eating Disorders Service

CONTENTS

  1. Purpose and Scope of the Operational Guidance
  2. Service Principles and Values
  3. Service Profile
  4. Service Aims
  5. Service Objectives
  6. Policies, Procedures and Protocols
  7. Criteria for Service Provision
  8. Access to Service
  9. Managing Referrals
  10. Managing Transfer and Discharge Arrangements
  11. Links and Interfaces
  12. Involvement
  13. Quality and Clinical Governance
  14. Staff Governance
  15. References

1. Purpose and Scope of the Operational Guidance

The purpose of this document is to provide guidance about NHS Tayside Eating Disorders Service for referrers and other professionals, service users and their carers, and voluntary organisations. The guidance includes information about the service’s aims and objectives, who should be referred to the service, and what the service provides. For consultation/advice about this document, or indeed any aspect of eating disorder management, please contact the service directly ().

2. Service Principles and Values

Eating disorders are a group of conditions related to body image disturbance and abnormal eating behaviour. These include anorexia nervosa, bulimia nervosa, and atypical eating disorders. Other conditions, including anxiety, depression, obsessional and personality disorders often co-exist alongside eating disorders. Eating disorders are serious and may be enduring mental disorders. They have the highest mortality rate of any psychiatric disorder. Early identification and appropriate intervention improves the clinical outcome for many people who have an eating disorder.

NHS Tayside Eating Disorders Service was established in recognition of the NICE (2004)¹ and QIS (2006)² recommendations that most people with eating disorders should be managed by a specialist, outpatient, multidisciplinary team. The service aims to provide a high standard of eating disorder assessment and treatment, which is person-centred and which maximises the recovery potential of service users. Treatment will generally involve a number of different components of care, including psychological therapy, nutritional work, and physical health and weight monitoring. In some circumstances, additional components, such as motivational work, or interpersonal or family therapy, may become a focus of care.

3. Service Profile

Who Are We?

NHS Tayside Eating Disorders Service is based in Dundee, and provides outpatient clinics in Dundee, Angus, and Perth and Kinross. The service offers specialist assessment and treatment to adults suffering from eating disorders, having access to psychological, medical and dietetic interventions. The service also seeks to support the work of colleagues managing eating disorders at the Primary Care and Community Mental Health Team levels within NHS Tayside, through training events, consultation and advice. NHS Tayside Eating Disorders Service forms part of the North of Scotland Managed Clinical Network for Eating Disorders and has access to inpatient beds at the Eden Unit, Royal Cornhill Hospital, Aberdeen.

Current Funded Establishment

0.6 wte Consultant Clinical Psychologist/Lead Clinician

0.5 wte Consultant Psychiatrist

1.3 wte Clinical Psychologists

1.0wte Specialist Nurse

0.8 wte Specialist Dietitian

0.1wte Lead Mental Health Dietitian

1.0wte Administrator

Where Are We?

NHS Tayside Eating Disorders Service is located within premises at 4 Dudhope Terrace, Dundee. The accommodation provides facilities for administration, basic physical health assessment and monitoring, and nutritional and psychological work, and is shared with other Dundee Community Health Partnership-managed services.

4. Service Aims

NHS Tayside Eating Disorders Service aims to ensure the safe and appropriate outpatient management of people with diagnosable eating disorders. The service will also co-ordinate the admission and discharge arrangements of those requiring inpatient care for their eating disorder. Specifically, the service aims to provide:

  • A safe environment in which to manage eating disorders;
  • A broad range of expertise and therapeutic options for the management of eating disorders;
  • A detailed assessment of the physical, psychological, nutritional and social needs of the patient;
  • An individually tailored combination of physical, psychological, nutritional and social treatment for the patient;
  • Smooth transition between the service and other treatment settings;
  • Information and advice for carers, referrers and other professionals, and voluntary organisations.

5. Service Objectives

  • NHS Tayside Eating Disorders Service will function in accordance with the NHS Tayside quality standards.
  • Service users will be seen within the timescales stipulated by the NHS Tayside waiting times standards.
  • Service staff will undertake comprehensive assessment and treatment of service users, and progress will be reviewed at regular intervals.
  • Service staff will involve carers, referrers and other professionals, and voluntary organisations, in the management of people with eating disorders, as appropriate.
  • Staff will aim to promote a de-stigmatising view of mental ill-health, including disordered eating and other related problems.
  • Staff will monitor and review services provided using agreed audit tools and outcome measures.
  • Staff will continue to foster an active and effective research programme, both within the Eating Disorders Service itself and in collaboration with other relevant services.
  • Service staff will continue to provide teaching and supervision for trainees and other personnel, as required.

6. Policies, Procedures and Protocols

Staff within NHS Tayside Eating Disorders Service will adhere to local and national policies, procedures and protocols, in addition to the professional standards and ethical guidelines of their relevant regulating bodies.

7. Criteria for Service Provision

Referring Agents

As a general rule, referrals to NHS Tayside Eating Disorders Service come from GPs and other medical staff, Adult Psychological Therapies Service staff and Community Mental Health Services staff (with the GP’s knowledge). A number of cases are transitioned from Child and Adolescent Mental Health Services.

Eligible

  • NHS Tayside Eating Disorders Service is aimed at people in age range 18 (16 for those not at school) to 64 years who have a diagnosable eating disorder. Primarily, this will include the diagnosis of anorexia nervosa, bulimia nervosa, and atypical presentations (e.g., binge eating disorder), where these are identified as the most significant presenting problem.
  • Where the eating disorder is co-morbid with a mental or physical health problem for which the person is receiving ongoing treatment from another relevant service, effective joint working will be actively pursued.

Not Eligible

  • NHS Tayside Eating Disorders Service is not aimed at people whose disordered eating is acutely life threatening and who, consequently, require admission to an inpatient unit (e.g., anorexic patients with BMI </= 13 and evidence of system failure; bulimic patients with daily purging and significant electrolyte imbalance). The service will, however, co-ordinate the admission and discharge arrangements for such people.
  • The service is not aimed at people who are actively psychotic, with ongoing positive symptoms, or, indeed, people whose disordered eating is driven by a psychosis.
  • Where alcohol/substance misuse is a primary presenting problem, referral should, in the first instance, be made to NHS Tayside alcohol/substance misuse services, although joint working with other agencies will be actively encouraged.
  • Where a learning disability is a presenting problem, referral should be made to NHS Tayside Learning Disabilities Service.

8. Access to Service

NHS Tayside Eating Disorders Service operates Monday to Friday, 9am to 5pm. Referrals to the service must be in writing, and these will be discussed and, where appropriate, allocated at the weekly team meeting.

9. Managing Referrals

Most patients accepted by NHS Tayside Eating Disorders Service will be offered outpatient treatment, which will generally involve psychological therapy, nutritional work, and physical health and weight monitoring. For a small number of patients referred, inpatient care may first be necessary due to the severity/complexity of their presentation at the time of GP/service assessment. The Eating Disorders Service will arrange admission to the Eden Unit, or other specialist provider, when such treatment is required.

All patients accepted by the Eating Disorders Service will be assigned a keyworker from the multidisciplinary team. Where patients are allocated a trainee member of the team as keyworker, overall responsibility for the case will sit with the relevant clinical supervisor.

Referrers will be informed in writing as soon as a referral is actioned and/or the patient attends for initial assessment. Regular progress reports will also be provided. Referrals to the Eating Disorders Service may be prioritised according to risk/urgency.

10. Managing Transfer and Discharge Arrangements

Transfers of care between NHS Tayside Eating Disorders Service and other agencies will generally be agreed and planned with the patient, their carers, and the other service(s) involved. Relevant referrers will be notified in writing of any transfers. Similarly, referrers will be notified in writing of all discharges from the Eating Disorders Service, which, again, will generally be agreed and planned with the patient, their carers, and any other service(s) involved.

11. Links and Interfaces

NHS Tayside Eating Disorders Service seeks to support the work of colleagues managing eating disorders at the Primary Care and Community Mental Health Team levels within NHS Tayside, through training events, consultation and advice. Similarly, where an Eating Disorders Service patient has a co-morbid mental or physical health problem for which they are receiving ongoing treatment from another relevant service, effective joint working will be actively pursued.

NHS Tayside Eating Disorders Service forms part of the North of Scotland Managed Clinical Network for Eating Disorders and has access to inpatient beds at the Eden Unit, Royal Cornhill Hospital, Aberdeen. Accordingly, team members work closely with their counterparts in the NHS Grampian and NHS Highland outpatient and inpatient clinical teams.

12. Involvement

NHS Tayside Eating Disorders Service aims to provide a high standard of eating disorder assessment and treatment, which is person-centred and which maximises the recovery potential of service users. Service users are encouraged to be actively involved in decision-making where their management is concerned, as, where consent is given, are their carers.

13. Quality and Clinical Governance

NHS Tayside Eating Disorders Service is committed to providing a high quality clinical service, and quality will continue to be monitored by means of clinical audit and evaluation. The service will comply with relevant local and national clinical guidelines/targets, such as QIS guidelines and HEAT targets.

14. Staff Governance

All members of the NHS Tayside Eating Disorders Service team are supervised regularly and are subject to annual appraisal. They are also required to participate in Continuing Professional Development (CPD) activities. Supervision, appraisal and CPD requirements are set by the relevant regulating bodies of the team members. Service staff engage in regular, in-house training, and contribute to teaching on eating disorders locally and nationally. All team members are encouraged and supported to participate in research activities.

15. References

  1. Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. National Institute for Clinical Excellence (NICE), 2004.
  2. Eating Disorders in Scotland: Recommendations for Management and Treatment. Quality Improvement Scotland (QIS), 2006.

TEDS Operational Guidance Page1 of 9

15/11/2018