Understanding the new NICE quality standards for eating disorders treatment

Introduction

It is recognised that there is wide variation in eating disorders services, both in terms of who is treated and the treatment itself. In many cases, services have developed their own models using different approaches and although they may originally have been a clear rationale for doing things in a particular way, it is hard to compare and measure what works best and what may not be working. From a patient and parent point of view, it is difficult to know what the standards for eating disorders treatment might be and therefore to know what to expect and what a good service looks like.

Recognising these issues, NICE (National Institute for Health and Care Excellence) has developed new quality standards that will apply to all assessments and services for children, young people and adults with an eating disorder. The NICE guidelines are not yet finalised; they are currently being considered by all eating disorders services in a consultation, which will be completed in April (2018).

From a Newbridge House perspective, they are very welcome: providing a clear, single framework for standards of eating disorders treatment. Critically, for people seeking help for eating disorders, the quality standards provide a set of measures to expect: assessment and treatment at the earliest opportunity, a discussion about their options in terms of psychological treatments for eating disorders.

We particularly welcome the recognition that if people have early intervention, their chances of making a full and lasting recovery are greatest. We also welcome the way the NICE guidelines focus on the fact that one individual may have support from more than one eating disorders services; for example, our patients move from community to inpatient then back to community services and often, depending on age, from child and adolescent services to adult. The standards recognise these transitions are a challenge which needs to be carefully planned and managed.

What are the NICE eating disorders quality standards?

The NICE quality standard is comprised of these six statements:

Statement 1: People with suspected eating disorders referred to an eating disorder service should start assessment and treatment at the earliest opportunity.

Statement 2: People with eating disorders have a discussion with a healthcare professional about their options for psychological treatment.

Statement 3: People with binge eating disorder participate in a guided self-help programme as first-line psychological treatment.

Statement 4: Children and young people with bulimia nervosa are offered bulimia nervosa-focused family therapy (FT-BN).

Statement 5: People with an eating disorder who are being supported by more than one service have a care plan that explains how the services will work together.

Statement 6: People with an eating disorder who are moving between services have their risks assessed

The principle behind the first statement is very important for people seeking help for eating disorders. Research by the national charity Beat found on average, there are three years between the first signs of an eating disorder appearing and people seeking and actually obtaining treatment. Yet we know, from the evidence, that a close association between early treatment and full recovery.

It is good to see the NICE guidelines set out the psychological treatments for eating disorders specific to each condition: guided self-help is established as the first line treatment for people with binge eating disorders and children and adolescents with bulimia nervosa should be given bulimia nervosa-focused family therapy (FT-BN). As a provider of eating disorders services for children and adolescents with anorexia requiring inpatient treatment, there is much complexity and no single psychological treatment will be sufficient alone. A broad ranging resource of interventions are needed to address the multiple causes of the disorder and we recognise the NICE guidelines for anorexia (2) stating individuals need to have a discussion with a health professional to explain their options for treatment, with choice if it is appropriate and in the best interest of the patient.

How does Newbridge comply with the NICE quality standards?

As a specialist inpatient service (young people are admitted to stay at Newbridge House for 24/7 treatment and care), we are not normally the first service people contact if they are worried their child may be showing signs of an eating disorder. Typically, when someone needs help for eating disorders, they see their GP or a school nurse first. This professional would then refer the young person to CAMHS (child and adolescent mental health services) to carry out a full assessment. There can be delays in these two processes for many different reasons and the NICE quality standards are a welcome focus on ensuring treatment commences at the earliest opportunity.

The assessments we undertake are to judge whether a child or young person needs inpatient treatment. They normally have a diagnosis (of anorexia) and are under the care of a community team; our assessment is whether they are responding to community based treatment or whether we need to ‘step up’ their treatment in an inpatient eating disorder service. We are asked to do these assessments by NHS commissioning teams (specialists in managing care and resources) and we always carry out our assessments within 48 hours of a request, usually earlier.

We put a great emphasis upon discussing the psychological treatments with our patients. Any individual being treated in an eating disorders services needs to have an understanding of how they are being treated and why; this is essential if they are going to engage with services and achieve change. Our patients can be as young as eight years old, so we have to ensure our treatments are age appropriate and explained fully. We have adapted a number of treatments for younger patients (for example the LEAP programme from Loughborough to address over-exercising). Choice can be offered, if it is appropriate and in the patient’s best interest. For example, our one-to-one therapy encompasses both CBT (cognitive behavioral therapy) and psychodynamic therapy based approaches.

The quality standards five and six are ones we recognise and whole-heartedly support; there is always a transition between services for all our patients. They will normally come from community based eating disorders services and in every instance, will be discharged to community services. Poor transition carries a risk of relapse and must be carefully planned and delivered. Community teams are invited to and usually attend our CPA (care plan approaches) every four to six weeks, so transition is planned for and considered throughout treatment, not just in the period close to discharge.