Introduction

NHS England is updating the Adult Eating Disorder Inpatient Service Specification to
address the gaps and challenges in the current system for those with severe and complex eating disorders. The previous service specification, developed almost a decade ago, has become outdated and fails to reflect current best practices or the broader understanding of eating disorders.

Specialist Adult Eating Disorder services are commissioned by NHS England for adults
ordinarily resident in England or otherwise under the commissioning responsibility of NHS England (as defined in the Manual of Prescribed Specialised Services).

These services are crucial for addressing the complex needs of patients with serious
eating disorders, such as anorexia nervosa, bulimia nervosa, binge eating disorder, and
avoidant/restrictive food intake disorder (ARFID).

These conditions are characterised by dangerous disturbances in eating behaviour,
leading to severe malnutrition, physical health complications, and high psychiatric
comorbidity, often requiring intensive, multidisciplinary treatment approaches.

The updated service specification aims to provide modern, evidence-based care that
meets the diverse needs of adults with eating disorders, including addressing comorbid
mental health conditions such as autism spectrum disorder and anxiety. The revision also reflects the shift towards integrated community care, as outlined in the NHS Long Term Plan.

Current service provision

Currently, services for adults with eating disorders are fragmented and often fail to provide the seamless care that patients need across different treatment settings. The service scope is heavily focused on inpatient and day-patient treatment, and there is limited provision for intensive community care.

Key challenges in the existing service model include:

1. Over-reliance on inpatient treatment Many patients are admitted to inpatient
services, though this is not always the most appropriate or effective care model.

2. Limited access to specialist care: Services are not equitably distributed, meaning
that some regions have limited access to high-quality specialist care.

3. Poor transition between services: Patients transitioning between inpatient,
outpatient, and community services often face delays or disruptions in their care.

Proposed changes to the service specification

The new specification proposes several key changes aimed at improving the quality and
consistency of care for adults with eating disorders

• broadened scope of services: the new specification introduces intensive
  community-based interventions alongside inpatient and day-patient care, creating a more continuous and integrated pathway of care for patients
• addressing comorbidities: the revised specification explicitly acknowledges the
  importance of treating co-occurring conditions such as autism spectrum disorder and personality disorders, with a focus on personalised, multidisciplinary care
• inclusion of new diagnostic categories: the service specification includes conditions such as avoidant/restrictive food intake disorder (ARFID) and binge eating disorder (BED), ensuring that these patient groups are better recognised and treated within the system

Focus on personalised and inclusive care

The revised service model introduces a multidisciplinary approach, ensuring that a team of healthcare professionals – including psychiatrists, psychologists, and dietitians – collaborates to provide holistic, tailored care.

Special attention is given to addressing the needs of neurodivergent individuals, particularly those with autism spectrum disorders, to ensure their treatment experience is appropriate and effective.

The specification also highlights the need for services to be culturally competent and inclusive, providing equitable care for ethnic minorities, transgender individuals, and other underserved populations.

Commissioning and operational leadership

The specialist eating disorder service for adults is nationally commissioned by NHS
England at an annual cost of approximately £86 million. Currently, the services are
operationally led by 14 NHS-Led Provider Collaboratives, which oversee the day-to-day
running of services and ensure consistency across the country.

However, from 1st April 2025, the NHS Integrated Care Boards (ICBs) will assume full
commissioning responsibility for specialist adult eating disorder services, marking a
significant shift towards localised commissioning and service delivery.

This transition is part of a broader effort to integrate specialised mental health services into NHS-led Provider Collaboratives and ICBs, aligning with the goals set out in the NHS Long Term Plan.

What is NHS England asking you to do?

NHS England is seeking your feedback on the proposed updates to the Adult Eating
Disorder Inpatient Service Specification. Your input is essential to ensuring that the final
specification reflects the needs of patients, carers, healthcare professionals, and service providers. We invite you to:

• review the proposed changes outlined in this guide
• consider how the changes may affect the quality of care, accessibility, and patient outcomes
• provide detailed feedback on the proposed specification and any areas that may
  require further refinement

The consultation survey can be completed online, and all responses must be submitted by 19 November 2024.

1. visit the consultation webpage.
2. fill in the required information, including details such as your role, organisation, and region
3. answer the consultation questions (see below)
4. submit your feedback

You must declare any conflicts of interest, including whether you or your organisation have received funding from companies related to the provision of eating disorder services.

Consultation questions

These questions are designed to gather your feedback on the proposed service changes:

1. What is your role in relation to Adult Eating Disorder services (e.g. patient,
   healthcare provider, carer, advocate)?
2. Do you support the integration of inpatient, day-patient, and community services as
   outlined in the proposed specification?
3. How do you think the inclusion of ARFID and BED in the service scope will impact
   care?
4. What do you think are the key benefits of introducing a more personalised,
   multidisciplinary care approach?
5. How do you believe the transition to NHS Integrated Care Boards in 2025 will
   impact the delivery of these services?
6. Please declare any financial or other conflicts of interest.