Eating Disorders the contribution of the NPHS Model of Care to service change

1. Eating Disorders the contribution of the NPHS Model of Care to service change Finding and using new routes through the maze! Peter Boyle, Public Health Specialist Peter.Boyle@nphs.wales.nhs.uk

2. Scope of session • Background • Model of Care 2006 • Role & impact of Cross Party Group • Ministerial involvement • Current situation • Implications for future Public Health activities

3. Characteristics of 2006 Model • Published as a discussion document for the Welsh Assembly Government and Local Health Boards to consider • The model aims to increase access to early intervention provided by local services: • reduce the time spent in inpatient care or other residential admissions, • decrease the likelihood of relapse after inpatient treatment and • improve the overall quality of services. • The model also reinforces the roles of primary care teams, generic psychiatric and physical health services, all working in partnership to identify, assess, treat and monitor people who have an eating disorder. • Intended to be phase 1 only

4. Impact of 2006 Model • Service planning within Trusts • Use in Business planning • Evidence of action by Assembly

5. Role & impact of Cross Party Group • Terms of reference, February 2008 • Intended work programme • Examples of Cross Party Group action

6. Cross Party Group –extracts from Terms of Reference • Setting up comprehensive data base of all services currently available throughout Wales to enable the Committee to look at this issue in a holistic manner. • Initiation of a cross cutting survey to quantify the reality of the ED problem in Wales. • GP/health professional: Awareness raising for improved diagnosis, this is a real problem throughout UK. • Initiate a questionnaire for GPs to enquire about the current provision from GPs and their knowledge of EDs. • An agreed care pathway, so that once people have been diagnosed they can access treatment/support at a level appropriate to their need. • A residential service that complies with NICE guidelines for the treatment of EDs.

7. Perception from outside Wales • Whereas there has been a lack of action—or insufficient action—on the issue in Scotland, the Welsh Assembly has taken dramatic and decisive action to combat eating disorders. It established a cross-party committee on the issue to compile a comprehensive analysis of eating disorders in Wales, including recommendations from the NHS in Wales on provision and support for patients and their families. • The committee has managed to raise awareness of eating disorders across Wales and has called for proactive campaigns that specifically target young women in schools and universities. It has also promoted the need for increased training in the health sector to equip front-line staff with the skills to identify and to deal effectively and efficiently with patients suffering from eating disorders. Scottish Parliament debate 6Mar08

8. Examples of Cross Party Group action • “Now that I have touched upon eating disorders, I note that we do not get to this subject until point 75 under specialist treatment services. My concern—I have written to you about this—is that there is no national care pathway at the moment with regard to eating disorders that is fully implemented by the Welsh Assembly Government. Therefore, there will not be equal consideration for eating disorders when we are discussing mental health capacity.” Bethan Jenkins, AM during debate on IMC • Letter to all LHBs asking for details of current services. • Correspondence with Universities re training. • Direct comment on (and during!) debates on Williams Report (IMC) and Aylward Report. • Securing meeting with Minister to raise concerns.

9. Notes ..meeting between Minister for Health & Social Services and the Cross Party group on eating disorders held 15th July 2008 in the Senedd. • Minister agreed that the document produced by the NPHS in 2006 entitled “Eating disorders care pathway/model of care” should be reviewed and updated. This review should take account of a) Ministerial announcement in respect of NHS structures b) co-morbidity with other conditions (depression, personality disorder, substance misuse etc) c) medical stabilisation and re-feeding d) any best practice issued since 2006. Action Peter Boyle to work with WAG officials to update document by mid September 2008. • The Minister said that once she is content with the updated document she would send it out to NHS bodies and require plans and implementation costs from them. • The need for training in respect of eating disorders was discussed. Additional training was needed both pre and post registration for health professionals, as well as for other disciplines e.g. school counsellors, staff dealing with looked after children etc. Action Officials to consider training needs in respect of eating disorders in advance of further discussion with cross party group in October 2008.

10. Current situation • 2008 Framework - differences compared to 2006 Model • Implications of funding announcement of £1.5m for eating disorders, 15 Oct 2008. • Current work programme for Cross Party Group and implications for NPHS. • Impact of changes across NHS in Wales.

11. Implications for future Public Health activities • Shift from ‘evidence’ to ‘influence’ • Implications for Advocacy role. • Role of Standards and evaluation. • Monitoring within new NHS. • …..and any others?