Our services went live earlier this year and provide Children and young People 08-19 (08-18 Wigan and Bolton) with an eating disorder Service which is fully integrated within a Community CAMHS offer.The Mid Mersey and Wigan and Bolton CYP CEDS are multidisciplinary, including specialist nurses, GP, clinical psychologists and dietician. The team offers supported eating, psychological therapy and management of physical health issues associated with eating disorders. Interventions provided will include; Assessment; Care Planning and physical monitoring; Therapy 1:1 and groups; dietetics 1:1 and systemic family therapy.
Co-Production
From start: Yes
During process: Yes
In evaluation: No
Evaluation
Peer: No
Academic: No
PP Collaborative: Yes
Find out more
Michelle Watson and Simon Postlethwaite - NWBH Wigan & Bolton Community Eating Disorder Service Service Manager
Our services went live earlier this year and provide Children and young People 08-19 (08-18 Wigan and Bolton) with an eating disorder Service which is fully integrated within a Community CAMHS offer.The Mid Mersey and Wigan and Bolton CYP CEDS are multidisciplinary, including specialist nurses, GP, clinical psychologists and dietician. The team offers supported eating, psychological therapy and management of physical health issues associated with eating disorders. Interventions provided will include; Assessment; Care Planning and physical monitoring; Therapy 1:1 and groups; dietetics 1:1 and systemic family therapy.
The services aim to help young people with anorexia nervosa, bulimia nervosa or atypical variations of these disorders, to recover fully in the community. Eating disorders, such as anorexia nervosa and bulimia nervosa, are mental health conditions that rarely get better on their own, so the sooner someone can get help, the more likely they are to make a full recover. Eating disorders are complex and recovery can be slow and sometimes feel near impossible for the children, young people and families living with one. We have supported many CYP on their journey through to recovery and examples of how we have supported children and young people within our services can be found in the inspirational and truly kind words given to the teams from the children, parents and families themselves;
“thank you doesn’t seem enough for what you have done…you have saved our daughters life.”
” you were the one that first found a way in , through the anorexia….we will never forget what you have done and be forever grateful.”
Wider Active Support
Our partnership with BEAT brings a collaboration of two organisations to provide easier access to appropriate services when needed. BEAT provides a range of innovative preventative and information interventions, at Primary Care level, to complement the wider service focusing on raising awareness of what is an Eating Disorder and how it manifests, what are the signs and symptoms and where those who recognise these symptoms can receive direct support and advice. This is complemented by information on the BEAT website and the development of a professional’s helpline. Our partnership with BEAT brings immeasurable benefits within the digital arena.
BEAT’s website provides a vast information resource to CYP, families/professionals, and access to BEAT’s helpline for CYP/ families across the 4 Boroughs to gain initial support and signposting is directly linked into our CYP CEDS Working with CYP/families who access the service as well as professionals and our partners at BEAT we are considering opportunities to develop new augmented reality technology approaches to improve availability and accessibility of information on eating disorders for CYP and professionals.
Co-Production
Working in co-production with the CYP, families and carers who use are services is essential ion creating a positive experience for the CYP living with an eating disorder. We talk to our service users at great length; they even decided on the name of the building where Wigan & Bolton CAMHS are based! (Helping Hands Centre) We could not do what we do without the support and feedback from our CYP and families. They help us to:
Inspire great ideas – involving CYP, families and carers can help with the creative process. It can also be enjoyable working as part of a team. it can add another dimension – ‘expert by experience’ might complement your work.
Share their experiences – working with people who have previously taken part in engagement activities can help guide through unfamiliar processes and also assist with our own professional development.
Provide essential insights – service users may have expertise in a host of relevant things such as understanding the needs of your target audience, timings and logistics, and suggestions of others you could work with. Strengthen relationships – working with our CYP and families can deepen and strengthen our relationships thus supporting collaborative working alliances.
Looking Back/Challenges Faced
One of the main challenges felt by both the Wigan & Bolton and Mid Mersey specialised eating disorder services was the number of referrals we had in the first quarter. This put a strain on the services within the first 3 months, however the team’s worked exceptionally hard at making the service seamless for the CYP and families. Looking back, we had not anticipated the high levels of referrals that would come through to our new service, and although the rate at which referrals are coming in is now at a more steady pace, we are nearing the amount that we thought we would see in 12 months within the first 2 months of the services going live! Further discussions are needed with the CCG’s regarding staffing levels for the future if this trend is to continue.
Sustainability
NWBH is very lucky in the fact that Dr Sandeep Ranote supports the specialised eating disorder services in both Wigan & Bolton and Mid Mersey and wants the services to be successful, quality driven, accessible and to demonstrate longevity. The services have staff that are both committed and passionate about the CYP and families that use our services. The vision is to develop high quality, innovative, specialist ED models, which focus on early intervention and prevention, whole system, integrated and multi-agency working and which are outcome focused. Service models should encompass the ED provision already available within local core CAMHS services and should support and enhance this local provision ensuring coordinated and seamless care.
Aims
• To deliver a personalised therapeutic assessment and intervention service to CYP whose needs are indicative of, or identified as requiring ED care.
• Improve the emotional wellbeing and mental health of CYP through identification of ED risk factors, prevention and early intervention.
• To provide support and to intervene to prevent escalation of need for CYP through high quality, evidenced based, accessible, convenient and safe ED services, delivered with kindness, compassion and patience.
• To work collaboratively with a range of stakeholders to broaden the approach taken to tackle the wider social determinants and consequences of ED problems.
• To support CYP to achieve their outcome goals.
NWBH is very lucky in the fact that Dr Sandeep Ranote supports the specialised eating disorder services in both Wigan & Bolton and Mid Mersey and wants the services to be successful, quality driven, accessible and to demonstrate longevity. The services have staff that are both committed and passionate about the CYP and families that use our services. The vision is to develop high quality, innovative, specialist ED models, which focus on early intervention and prevention, whole system, integrated and multi-agency working and which are outcome focused. Service models should encompass the ED provision already available within local core CAMHS services and should support and enhance this local provision ensuring coordinated and seamless care.
• To support CYP to achieve their outcome goals.
Evaluation (Peer or Academic)
The Eating Disorder services for Wigan & Bolton and Mid Mersey are still in their infancy, only going live in April of this year. We evaluate our services with PEQ’s (Patient experience Questionnaires) and continuously talk to the CYP, parents, carers and families about how they feel regarding the service and its effectiveness. We are evaluated from a data collection perspective through the CCG’s and this is done quarterly to ensure we are working within the Access to Waiting Times standards and that NICE concordant treatments are offered to CYP when attending appointments. We will be in a better position for a full evaluation after 12 months of continuous service.
Outcomes
Treatment for a Anorexia Nervosa often includes inpatient, residential, or day programmes. However, studies of the effectiveness of such treatment programmes for AN are limited. The available data suggest that hospital treatment for teenage AN is not more effective on average than outpatient treatment. Eating Disorders are known to give one of the highest morbidity rates and often result in high cost patient admissions when identified late in primary care. Data from the Health and Social Care Information Centre (HSCIC) shows (February 2015 to January 2016) a total of 2,703 finished admission episodes (FAEs) for an ED. This is an 8% decrease from 2,951 for the previous 12 months. In the same time period, total FAEs for all conditions increased by 2%. Of these:
• 2,060 (76%) anorexia, 136 (5%) bulimia and 507 (19%) other ED.
• 2,454 (91%) female and 247 (9%) male. Similar proportions are shown on the previous 12 months: 2,717 (92%) and 234 (8%) respectively.
• The most common age for a patient being admitted to hospital for an ED was 15 years old for both females (308) and males (29).
• ED admissions (where length of stay in hospital is known), 415 (19%) were admitted and discharged on the same day, 1,461 (66%) spent between one day and 3 months in hospital, 243 (11%) spent between 3-6 months in hospital, while 105 (5%) spent six months or longer as an inpatient.
• ED admissions had longer hospital stays (mean = 39 days) compared to admissions overall (mean = 2 days).
The evidence also suggests that young people seen in a generic community based CAMH service have a higher rate of inpatient admission than young people seen in a specialist dedicated ED service. Eating Disorders have a high cost to individuals and their families/carers in terms of emotional impact, disruption to education and employment and in their access to physical and emotional wellbeing and mental health services through their life span. Our specialised and dedicated Eating Disorder services for Wigan & Bolton and Mid Mersey within the community, reduce the need for long periods of hospital stays for CYP and support the families with structured care plans for when a CYP leaves hospital. We also hope to reduce hospital admissions for CYP with an eating disorder. CYP CEDS also support the CYP while in hospital and uses as whole team approach within the multi-disciplinary team.
Sharing
The North West Boroughs Healthcare Foundation Trusts Community Eating Disorder services (Wigan & Bolton and Mid-Mersey) attend regular ED networking meeting where we are able to share knowledge and best practice with other eating disorder services from across the North West.
The added value of NWBH also providing Wigan-Bolton CYP CEDS, is to enable specialist eating disorders services’ cross-cover arrangements for high quality patient care. Also high quality strategic and clinical supervision to Mid Mersey and Wigan-Bolton CEDS through Dr Sandeep Ranote, who continues as NWBH clinical lead for eating disorders strengthened by her role as NHS England clinical networks CAMHS lead, GM devolution CEDS lead and her role as national CEDS expert reference group member developing AWT guidance, QNCC standards and national workforce curriculum.
Is there any other information you would like to add?
Just that I am very proud of what the eating disorder teams have achieved in such a small amount of time; well done!!
