GM Devolution: CAMHS Revolution – Eating

Disorders Leading the Way

Dr Sandeep Ranote – NHSE Strategic Clinical Network Lead - CAMHS:

http://www.bbc.co.uk/news/health-35576774

IN THE SPOTLIGHT

WHY, HOW & WHEN? • 1 in 150 female YP – anorexia nervosa (AN)

• 1 in 25 female in lifetime – bulimia nervosa (BN)

• 90% female

• 1.6 million UK people directly affected – BEAT 2007

• High rates of co-morbidity

• AN highest mortality of any psychiatric disorder

• Geographical variations in service provision still high

• Total annual UK cost £1.2 bn - £9.6 bn – BEAT review 2012 & 2014

• Carer burden high and underestimated

• CAMHS use of tier 4 admission for ED high > 35%

• Often due to poor/no specialist community or ‘mini team’ provision

WHY, HOW & WHEN?

• Wigan pilot (> 200 families) demonstrates need

• > 90% families treated rated service 4/5 out of 5

• > 90% families would recommend service (F & F

test)

• > 85% improved outcomes

• 10-12% admission rate to Tier 4

• Increase in admissions seen in 2013 with

national picture

WHY, HOW & WHEN? • Evidence base supports CAEDS – community adolescent eating

disorder service

• MDT integrated model recommended

• Partnership working

• Critical window for intervention 3-5 years

• Clear transition pathway

• Multimodal therapeutic package of care, person centred, evidence

based, National clinical outcome measures (DATA!)

• EARLY INTERVENTION KEY

• Shared decision making

• Experts by experience continue on development group

• Recovery Model

ASPIRATIONS

• Education and training in primary care and schools

• Junior MARSIPAN in reach to paediatric ward / Junior

MARSIPAN hub

• Day unit

• 2 specialist beds – Fairhaven

• 0-25 or ageless service

• Peer Mentoring

• Parent Support Groups led by parents

WHAT NOW?

• £30m recurrent funding – Autumn budget 2014

• £150m in total over 5 years

• Transformation of services in England for children and

young people with eating disorders up to 18 years old

• Development of CAEDS

• Population minimum for service – 500k (all ages)

• Access and waiting time standards guide – July 2015

Wigan Borough Pathway

Wigan Borough ED CQUIN

Tier 4 Specialist Eating Disorder Unit

Proposed CAEDS Pathway

CAEDS

SCHOOLS LINK

WORKER

CAEDS

PRIMARY

CARE LINK

WORKER

TIER 4 ED

UNITS

NON

5BP

5BP CAMHS

General

Community

CAMHS Urgent

Response Team Fairhaven

5 YEAR PLAN

DEVELOP 2

SPECIALISED BEDS &

DAY SERVICE

SCHOOLS

LA

THIRD SECTOR

COLLABORATION

HALTON CAEDS SPOKES

SPECIALIST MDT

WIGAN / BOLTON

GM DEVO

WARRINGTON

ST HELENS

KNOWSLEY

PAEDS

PSYCHIATRY

CYP IAPT

FAMILY THERAPY

CASE COORDINATION

CBT

MOTIVATIONAL THERAPY

DIETETICS

OTHER EVIDENCE BASED

THERAPIES

THE HOUSE OF CAEDS

WWL

PAEDS

HUB

GM DEVO

CLUSTERS

WHISTON

PAEDS

HUB

Numbers / Figures Data from JSNA 2013 –Local Authority

Wigan – Total Population = 319,690

5-19 Population = 55,438

ED Team

Warrington Total Population = 205,109

5- 19 Population = 36,221

Halton Total Population = 125,970

5-19 Population = 22,932

Knowsley Total Population = 146,086

5-19 population = 26,907

St Helens Total Population = 176,221

5-19 Population = 29,714

Total pop. = 653,386

5-19 pop. = 115,774

50 + cases open 30-40 new refer

per annum

Community Eating Disorder Service

Number of referrals per annum 150 100 50

Whole time equivalents

Head of service (psychiatry/psychology) 1.9 1.3 0.6

Clinical psychologists 2.8 1.9 0.9

Eating disorder therapists (SFT-ED/MSFP-ED/CBT-ED) 4.9 3.3 1.7

Nursing staff (nursing/home treatment) 2.2 1.5 0.8

Speciality doctors (psychiatry) 1.2 0.8 0.4

Assistant psychologists (SFP-ED/ MSFP-ED/CBT-ED support) 2.7 1.8 0.9

Paediatricians (physical health) 1.9 1.3 0.6

Dieticians 1.9 1.3 0.6

Administrative staff 2.0 1.4 0.7

• Population-based: minimum 500K (all ages) so may span more than one CCG • Referrals for anorexia nervosa, bulimia nervosa, binge eating disorders and co-existing

problems (e.g. anxiety and depression) • Min of 50 referrals per year • Enable direct access to community eating disorder treatment via self-referral, GPs,

schools, colleges and voluntary sector

Table 5: Whole time equivalent staff broken down by profession

Workforce Opportunities

• Systemic Family Practice training through CYP-IAPT service transformation.

• Specialist Supervisor training

• Support training opportunities

• Partnership working – increased school based / primary care liaison

• Become lead provider

GM DEVO

• Strategic priority

• 3 Clusters

Pennine

Salford/Central

Wigan/Bolton

• Networked approach

• Workforce training

• Sharing and learning

• Best practice models

• GM standards

• Future development