GM Devolution: CAMHS Revolution – Eating Disorders Leading the Way

Dr Sandeep Ranote – NHSE Strategic Clinical Network Lead - CAMHS

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 CEDS-CYP – community adolescent eating disorder service as most cost effective

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 – delay increases long term health costs

Shared decision making

Experts by experience to co-develop pathways

Recovery Model

More studies underway

ASPIRATIONS

Education and training in primary care and schools

Junior MARSIPAN in reach to paediatric ward / Junior

MARSIPAN hub

Day unit

Tier 4 provision

0-25 or ageless service

Peer Mentoring

Parent Support Groups led by parents

Primary care / schools link

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 CEDS-CYP

Population minimum for service – 500k (all ages)

Access and waiting time standards guide – July 2015

National whole team training curriculum – 2016

QNCC CEDS-CYP Standards - 2016

WHAT NOW?

Wigan Borough ED CQUIN

Tier 4 Specialist Eating Disorder Unit

Proposed CEDS-CYP Pathway

CEDS SCHOOLS

LINK WORKER

CEDS

PRIMARY

CARE LINK

WORKER

TIER 4 ED

UNITS

NON

5BP

5BP CAMHS

General

Community

CAMHS Urgent

Response TeamFairhaven

5 YEAR PLAN

DEVELOP 2

SPECIALISED BEDS &

DAY SERVICE

SCHOOLS

LA

THIRD SECTOR

COLLABORATION

HALTONCEDS 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 CEDS

WWL

PAEDS

HUB

GM DEVO

CLUSTERS

WHISTON

PAEDS

HUB

Community Eating Disorder Service

• 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 sectorTable 5: Whole time equivalent staff broken down by profession

Number of referrals per annum

Head of service (psychiatry/psychology)

Clinical psychologists

Eating disorder therapists (SFT-ED/MSFP-ED/CBT-ED)

Nursing staff (nursing/home treatment)

Speciality doctors (psychiatry)

Assistant psychologists (SFP-ED/ MSFP-ED/CBT-ED support)

Paediatricians (physical health)

Dieticians

Administrative staff

GM DEVO

• Strategic priority

• 3 Clusters

Pennine

Salford/Central

Wigan/Bolton

• Networked approach

GM DEVO

• GM ED Network

• Workforce training (National

Programme - NHSE)

• Sharing and learning

• Best practice models

• GM standards & public

awareness

• Shared digital solutions

• Future development

• Single site / 2 site Tier 4 “GM

beds 4 GM kids”

• Single site / 2 site day

provision

GM DEVO

• Shared VCS / University work

• School / primary care work

• Thrive

• Minded 4 MCR

• KPIs

• Crisis

• Service specification

ILLNESS IMAGERY

“BITCH”

“IT”

CLINICAL LEADERSHIP

Collective leadership

Creative talent mapping

Clinical voice and drive

Clinical quality

Clinical conduit

GM DEVOLUTION: HEALTHCARE

REVOLUTION

Children & Young People

A third of our population BUT all

Of our future

@GMLSC_SCNs

#time4CAMHS2Bseen&heard