The alarms should no longer be ignored: A Survey of the Demand, Capacity and Provision of Adult Community Eating Disorder Services in England and Scotland before COVID-19

Abstract

This national survey compared the demand and capacity of adult community eating disorder services (ACEDS) to NHSE Commissioning guidance. Results: Of 21 services approached in England and Scotland 13 responded (10.7 million total population). Between 2016/17 and 2019/20, the average referral rate increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), yet 46% of referrals were 18-25 years old. Most ACEDS had waiting lists and rationed access. Less than half of services were able to provide full medical monitoring, adapt treatment for co-morbidities, provide seamless transitions across the care pathway, or offer assertive outreach. ACEDS were 15% funded to meet demand, and to achieve parity with the CEDS-CYP would require an estimated £7 million in funding per million population. Clinical Implications: Even before the pandemic, ACEDS experienced a growing demand that exceeded its capacity. Given the increase in eating disorders since, substantial investment is required for ensuring safe and effective NHS services.