Mental Health Eating Disorders WorkshopSummary notes of the Eating Disorder Workshop held on 7th July 2015 at 1.00pm at Meeting Room L, The Innovation Centre, St Cross Business Park, Newport

Present/ Apologies

Present,Sue Lightfoot, Head of Commissioning, IOW CCGJohn Doherty, Head of MH, LD and Community Partnerships, IOW NHS Trust Beverley Fryer, Quality and Safety Lead, IOW NHS TrustDr Umama Khan, Consultant, IOW NHS TrustDr Bowers Alexis, Consultant Psychiatrist, IOW NHS TrustDr Judith Moore, GP Service Lead, IOW NHS TrustSarah Todd, Dietician, IOW NHS TrustDavid Sellers , Modern Matron, IOW NHS TrustStacey Cripps, Deputy Service Lead, IOW TrustJane Morgan, Social Care Practitioner, LAClare Dorn, Case Manager, NHS EnglandDanny Mitchell, MH Practitioner, NHS EnglandDr Kate Cambridge, GP, IOW NHS TrustSue Morris, CCAMHS Team Leader, IOW NHS TrustHelen Figgins, Commissioning Manager, IOW CCGKaren Kerley, Joint IOW LA / CCG CommissionerMichelle Jones, Children’s Service’s IOW CCG

Apologies,Billie Hunter, Psychological Therapist, IOW NHS TrustTracy Keats, Adult Safeguarding, IOW CCGMary Jelf, Care Co-ordinator, IW NHS TrustEmma Blake, General Paediatric and Paediatric Mental Health ConsultantHeidi Pinfield Wells, Senior Psychological Therapist for CMHS

NOTES BY: Rosie Campbell (RC)- AdministratorItem numberas per agenda

Action Initial

1. Welcome, introductions and overview – Sue Lightfoot (IOW CCG)

Following the welcome and introductions SL gave an overview of the plan of the afternoon workshop, including;

Reason for the meeting – to agree coherent pathways for Anorexia Nervosa and Binge Eating / Bulimia.

Commissioning of an integrated pathway that is a person centred pathway, and includes support for carers, family and friends.

To be aware of inadequate local provision. To create a MARSIPAN Steering Group.

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SL informed the group of statistics around eating disorders. People admitted for an eating disorder are more likely to stay in hospital for a longer period of time with 32% staying longer than a month compared to 1% of all FAEs. Eating disorders can affect women, men and children but the most at risk are adolescent females and young women (aged 15-24).

2. Review of previous workshops and actions and outputs

HF explained that from the previous workshop in November 2014 issues highlighted included -Reviewed data:

– Challenges of data available– The Isle of Wight in 2013/14 had 16 Finished Admission

Episodes (FAEs) for patients with a primary diagnosis of Eating Disorder (F50 Eating Disorders)

The actions identified included-• Implementations of Marzipan Steering group and guidance

across the whole of the IW NHS Trust• Data capturing of eating disorders• Training Audit to a understand competency of work force to

access and treat• Early identification and intervention through:

– Addressing stigma and improving awareness in families and schools

– Look at options of using the GP screening tool to help with earlier diagnosis and intervention

• Develop a care pathway

3. The Management of Really Sick Patients

with Anorexia Nervosa (MARSIPAN)-Dr Alexis BowersWhat is MARSIPANAB explained the development of MARSIPAN arose out of concerns that a number of patients with severe AN were being admitted to general medical units and sometimes deteriorating and dying.This has led to the following to be provided-

Advice on physical assessment A brief handout to send to all front-line medical and

psychiatric staff Advice to the primary care team and criteria for

admission to both medical units and specialist eating disorders units as well as non-specialist psychiatric units,

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and criteria for transfer between those services Advice on membership of the in-patient medical team Medical, nutritional and psychiatric management of

patients with severe anorexia nervosa in medical units, including the appropriate use of mental health legislation

Advice for commissioners on required services for this group of very ill patients.

The Implementation of MARSIPAN in IW NHS Trust

The in-patient medical team should contain:A physician and a dietician with specialist knowledge in eating disorders, preferably within a nutrition support team, and have ready access to advice from an eating disorders psychiatrist. If an eating disorders psychiatrist is unavailable, support should come from a liaison or adult general psychiatrist.

Also included are guidelines on the location of care. Unless the patient requires medical services that are not provided, patients with severe anorexia nervosa should be cared for in a SEDU, if available.

MARSIPAN guidelines should be adhered to throughout this process with regional MARSIPAN policies in place.

4. Round Table discussions: Draft Pathway

The pathway and cluster specification aims are:• Decrease the length of time between the onset of eating

disorder and access to appropriate treatment• Improve the data capturing of people with eating disorders• Reduce the physical and psychiatric morbidity, social disability

and mortality caused by eating disorder

Pathway Review and suggested amendments for Anorexia Nervosa and Binge eating and Bulimia-

Discussions were had on what was feasible for Primary Care GP’s and what should be included in the initial assessment. Ensuring GP’s use SCOFF questionnaire prior to referral was agreed.GP’s to offer Full Bloods to help assist in early diagnosis was also decided.A single point of assessment and ensuring staff are adequately skilled for assessment was also highlighted.

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Consistent Coding within Primary Care is highlighted as a requirement to enable the recording of concise data.

Physical status monitoring was also mentioned-NICE guidance for Primary and Secondary Care to implement an agreement with GP’s.Action: AB to share a Kings College template with HF, HF to amend and circulate to the group.

5. Way Forward

The implementation of a MARSIPAN Steering Group was discussed as an outstanding action from the previous workshop and the importance if this group moving forward.To be included are Dr Alexis Bowers, Dr Grellier, John Doherty, Dr Emma Blake, Lyn Oldham, Sarah Todd, Dr Judith Moore, Billie Hunter, Stacey Cripps and Shaun Stacey. Acute nursing staff and General ward staff to also be included.Data Collecting and Coding to be included as an agenda item for these meetings. AB and JD to update to SL after initial MARSIPAN discussion to give a timeline, attendee list and possible tasks.Action: RC to email JD with the initial list of attendees.

Following on from this workshop and relevant consultations the below pathways have been finalised for approval by the CCG Executives.

RC

Present- Apologies-

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Sue Lightfoot, Head of Commissioning, IOW CCGJohn Doherty, Head of MH, LD and Community Partnerships, IOW NHS TrustBeverley Fryer, Quality and Safety Lead, IOW NHS TrustDr Umama Khan, Consultant, IOW NHS TrustDr Bowers Alexis, Consultant Psychiatrist, IOW NHS TrustDavid Sellers, Modern Matron, IOW NHS TrustStacey Cripps, Deputy Service Lead, IOW TrustHelen Figgins, Commissioning Manager, IOW CCGKaren Kerley, Join IOW LA / CCG Project ManagerMichelle Jones, Children’s Service’s IOW CCG Sue Morris, CCAMHS Team Leader, IOW NHS TrustDr Judith Moore, GP Service Lead, IOW NHS TrustSarah Todd, Dietician, IOW NHS TrustDavid Sellers , Modern Matron, IOW NHS TrustStacey Cripps, Deputy Service Lead, IOW TrustJane Morgan, Social Care Practitioner, LAClare Dorn, Case Manager, NHS EnglandDanny Mitchell, MH Practitioner, IOW NHS TrustDr Kate Cambridge, GP, IOW NHS Trust

Keats Tracy, Adult Safeguarding, IOW CCGBillie HunterMary JelfEmma BlakeHeidi Pinfield Wells

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