The London Centre for Eating Disorders and Body Image Ltd

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff assessed the needs of all patients on admission. They developed individual treatment plans which were reviewed regularly and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. Staff from different disciplines worked together as a team to benefit patients.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 5 patient care and treatment records.

Staff completed comprehensive initial assessments of patients soon after their referral to the service. Where patients were deemed higher risk, they would have their initial assessment with the psychiatrist.

Following their assessment, patients were offered treatment options, which included psychological therapies, dietetic support, occupational therapy or medicines. Patients told us treatment plans were specific to their needs, and created with their involvement.

Feedback from people using the service was positive. Patients felt involved in their assessments and felt confident that staff understood their individual needs.

Where appropriate, staff weighed patients in the clinic and at regular intervals throughout their treatment. The clinic had 3 weighing scales. At the time of inspection, calibration records were not available. The service had since contacted the manufacturer to arrange yearly calibration of their equipment.

We scored the service as 4. The evidence showed an exceptional standard. The service always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service planned and delivered people’s treatment with them.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). These included a range of psychological therapies, dietitian input, family therapy and medication. For example, staff told us they used Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) therapy for their adult patients. Clinical records demonstrated that treatment was provided in line with current guidance.

All patients were very happy with the treatment they received. One patient old us staff were very knowledgeable on their diagnosis of Avoidant Restrictive Food Intake Disorder (ARFID), which they felt other services had difficulty understanding and treating.

Staff told us they kept up to date with current best practice by attending external conferences, attending training and reviewing research. Within the service, training was provided on specialist areas for other staff members. For example, there was a training session on Autism Spectrum Disorder (ASD) and how this can link with their work in treating eating disorders. Clinicians also attended clinical case discussions, where they were able to present a case, and receive support and advice from their colleagues.

Staff made referrals to external specialists where required. For example, staff referred their patients for ASD assessments where deemed clinically appropriate. They also referred patients to specialist eating disorder NHS services.

The service had a number of quality improvement projects, for example, their website redevelopment to improve accessibility. The service had also recently developed their Intensive Outpatient Programme (IOP) which supported patients with 5 sessions per week, for a 6-week intensive period. The sessions involved a range of professionals, such as therapists, a doctor and a dietitian. This was implemented based on patient and clinician feedback to the service.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service worked well together to support people. Staff told us there were good working relationships between all staff within the service. Patients told us the staff working with them worked well together, and all staff were kept up to date between their sessions.

Staff told us they felt supported by their team members and managers. They told us there was clear communication between clinicians, via email and phone calls. When working jointly for a patient, staff were able to access each other’s internal record keeping notes to keep up to date on their latest information.

The service held a weekly meeting, attended by the clinical director, clinic lead, personal assistant, and on occasions the consultant psychiatrist. This meeting had an agenda, which covered areas such as, service risk, incidents, complaints, audit results, the wait list and new assessment outcomes. Minutes for these meetings were recorded. Minutes were not shared with the wider team, however, managers shared important information in all-staff emails, individual supervision and ad-hoc staff meetings. We saw examples of emails being sent to staff, such as a reminder of the risk escalation protocol following assessments and helpful information on what to do if they have any concerns with their remote appointment platform. Staff also told us they were informed and consulted on the Intensive Outpatient Programme (IOP) prior to this going live. Staff told us they recently came together to discuss their stance on the usage of weight loss injections.

The service had effective working relationships with teams outside the organisation. For example, patient’s GPs, local authority safeguarding leads, and local NHS eating disorder services. One patient told us staff had discussed their care with their previous medical team prior to their appointment. This allowed the clinicians to have up to date information on their treatment so far.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service supported people to live healthier lives. They offered advice and guidance as part of their treatment. Patients had access to dietitians within the service who supported patients with dietetic assessments, meal support programmes and healthy eating advice.

We scored the service as 3. The evidence showed a good standard. Whilst the service did not consistently carry out formal outcome measures, the service informally monitored people’s care and treatment to improve it. They ensured that patient outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

As a result of patient feedback the provider had streamlined and reduced the use of a range of outcome measures, introducing instead the Likert scale to ensure ongoing monitoring.

Some individual clinicians told us they did use outcome measures where appropriate. For example, the Patient Health Questionnaire-9 (PHQ-9) which measures depression and the Eating Disorder Examination Questionnaire (EDE-Q).

The service did have an informal Likert scale measurement for patients to self-reflect on their recovery throughout treatment. This questionnaire asked patients to rate their thoughts and feelings from 1-10 on areas such as ‘thoughts about my weight or shape have taken up a lot of my time or attention’, ‘I feel confident that I can cope with my eating or body image difficulties, or use strategies I’ve learned’, and ‘I feel I am meeting my goals for treatment’.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Patient’s signed agreements with the service before they started treatment. These forms included consent to start treatment and an understanding of the cancellation and missed appointment policy. The service collected consent to share information with GPs, other services and family members at the point of initial referral. Patients told us staff routinely asked for consent to share information with external services and family throughout their treatment.

The records we reviewed showed patients were involved in discussions around medicines and had consented to treatment. Patients told us they were able to make their own decisions around the treatment they received. Staff told us consent to continue therapeutic treatment was often implied in that the patient attended these sessions regularly.

The service did not explicitly document a patient’s mental capacity. Whilst clinicians were trained in completing capacity assessments, managers told us there had been no clinical need to complete a formal capacity assessment. Staff told us if there were any concerns for a patient’s capacity, they would be referred to specialist services, as they would likely need more intensive support.