Specialised Eating Disorders Inpatient Service Specification for Adults

This page outlines the key elements of a specialist inpatient service for adults with eating disorders (EDs). It is intended for commissioners, service managers, clinicians and stakeholders who develop or evaluate such provisions.

1. Purpose and Scope

The specification defines the minimum standards required for a safe, effective, and patientcentred inpatient service for adults (18years) with severe or complex eating disorders. It applies to new services, extensions of existing units and any provider delivering adult inpatient care under the NHS or equivalent health systems.

2. Service Population

The service must accept adults who meet one or more of the following criteria:

• Diagnostic criteria for Anorexia Nervosa, Bulimia Nervosa, BingeEating Disorder, Avoidant/Restrictive Food Intake Disorder, or Other Specified Feeding or Eating Disorder (OSFED) as per DSM5/ICD11.
• Medical or psychiatric complications that cannot be safely managed in a community setting (e.g., severe malnutrition, electrolyte imbalance, cardiac instability, refractory selfharm).
• Failure of intensive community treatment (e.g., daypatient programmes, outpatient CBTED) to achieve clinically significant improvement.
• Assessment of risk to self or others that requires 24hour monitoring.

3. Core Service Features

3.1 Clinical Staffing

All staff must have specific training in eatingdisorder management and the service must provide regular supervision.

• Psychiatrist fulltime or equivalent, with experience in adult EDs.
• Clinical Psychologist specialist in evidencebased therapies (e.g., CBTED, MANTRA, FBTadult).
• Registered Dietitian expertise in refeeding, nutrition assessment and education.
• Nursing team at least 1:6 nursetopatient ratio (day) and 1:8 (night), with EDspecific competence.
• Occupational Therapist for activity planning, body image work and skills training.
• Social Worker to address housing, benefits, safeguarding and discharge planning.
• Peer Support Worker livedexperience staff to enhance engagement.

3.2 Medical Care

Provision of 24hour medical assessment and intervention, including:

• Initial medical clearance and weekly monitoring of vitals, electrolytes, cardiac rhythm and weight.
• Refeeding protocol aligned with NICE guidelines gradual caloric increase, monitoring for refeeding syndrome.
• Access to acute care (e.g., emergency department, intensive care) when needed.

3.3 Therapeutic Programme

A structured, multidisciplinary programme should run 7days a week:

• Individual psychotherapy (minimum 1hour/week).
• Group therapy (CBTED, DBT skills, body image, psychoeducation).
• Family or carer work at least two sessions per week where appropriate.
• Nutrition sessions daily meal support, food exposure, education.
• Physical activity lowimpact, supervised, with medical clearance.
• Occupational therapy daily activities, coping strategies, vocational planning.

3.4 Environment

The inpatient setting must promote recovery and safety:

• Singleoccupancy rooms where possible; if shared, clear boundaries and safeguards.
• Calm, neutral dcor; access to natural light and safe outdoor space.
• Secure storage for personal belongings to reduce hoarding or restriction behaviours.
• No access to means of selfharm; staff trained in deescalation.

3.5 Length of Stay and Discharge

Typical inpatient stay ranges from 4 to 12weeks, determined by clinical progress rather than arbitrary time limits. Discharge planning must begin at admission and involve:

• Clear criteria for medical stability (e.g., weight target, electrolyte normalisation).
• Psychological readiness demonstrated engagement with therapy and coping skills.
• Community stepdown options daypatient, intensive outpatient, or supported accommodation.
• Written relapseprevention plan and scheduled followup appointments.

4. Governance and Quality Assurance

The service must meet the following governance standards:

• Registration with the Care Quality Commission (or equivalent body).
• Regular audit against national eatingdisorder indicators (e.g., admission rates, average length of stay, readmission within 30days).
• Patient and carer feedback mechanisms quarterly surveys and a complaints pathway.
• Continuing professional development annual training in latest ED evidence.
• Data collection for research and service improvement, respecting GDPR.

5. Integration with Wider Services

Effective inpatient care depends on seamless links to:

• Community mental health teams for postdischarge continuity.
• Specialist eatingdisorder day programmes to provide steppeddown care.
• Primary care shared care agreements for medication and monitoring.
• Safeguarding agencies clear protocols for protecting vulnerable adults.

6. Funding and Cost Considerations

Funding should reflect the intensity of staffing and the need for specialist resources. Typical cost drivers include:

• Higher nursetopatient ratios and specialist medical input.
• Dietitian and psychology hours (often exceeding standard band3 rates).
• Infrastructure secure rooms, therapeutic spaces, technology for monitoring.
• Training and supervision programmes.

Commissioners are encouraged to adopt a valuebased approach, recognising that investment in specialist inpatient care reduces longterm acute admissions and improves functional outcomes.

7. Monitoring Outcomes

Key performance indicators (KPIs) should be reported quarterly:

• Medical stabilization (weight gain, electrolyte balance).
• Psychological improvement change in EDEQ or similar scores.
• Readmission rates at 30days and 6months.
• Patientreported experience measures (PREMs).
• Length of stay versus target benchmarks.

8. Conclusion

A specialised inpatient service for adults with eating disorders must combine expert medical care, evidencebased psychological treatment, and a supportive environment. By adhering to the specifications above, providers can deliver safe, highquality care that reduces morbidity, supports recovery, and facilitates a smooth transition back to the community.