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

Aims/Methods: This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) to NHSE commissioning guidance. Results: Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016/17 and 2019/20 mean referral rates 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), but 46% were aged 18–25, 54%>25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for co-morbidities, offer assertive outreach, or provide seamless transitions. For patient volume, ACEDS workforce budget was 15% compared to the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for ACEDS. Clinical Implications: This study highlights the severe pressure in ACEDS, which has increased since the pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance for adults, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.