Eating disorders are serious mental illnesses that have enduring physical and psychological impacts. This is compounded by known difficulties accessing timely, consistent, and appropriate care across the system. The Government has set out its long-term approach to mental health reform as part of the 10-Year Health Plan for the National Health Service. This plan is built around three key shifts, from hospital to community, from sickness to prevention, and from analogue to digital, all of which are essential to improving care for those with eating disorders.

In January, NHS England published long-awaited updated commissioning guidance for children and young people’s eating disorder services. The guidance takes a whole-pathway approach, prioritising community-based care, earlier identification and intervention, and better integration with schools, colleges, and primary care.

Specialised adult eating disorder inpatient services are not commissioned based on fixed thresholds. Admission decisions are made by multidisciplinary clinical teams following a comprehensive assessment of clinical risk, including physical health, psychiatric presentation, rate of deterioration, and wider social factors. Body mass index may inform clinical assessment but is not used in isolation to determine access to inpatient care.

Integrated care boards (ICBs) commission services across the full pathway, including both adult and children and young people’s provision. This enables resources to be allocated at a system level based on population need, with specialised inpatient services forming part of a broader continuum of care.

Where individuals are not admitted to specialised inpatient services, responsibility for ongoing care and risk management remains with local clinical teams under ICB commissioning arrangements. Safeguarding is managed through established NHS and statutory multi-agency frameworks, ensuring that individuals at risk continue to receive appropriate oversight and support.

Specialised inpatient services operate as part of an integrated system, with NHS Led Provider Collaboratives supporting coordinated care and clinically led decision-making based on individual need.