Adult Eating Disorder Alternative to Hospital Admission and FREED Service

Service Specification

Adult Eating Disorder Alternative to Hospital Admission (AL2A) and FREED Service

North Yorkshire and York (NYY)

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1. Purpose of the Specification

The Humber and North Yorkshire Specialist Mental Health Provider Collaborative (the commissioner), seeks to procure an Adult Eating Disorder Alternative to Hospital Admission (AL2A) service, inclusive of First Episode Rapid Early Intervention for Eating Disorders (FREED).

The service will provide intensive, time-limited, community-based interventions as an alternative to inpatient admission, and as step-down support following admission, in order to:

• Reduce avoidable admissions
• Reduce length of inpatient stay
• Improve patient experience and outcomes
• Reduce out-of-area placements
• Deliver value for money through invest-to-save approaches

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2. Service Objectives

The Provider shall deliver a service that achieves the following objectives:

1. Reduce the number and duration of adult eating disorder inpatient admissions (including out-of-area placements)
2. Provide safe, effective, intensive community-based care for adults at high risk of admission
3. Support earlier discharge from inpatient care through structured step-down support
4. Reduce the need for restrictive interventions, including naso-gastric (NG) feeding
5. Improve equity of access to eating disorder services across North Yorkshire and York
6. Deliver early intervention through the FREED model to prevent illness escalation
7. Improve patient-reported outcomes, experience, and family/carer involvement

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3. Scope of Service

3.1 Eligible Population

The service shall support:

• Adults (18+) with a diagnosed eating disorder
• Individuals at high risk of admission to an acute or specialist eating disorder inpatient service
• Individuals requiring step-down or early supported discharge from inpatient care
• Individuals where intensive community support may prevent deterioration, including risk of NG feeding
• Young adults aged 18-25 eligible for FREED where commissioned and clinically appropriate

3.2 Exclusions

• Crisis response or 24/7 home treatment provision
• Emergency medical care (to be delivered via existing acute pathways)
• People who do not have a diagnosed eating disorder
• People aged under 18
• People not registered with a GP within North Yorkshire and York and/or People who do not live within North Yorkshire and York

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4. Service Model Requirements

4.1 Core Model

The Provider must deliver:

• Intensive, time-limited intervention of up to 12 weeks
• A stepped-care approach supporting both admission avoidance and early discharge
• Integration within existing community adult eating disorder MDTs
• Close working with inpatient services, acute hospitals, crisis teams, and community mental health teams

4.2 Geographic Delivery Model

The service must operate as two locality-based teams:

• Team A: Hambleton, Harrogate & Richmondshire
• Team B: York & Scarborough

Provision must be flexible to meet rural and urban population needs, including travel, virtual delivery, and outreach.

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5. Interventions to Be Delivered

The Provider shall deliver, as a minimum:

5.1 AL2A Interventions

• Supported eating (1:1 and group, face-to-face and virtual)
• Meal planning, shopping, cooking, and eating-out support
• Daily living skills development
• Family and carer coaching and supported meal guidance
• Development of recovery-focused support plans
• Exposure-based and skills-based interventions
• Social inclusion, occupational engagement, and signposting (e.g. employment, education, social prescribing)
• In-reach to acute hospitals, including daily support when admitted
• Contribution to bed management and admission decision-making processes

5.2 FREED Pathway

The Provider shall deliver the FREED model in line with national evidence, including:

• Initial screening contact within 48 hours of referral
• Assessment within 2 weeks
• Treatment commencement within 4 weeks
• Highly coordinated, early-intervention care aimed at reducing duration of untreated illness

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6. Workforce Requirements

The Provider must evidence a workforce model consistent with:

• Clearly identified clinical leadership and governance
• Competence in delivering evidence based interventions for eating disorders, including the assessment and treatment of complex eating disorder presentations with co morbid physical and mental health conditions.
• Capacity to work flexibly across home, community, and virtual settings
• Cultural competence to address health inequalities

Indicative staffing expectations include:

• A Multi-Disciplinary Team with relevant professional registration trained in working with people with a diagnosed eating disorder
• Support staff trained in eating disorder care
• FREED workers with appropriate specialist experience

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7. Interfaces and Dependencies

The Provider must demonstrate robust arrangements for:

• Integration with community adult eating disorder teams
• Joint working with inpatient eating disorder services
• Participation in provider collaborative bed management meetings
• Liaison with acute trusts, crisis services, and community mental health teams
• Alignment with mental health hubs and neighbourhood teams

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8. Key Performance Indicators (KPIs)

8.1 Activity and Access

KPI Measure

AL2A caseload Number of individuals supported per quarter

Time to AL2A intervention ≤5 working days from referral

FREED screening ≥95% within 48 hours

FREED assessment ≥95% within 14 days

FREED treatment start ≥90% within 28 days

8.2 Impact and Outcomes

KPI Measure

Admission avoidance % of AL2A episodes avoiding inpatient admission

Length of stay Reduction in average inpatient LoS for stepped-down p…