NHS Gloucestershire: Evaluation for eating disorder services

The challenge‍

After significant pressure on services and a surge in demand following the pandemic, Gloucestershire’s eating disorders pathway had resumed its transformation programme. The team had already improved waiting times, but before moving forward, they needed a more human and empathetic understanding of how people experience the pathway-from first signs of a problem to recovery.

They wanted to evaluate the Specialist Community Eating Disorders (SCED) Service in the context of the broader system, and use this to shape strategic investment decisions that would improve access, experience and outcomes for people with eating disorders.

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What we did‍‍

We led a service evaluation that focused on lived experience across the whole pathway, from prevention and early help through to recovery. Our approach was shaped by empathy, sensitivity and co-creation with participants.

• Collaboration with stakeholders from across the trust and ICB
• Expert interview with the Clinical Lead for the SCED service
• Analysing existing research, data and other background information
• Creating a safeguarding approach
• Conducted qualitative research with current and past SCED service users
• Developed pen portraits, insights & priority investment areas
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What we learned‍

The evaluation provided a rich picture of the user journey-highlighting gaps, frustrations and opportunities for improvement at each stage of the pathway. Insights included:

• Access & referral: Adults and people with co-existing conditions often faced missed or delayed diagnoses, with GPs heavily focused on weight rather than mental health.
• Waiting periods: Waiting for treatment was emotionally and physically damaging, with some people deteriorating during this time. Those who weren’t “ill enough” described a sense of needing to ‘earn’ their care.
• Therapeutic support: People valued compassionate, relationship-based therapy and having the ability to try different approaches. Delays in accessing mental health support affected trust and motivation.
• Inclusion & access needs: People with disabilities felt excluded or deprioritised. Carers were often treated as patients, while the individual felt ignored.
• Discharge & recovery: Leaving the service was often described as abrupt and unsupported. Many felt sad to lose their therapist relationship and unsure how to sustain recovery.
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Service evaluation in action‍

We took a holistic approach to the evaluation: 

• Evaluated how the SCED service sits within the wider system
• Captured detailed insight from real experiences, structured by pathway stages
• Developed evidence-backed “How might we…” questions to support service design
• Identified priority areas for transformation based on user need, not assumption

Our evaluation was directly shaped by those who use the service. We spoke to people who were in recovery, still receiving support, or navigating other life challenges. The result is a grounded, user-led view of what the pathway does well-and what needs to change.
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The outcome‍

The evaluation has already informed planning within the transformation programme. It provided:

• Pen portraits of users that centre real emotional experiences
• Journey-stage insights that align with service touchpoints
• Priority areas for investment, including:
  
  • Mental health support from first contact
  • Better GP understanding and referral processes
  • A more inclusive approach for disabled service users
  • Improvements to discharge and aftercare
  • Better support during waiting periods

This work gave Gloucestershire ICS the confidence to move forward with transformation grounded in what matters most to service users. It set a new standard for service evaluation - one that’s human, evidence-based and actionable.