Implementing service transformation for children and adolescents with eating disorders across England: the theory, politics, and pragmatics of large-scale service reform

Plain English summary Eating disorders are among the most serious mental health problems affecting children and young people. There has been accumulating clinical and research evidence that early expert outpatient treatment is effective and can also significantly reduce the need for costly inpatient care, indicating that investing in community-based eating disorder services is likely to be both clinically and economically beneficial. This paper describes a large-scale service transformation programme following a major government investment (initially £30 million/year, since then increased to over £50 million/year) aimed at service level change in the provision of eating disorder services for children and adolescents in England. We describe the history, background, political context, and clinical and research evidence that contributed to the government's decision to invest in new services for eating disorders. We also provide a brief account of the implementation of an England-wide whole team training to support the creation of a network of over 70 dedicated community eating disorders services for children and young people.