The elements of a service to emulate

Orri, an independent specialist eating disorder service in Central London, won an outstanding rating from the Care Quality Commission following its very first inspection.

It went down so well with the inspectors that, as we reported last month, the watchdog’s head of hospital inspection praised it as ‘an excellent example to other providers who should look to learn from this report’. Prof Paul Robinson, consultant psychiatrist at Orri, tells more.

Having been associated with Orri from the outset, I was delighted to read this very positive report from the Care Quality Commission (CQC).

I have long been convinced that most patients with severe eating disorders do not require admission to inpatient care.

And I have also considered that – for those who are admitted –some could have avoided admission with intensive community care and some, perhaps most, could be discharged early when medically stable, to such care.  

That was the basis for the service I developed at the Royal Free Hos­pital in the 1990s and I was so pleased when Orri’s founder and chief executive Kerrie Jones, who is a leading psychotherapist in the eating disorder sector, invited me to be part of the Orri project in 2019. 

Elements of success

The idea that one can treat people with severe eating disorders in day care has been supported by the eating disorder charity BEAT and NICE but unfortunately not taken up universally, for reasons that escape me. Thankfully, Orri has now shown that it can be done effectively and safely.

What are the elements that have contributed to the success of Orri?  

They are many, and the CQC has recognised them, but I would like to point to a few key areas that I believe to be essential.  

The first is effective leadership, and I am referring here not only to our excellent chief executive, but also to the whole senior clinical and management team.  

Their belief in the Orri model and their high professional standards allow the rest of the staff to participate in what some in the eating disorders field regard as a risky enterprise. 

It is only when the leadership are able to convey a sense of professionalism, adherence to safety and to outcome monitoring, that more junior staff, as well as clients, can feel confident enough to get on with the difficult task of client  recovery.  

A second key area is adherence to effective professional practice, backed by research evidence, where that exists, and to professional standards where it does not.  

The fact that this is universal at Orri means that the quality of care provided is as high as it can be.  

Building relationships

I believe the third area that contributes hugely to Orri’s success is the relationships built up between staff and clients. People with eating disorders can experience criticism and rejection when it comes to their beliefs about eating and the body. 

They can be dismissed as seeming ‘self-absorbed’. At Orri, a compassionate approach from staff recognises that our clients are in the grip of a compulsion they cannot control and getting alongside the client in this way is an essential part of helping them move on to a healthier way of life. 

Could Orri, with five stars, do any better? Of course, the answer is ‘yes’. The model needs to be made available to all NHS patients using both face-to-face and online therapy.

And as well as thinking of expanding existing Orri in a new location, and perhaps establishing Orri 2, we might consider whether other community approaches such as home care might be within our reach.

Whatever the future holds, Orri has, through its successful CQC inspection, become  established as a beacon service to be used and emulated by other services. For Orri and its model, the future looks very promising.

Prof Paul Robinson (right) is research and development director at Orri and professor (Teaching) Division of Medicine, University College London