13. Mrs B says the CED team were wrong to advise the hospital to keep Miss Z in a wheelchair for longer than required and restrict her movement. Mrs B says the advice provided did not allow her to cross a room to go to the toilet or walk even the smallest amount each day in hospital despite asking staff to let her. She says the advice from the CED team did not allow Miss Z to move her legs in her hospital bed and denied her physical activity.
14. Mrs B believes the lack of movement, exercise, and being confined to the wheelchair, had a negative impact on Miss Z’s health. We appreciate Mrs B will have been upset and distressed at seeing Miss Z in the condition she was in and the decline in her health.
15. The records indicate Miss Z was excessively exercising (one to four hours a day), had a desire to lose weight, had body image concerns, and felt guilty binge eating and vomiting, which is why the GP referred her to the hospital.
16. Due to Miss Z’s weight being extremely low on admission (43.5kg), the CED team advised the hospital that wheelchair use was necessary when moving around the ward to avoid any risk, and the need for complete rest. Concerns about Miss Z continued over the months and a letter in May 2024 indicates Miss Z remained significantly underweight. The CED team advised wheelchair use must remain to prevent any risk occurring.
17. The records indicate in July 2024, Miss Z was worried about using a wheelchair which the hospital acknowledged. The hospital felt if Miss Z engaged with the meal plan in place, there could be talks about whether she could go to the bathroom and back to bed with a few steps walking. This would need to be matched with her engagement due to the risk of losing weight.
18. We can see from the records that on 1 July the staff saw Miss Z exercising in the bathroom doing star jumps, then on 15 July performing leg exercises in her bed. She was advised to stop. The records show a wheelchair was continued for mobilisation outside of bed use during July and August 2024.
19. The records indicate in August 2024, the CED team held a 1-1 with Miss Z where she raised her frustration about the use of a wheelchair and felt annoyed she could not do more outside of the wheelchair and spoke of being bored. Despite Miss Z’s health improving, the advice for further wheelchair use and restricted physical activity continued to avoid any risk to her health.
20. Miss Z’s care plan states she should remain on bed rest and use a wheelchair for all time spent off the bed. Any time off the ward should be in a wheelchair. She should spend minimal time outdoors and remain well wrapped up and fully supervised if outside.
21. We are sorry to hear about the frustration and annoyance Miss Z experienced and we are sorry to hear about the worry Mrs B was caused.
22. The NICE guidance says when deciding the most appropriate care for a patient admitted with an eating disorder, the patient’s weight must be considered, and blood tests and physical observations must be carried out. It says if a patient with an eating disorder is exercising excessively, they must be advised to stop.
23. The NICE guidance says when assessing and monitoring the physical health of a patient with an eating disorder, the review should consider weight or BMI, blood pressure, relevant blood tests, and problems with daily functioning, assessment of risk, an ECG, and a discussion of treatment options.
24. The NICE guidance supports appropriate mobilisation only when clinically safe. It says decisions regarding mobility and wheelchair use are informed by the overall clinical picture, trends in physical health recovery, and the patient’s compliance with the treatment model.
25. The MEED guidance is directly applicable to patients admitted to hospital and describes strict bed rest, close monitoring, and no independent mobilisation for severely medically compromised patients on acute wards.
26. The MEED guidance says some degree of gentle activity like watching TV or reading can help reduce distress without any additional risk. It says restriction of excessive activity with an explanation of the rationale is helpful to patients and family.
27. The MEED guidance also says it is important to keep a patient supervised to prevent dysfunctional exercise. Arrangements for toileting and washing need to be considered to prevent excessive exercise. It says a clinician should prevent a patient from engaging in unhealthy activities such as excessive exercise, which is typically associated with a fear of weight gain.
28. Our adviser says several factors needed to be considered whether a patient should remain in a wheelchair. These include heart rate, degree of weight loss, compulsive exercise behaviour, and overall compliance with the meal plan.
29. The records show that these factors were considered by the CED team and were documented as the clinical reasons supporting the use of a wheelchair. Our adviser said the decision to recommend its use was appropriate.
30. By mid to late July, Miss Z’s weight and parameters were stabilising and improving, which our adviser said would typically prompt consideration of discontinuing wheelchair use. However, wheelchair use was continued due to ongoing concerns about inadequate compliance with the treatment plan, and observations of Miss Z engaging in exercise within the bed space.
31. Our adviser says if the wheelchair was removed at that stage, additional strain would have been placed on Miss Z’s recovery and would have negatively affected her health.
They said it is usual and appropriate to take a cautious approach to limit further energy expenditure to support further physical recovery.
32. We can see the CED team provided appropriate advice and followed the MEED guidance for the management of eating disorders in managing Miss Z’s health appropriately, specifically about her wheelchair use.
33. We have seen no evidence of inappropriate restriction of Miss Z’s mobility and we consider the CED team’s advice for these clinical decisions was in line with the NICE and MEED guidance.
34. This guidance recommends strict bed rest and restrictions on independent mobilisation when a patient is physically compromised. If Miss Z walked or exercised too early on the ward, it would have prevented her success and affected her recovery and overall health.
35. We offer our sympathies to Mrs B and Miss Z, and we recognise how distressing and upsetting it must have been especially with Miss Z’s health declining and the worry Mrs B experienced.
36. After reviewing all information, we have seen no indications of failings in the advice the CED team provided regarding Miss Z’s mobility. We will therefore take no further action on this complaint. We wish Mrs B and Miss Z the best for the future, and we thank Mrs B for bringing this complaint to our attention.