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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate the right hon. Member for Knowsley (Sir George Howarth) —my right hon. Friend, if I may call him that—on securing this important debate on eating disorders awareness during Eating Disorders Awareness Week.
This is a subject close to my heart; it is a subject that we talk about frequently over at the Department and it is on the desk. It is so important because, as I think the hon. Member for Worsley and Eccles South (Barbara Keeley) mentioned, the morbidity rates among young women suffering with eating disorders are the worst of any mental health issue. It is the most serious of all mental health issues that children and young people, and indeed adults, can suffer from. That is why it has such a high priority within the Department.
People with eating disorders often suffer in silence, but Eating Disorders Awareness Week brings this important issue out into the open and provides information and advice for those who seek help. I pay tribute to all those who are working hard to raise awareness of eating disorders, in particular the charity Beat, which hon. Members will know is supported by the Government and does so much to support young people through its helplines and support groups. I have met with Beat and I am incredibly impressed by the charity. It does incredibly good work.
We also have passionate and committed individual campaigners such as Hope Virgo, who has been mentioned a couple of times today. They are also doing much to raise the profile of eating disorders and to show people who are suffering from an eating disorder that, as hard as that is, it is possible to fight them and to get well.
As I have said, eating disorders are serious and life-threatening conditions; they can be devastating for those who are suffering, their family members and the people around them. That is why we want to ensure that people have access to the right mental health support in the right place and at the right time. Improving eating disorder services is a key priority for the Government, as I have said, and is a vital part of our work to improve mental health services. We know that the earlier an intervention is made and treatment provided, the greater the chance of recovery.
Alexander Stafford (Rother Valley) (Con)
The waiting time figures for child eating disorder appointments in London show 97.1% of urgent cases being seen within one week and 92.8% of routine cases being seen within four. In my constituency, the figures are 78.6% and 78.3% in the same circumstances. Does my hon. Friend the Minister agree that, as part of our great levelling-up agenda for this country, the young people in my community in Rother Valley and across South Yorkshire deserve the same waiting times for eating disorder services as Londoners currently enjoy?
Ms Dorries
I thank my hon. Friend for that intervention. I will go on to talk about waiting times, but he is absolutely right. It is a trial that we have rolled out to ensure that, across the country, anybody who presents with a serious first instance eating disorder is seen within one week and routine cases are seen with specialist help within four weeks.[Official Report, 19 March 2020, Vol. 673, c. 12MC.] That has been rolled out and tested across the country by NHS England, and I am incredibly impressed at some of the statistics that I am hearing; I thank the hon. Member for Worsley and Eccles South for citing her own constituency.
This is a trial and, as we know, everybody has yet to meet the standards; that is the responsibility also of the clinical commissioning groups, because this is quite complicated.[Official Report, 19 March 2020, Vol. 673, c. 12MC.] I will go on to talk about that, but I am actually impressed even with those statistics, considering what it was like before. I am pleased to hear the figures that my hon. Friend the Member for Rother Valley (Alexander Stafford) quotes for his constituency, but they do have to be, to quote a phrase, “levelled up” along with everywhere else.
We know that the earlier an intervention is made and treatment provided, the more successful it is. One of the services in our mental health profile, which is not focused on eating disorders but which I am particularly impressed with, is the trailblazer schemes that we have rolling out into schools. Staff working on the schemes can pick up young people’s eating disorders at the very first signs. Outcomes are promising if they intervene at that very first stage, because the pattern of behaviour does not become established or embedded. They can intervene very early on.
On the point from my hon. Friend the Member for Rother Valley, we set up the first standard to improve access to eating disorder services for children and young people to ensure that, by the end of 2021, 95% of all children and young people with an eating disorder will receive treatment within one week for urgent cases, and within four weeks for routine cases. We are on track to meet that commitment, and figures I have seen today suggest that we may be on track to meet it early, which would be fantastic.
The number of people seeking treatment for eating disorders is sadly rising—or maybe it is a good thing, because people are not so stigmatised, are aware that help is there and are seeking it. However, that rise makes even more encouraging the corresponding increase in the number of patients who actually receive the care that they need. In-patient treatment should be a last resort, which is why in 2014 the Government announced a £150-million investment to expand community-based eating disorder care. We are making good on that promise, and as a result, 70 dedicated new or extended community services are now open or in development.
Indeed, I visited one myself and met the amazing staff who work there—it takes incredible skills to work with people who suffer from eating disorders—and some of the sufferers, and saw that work taking place. People who go into these units are usually there for quite a while; it takes some time to work through this. However, the outcomes looked incredibly promising, particularly for the young women I spoke to. The fact that we have 70 of those dedicated units open now, or about to open, across the country is an incredible step forward in addressing this problem.
That has led to sufferers receiving swift access to treatment within the community, because it is important that they receive treatment near to where they live, close to their families, schools and friends, and that their treatment causes as little disruption to their lives as possible. By improving care in the community, we can improve outcomes and recovery, reduce rates of relapse and prevent eating disorders continuing into adulthood, which is really important.
Caroline Nokes (Romsey and Southampton North) (Con)
I thank the Minister for giving way; there is nothing more aggravating than somebody coming very late to a debate, but I have been in the International Women’s Day debate all afternoon. On relapse or eating disorders continuing into adulthood, does she agree that we have made massive strides forward in treatment for young people, but that there remains a problem of transition when sufferers turn 18? For those who develop an eating disorder slightly after their teenage years, or even well into adulthood, there is still a challenge in accessing services for those not eligible for children’s services.
Ms Dorries
My right hon. Friend makes an important point. That is why we invested £2.3 billion in mental health services, which, as I always say, is more than half the entire prison estate budget. We are focusing on young people and young women in this debate, but funding for mental health services is growing faster than the overall NHS budget. That funding and the development of community services is there to pick up exactly the cases she cites.
No mental health service, other than the very extreme, is better delivered in a hospital than in the community, whether for children, young people or adults. Despite that investment in community mental health services, our challenge is unprecedented, and our challenge is about workforce—it is about attracting people to work in this arena and to help us develop the community services that we need to provide treatment for adults and young people. That is the challenge we have taken on, and it is a challenge that we are meeting and moving forward with. It is our ambition and my absolute hope that children, young people and adults, regardless of their age—this illness is severe, whether in adults or children and young people—receive the treatment they require, when they require it.
Jim Shannon
These plans will require a close working relationship between the Department of Health and Social Care and the Department for Education. I am sure that that is what the Minister refers to, but will she confirm that that is the case?
Ms Dorries
Absolutely, and the Green Paper, which I am sure the hon. Gentleman will be aware of, references the mental health of young people in schools. However, it is also about the trailblazer schemes, peer support workers and other people who go into schools who specialise in how to identify this and pick it up. Teachers have a huge job, and I think if we were to say that they needed to pick up when someone is suffering from an eating disorder, they would probably throw their hands up, because it requires specialised training. It is a skill, and it takes careful handling when identifying someone who is suffering from an eating disorder. So yes, of course we work across Departments, but it is those specialised and trained mental health workers in schools who will pick this up.
Barbara Keeley
We have a few moments left, so I refer the Minister back to the point I raised about relapse. We are largely talking about adults, and there is a mismatch between the average duration of an adult eating disorder—a large number of patients have severe and enduring illnesses—and the shortness of the therapies that they get. Professor Janet Treasure told me that a solution could be to increase the knowledge and skills of patients with those long, enduring conditions and their carers, so that they can self-manage the illness in parallel with clinical care. She is working on a pilot of that. I do not know if the Minister has heard about that, but I wanted to raise it as something that we ought to give attention to.
Ms Dorries
That is incredibly interesting. I had not heard about it, but I am sure that my officials will take note of it. We have an open door for anything that we can identify that helps us in targeting and providing services. We are looking for solutions to the problem. As I said, the money is there. Claire Murdoch, who I mention in almost every debate, and Professor Tim Kendall are rolling out mental health services across the country via NHS England. They have probably heard of it and are probably looking at it, but I am sure that we will take note and check if that is the case.
Although eating disorders are commonly first experienced by people when they are young, they can continue into adulthood. Following a report on how NHS eating disorder services were failing patients, NHS England convened a working group with Health Education England, the Department of Health and Social Care and other partners, which goes to the point that my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) made. We are working in collaboration to address the report’s recommendations and to take them into account when planning for improvements to adult eating disorder services. Work is in progress on that.
We are continuing the investment in mental health services through the NHS long-term plan, as I think most people know. The £2.3 billion is with NHS England, which has a long-term plan to deliver on mental health and is moving at incredible pace. Even today, although it is not relevant to the debate, it announced the opening of gambling clinics across the UK. Community services are being rolled out across the UK so that people in mental health crises do not end up in casualty. It is an incredibly impressive roll-out of mental health services across the UK, including for eating disorders.[Official Report, 5 March 2020, Vol. 673, c. 12MC.]
That long-term plan will give an additional 345,000 children access to mental health support; 380,000 adults access to psychological therapies; and 370,000 adults access to better support for severe mental illness by 2023-24. It commits to the delivery of eating disorder waiting time standards, which I have already spoken about, and I hope that we will reach those before the end of next year. The plan has also committed to the design and roll-out of a new integrated model of adult community mental health care.
To increase further the number of people seeking treatment for their eating disorder, the Government recognise that raising awareness and reducing stigma are incredibly important. Here I should come on to a few of the points made by the right hon. Member for Knowsley. I shall go through them backwards, because that will be more positive in terms of affirmative answers. He mentioned social media providers, their role in body image and the impact that they have on young women. My right hon. Friend the Secretary of State for Health and Social Care has already—this happened recently—held a roundtable with social media providers. It was an incredibly positive meeting, but that is something that needs to continue, because when it comes to social media interactors, providers and platforms need to be aware of the impact that their forums have on young women, so we are continuing that dialogue with them and, I hope, are continuing to push that point.
The right hon. Gentleman made a point about the entertainment industry and its relationship and responsibilities with regard to body image. I announced two weeks ago that I am holding a roundtable with the entertainment industry. That was as a result of the death of Caroline Flack, who took her own life. For me, that was a watershed moment. It is time for the entertainment industry to be aware that it does not have a duty of care only to the people who they take on a contract to work with them. This is not just about sudden fame and reputation loss. The industry has a wider responsibility in relation to images that it projects and how it projects them, because young women and, indeed, many people absolutely are influenced by what they see—their perceived role models—through the lens of television or the cinema. The entertainment industry definitely has a responsibility, so in response to the right hon. Gentleman’s question, I can say that I have already put that in train.
In relation to a review of the long-term effectiveness of CBT, I defer to the expertise and knowledge of our friend from the Scottish National party, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who made the point that short-term CBT may not be as effective, in terms of how it is delivered, for such long-term conditions. It may be part of the treatment, but as we know, when it comes to eating disorders, treatment is very prolonged in some cases. I am sure that CBT has a definite role, but it should not be seen in isolation. Management of eating disorders takes the input of physicians and psychologists—people who are expert in managing these conditions and working in this field. Therefore I would say yes, but not in isolation.
Dr Cameron
I thank the Minister for making that point. I think that there should very much be a formulation-driven treatment plan whereby all the issues that the person presents with are taken on board, and different aspects may require different parts of treatment. I do not think that often happens currently, particularly where people present to primary care services and perhaps do not get the specialist services that they need, but I hope the work that is being done will streamline that for the majority of people in the future.
Ms Dorries
I am sure that Claire Murdoch and Tim Kendall at NHS England are all over that and very aware of that. A streamlining approach to treatment is about getting people seen within the first week. If people are first seen within the first week when they present with their first crisis, that is the time when greater intervention can happen and when that treatment plan can be designed and put in place and there can be that entire care pathway through. I will not say that I think that that would shorten the illness, because I do not know. The hon. Lady probably knows more than I do, but I would think that an effective treatment plan with CBT and everything that is involved in that would provide a better outcome than piecemeal interventions along the way.
The right hon. Gentleman’s first point was careful consideration of Beat and so on. I am a huge admirer of Beat. It provides an incredible service. Its helpline deals with 30,000 people a year, I think, if I am not mistaken—it is a few weeks since I saw Beat. The support service that it provides, particularly to young women who are looking for someone to talk to and advice and help, is second to none. We are absolute supporters of Beat.
Let me just go on to the point made by my hon. Friend the Member for Broxbourne (Sir Charles Walker) about diabulimia. It is also of course the point that the right hon. Member for Knowsley raised repeatedly. We are absolutely committed to ensuring that people with diabulimia receive the treatment that they need. That is why NHS England announced in February 2019 the piloting of services. The services are being piloted on the south coast and in London, and NHS England will evaluate and monitor the pilots and take the learning from them. I will raise what the results show, if the results are through yet from the pilots, and what learning there has been and how it will apply across the UK.[Official Report, 19 March 2020, Vol. 673, c. 13MC.] I am sure that the officials will take a note, and when I have had that meeting, I will report back to the right hon. Gentleman and let him know exactly what the findings are and where we are going on that. The group that we are talking about is very small, but it is at the extreme end and requires very serious consideration.
I think that those are all the points that were raised and that I need to answer.
Barbara Keeley
Could I remind the Minister of another two? I think that a number of us raised the issue of training, and I asked whether she would be a champion of improving training.
Barbara Keeley
There is also the question about when waiting time targets will be introduced for adult eating disorder services.
Ms Dorries
Absolutely. On training for GPs, I take the hon. Lady’s point exactly. The NICE guidelines are incredibly clear, in terms of the Hope Virgo campaign and taking BMI, weight and other things into consideration. The NICE guidelines are clear, and it is up to the clinical commissioning groups to ensure that GPs and others do not take weight as a consideration. Tim Kendall is all over this and is working on it. We want GPs and others to abide by what are already very strict NICE guidelines. We have the guidelines; we just need the medical profession to implement them, but I had an idea when the hon. Lady asked her question. We are talking about training for GPs with the General Medical Council and we will continue to hold conversations about that, and I am sure that NHS England is doing exactly the same thing, but there are quicker ways to get information through to GPs.
When I was a nurse and I was training, it was the Nursing Times that informed us, on a weekly basis, of what was new in treatments and operative procedures. For GPs, it is Pulse and other magazines that they receive. I think that there might be a quicker way into GPs’ surgeries to alert them to the fact that the NICE guidelines are not being applied by GPs or by clinical commissioning groups. I think that there may be more inventive ways around that. Yes, training GPs absolutely is important; it is important to include this issue in the GP training programme, but in terms of getting a message through to GPs now, I think that we need to look at a more innovative way of doing that.
On money being diverted and ring-fenced, I think that the hon. Lady knows that the money from the £2.3 billion that goes to the CCGs is ring-fenced for mental health services only. They are not allowed to siphon it off and use it for anything else. We have our own queries as to whether some are doing that, and I know that NHS England, because I raised this with it the last time I met it, is doing an evaluation of clinical commissioning groups and having a look and checking that that money, which is ring-fenced, is spent only on—
Andrew Rosindell (in the Chair)
Order. Could I ask whether the Minister intends to give the proposer of the motion his usual two minutes to wind up the debate?
Ms Dorries
I think that the right hon. Gentleman, if he wants to talk to me at any time, knows that he can catch me anywhere. I will now give way to him.
Andrew Rosindell (in the Chair)
I thank the Minister and call Sir George Howarth.