NHS Eating Disorder Services

Baroness Parminter Excerpts

Thursday 29th June 2023 Lords Chamber

Asked by

[Baroness Parminter]

To ask His Majesty’s Government, further to the publication of the report by the Parliamentary and Health Service Ombudsman Ignoring the Alarms: how NHS Eating Disorder Services are failing patients, in December 2017, what progress has been made in relation to NHS Eating Disorder Services.

[Baroness Parminter (LD)]

My Lords, as this Question for Short Debate makes clear, in 2017 the Parliamentary and Health Service Ombudsman published its inquiry Ignoring the Alarms, which outlined the severe failings of National Health Service eating disorder services after its investigation into the death from anorexia of 19 year-old Averil Hart and two other young women. That was also the year when my eldest daughter was diagnosed with anorexia, so we began our journey through CAMHS and the adult eating disorder services, community care, day hospitals and in-patient settings. During our journey, in 2019, the Public Administration and Constitutional Affairs Committee down the other end of the building undertook a follow-up inquiry into the PHSO report and found that the necessary steps that the PHSO had asked for were not being undertaken.

In February this year, the Health Service Journal looked into the deaths of 19 people from eating disorders where the coroners had indicated concern about the level of care. Issues about care in those services were highlighted six years ago by the PHSO, the three main issues being delays in treatment to get care, shortages of beds and paucity of medical training. It is very clear that very little progress has been made in six years.

I turn to the first of those three areas, delays in treatment. We know that the number of people, particularly young people, suffering from eating disorders skyrocketed during Covid and the associated lockdown, but even back in 2016, before the pandemic, the PHSO said that there needed to be an audit of National Health Service eating disorder services, because there had not been one. Anyone in business knows that if you do not measure something, it does not matter. You cannot make management choices and management decisions unless you know what the services are.

That audit did not take place. I have been asking about it consistently. I see the noble Lord, Lord Evans, on the Front Bench. As recently as March, I asked him when this audit—which, according to the PHSO back in 2016, is urgent—would take place. That NHS audit still has not been authorised. I ask the Minister who will respond to the debate when that initial step of an audit of existing eating disorder services will be undertaken.

Equally, the PHSO said that there needed to be much clearer parity between adult and children’s eating disorder services. For perfectly understandable reasons, improving children and young people’s services was the priority. Children have a waiting time standard, but there is still no such standard for adults. Beat, the leading charity in this space, suggests that as little as 1% of adults with eating disorders can currently access specialist care and that the average wait time is two years. Eating disorders can be fatal, but if they are treated quickly they can be recovered from. Let us not forget that eating disorders do not start just when you are a child; they can start when you are an adult. If you are waiting for two years, that critical window of opportunity to stop you requiring further expensive hospital treatment later on will be missed.

Given that NHS England has identified an access and waiting time standard for adults with eating disorders, why have Ministers not approved it, given it the necessary funding to implement it and committed to monitor it as we move forward? As I said, we know that if people do not get these services quickly they will get worse, which will mean they will require more costly hospital treatment. There is still a dire shortage of specialist in-patient beds for people with eating disorders.

I know this myself. When my daughter first needed a specialist bed back in 2017, there was none. As a 17 year-old, she had to spend a month in a general hospital, in a busy adult ward, while they tried to keep her alive through force-feeding, because there were no beds anywhere in the country. When one became available, it was in Birmingham, over 100 miles from where we live. She was there for six months. My husband and I were able to afford the travel, and to take the time out of attending the House of Lords to go to all the relevant meetings, but that is not feasible for a lot of people.

It is still going on. When my daughter needed a second bout of in-patient treatment last year, she was, fortunately, sent to an excellent hospital in Buckinghamshire, much nearer to Surrey. But there were people with her in that hospital from Devon. You can be sent literally anywhere because there is such a shortage. When I last asked a Question about how many NHS beds there were for adults, the Answer the Minister gave was around 400. This is when we know that the number of people suffering from eating disorders is skyrocketing, and there are times when they need that specialist care.

Let us not forget: people with severe and enduring eating disorders can recover. You still find people who recover after having eating disorders for decades, and it is the job of the state to hold those people in safety, to keep them alive until they are ready to recover. At the moment, just as the PHSO said back in 2016, we are still failing to have enough beds for those with severe and enduring eating disorders.

I am sure that the Minister will tell us about some of the really good things that the Government are rightly doing, such as investing and rolling out the FREED programme, which is about ensuring that we get to people quickly when they have initially been identified. We have rolled that out a bit, but we must not forget that we still need treatment and hospital beds for those who are severe and enduring.

The third area that the PHSO focused on was the paucity of training for medics on eating disorders. It was identified that a medic was likely to get under two hours of training on eating disorders—under two hours on an illness which, as many Members will know from people in their own families or acquaintances, is becoming something we recognise is happening everywhere.

There has been some progress. I commend the work of the GMC and others, who have put together online resources that medical students and year one foundation doctors can now be provided with, but these are voluntary, not mandatory. I commend the work of the Royal College of Psychiatrists, from whom I benefited from having a parliamentary scholar for a short while: they have initiated a credentialling scheme for training doctors to improve care for eating disorder services. In year one, it has only 30 doctors. It is a start, but we are at the foothills of what needs to be done in training.

There is one resource, which has been produced in the last year by the Royal College of Psychiatrists and has been endorsed by the Academy of Medical Royal Colleges, called the Medical Emergencies in Eating Disorders guidelines. I think that this is a superb resource. It aims to help anyone—whether you are a GP, nurse, therapist, dietician, paediatrician—who is faced with someone presenting with eating disorder symptoms with how they can risk-assess that person. There is a very straightforward risk assessment tool with a traffic light system. There is even a two-page summary, so, if you are a nurse and have not really had any training on eating disorders—or if you are in an A&E unit, where you often find people coming in with eating disorders—you can just download the two pages. These pages are a checklist of what you need to look out for. This is a really superb resource, which has been provided as a way to try to fill many of the gaps, which have been allowed to result in unnecessary deaths, which happened because people just did not know what to do.

I do not know—I do not imagine the Front Bench opposite will know—how that resource is being promoted. I do not ask but urge the Minister, when he goes back to his new department, to ask how it is promoting the MEED guidelines, because I think they could be a powerful way to stop some of the unnecessary deaths that are happening as a result of eating disorders.

I am running out of time, so I will end by saying that, despite the doom and gloom—I really am worried about the unnecessary deaths that are happening on this Government’s watch—there is much that is good going on. I commend all the staff who are caring for people like Rose, in difficult circumstances, and the campaigners and the families for all that they do. However, I say to the Minister that, six years on, very little progress has been made. The people suffering from these vicious, cruel diseases deserve so much more.