Eating Disorders: Provision of Care

Lord Lexden Excerpts

Tuesday 4th February 2020 Lords Chamber

[Lord Lexden (Con)]

My Lords, I cannot claim to be an expert on the subject of this very important debate, for which we are indebted to the noble Baroness, Lady Parminter, who has done so much to help make known the extent of the suffering associated with eating disorders and involved herself so fully in the work of bringing relief to those who suffer, while promoting greater understanding of the causes of this deeply distressing condition.

My participation in this debate stems from my admiration for all that is being done by our remarkable health professionals—often in difficult circumstances, as we have heard from the noble Baroness—and by so many members of staff in our country’s schools to help those afflicted by eating disorders. It is on education that I will concentrate, drawing on the work and great experience of my friend and close colleague, Neil Roskilly, chief executive of the Independent Schools Association, a body that represents the interests of some 550 smaller independent schools, and of which I am president. Our member schools are increasingly sensitive to the needs of children who develop eating disorders or are at risk of doing so. Forming small, closely knit communities, they are only too ready to share the expertise that they are accumulating with state schools in the spirit of partnership that increasingly characterises the relationship between the two sectors of education. The more closely that they can be drawn together, the more our country will gain.

Schools in many parts of the country can now benefit from the excellent work being done by the charity Beat, which was mentioned by the noble Baroness, Lady Parminter, and with which she is closely associated. It is making a major contribution, particularly through its expanding programme of training for schools, and is keen to do more. I shall return to it later in my remarks.

Schools are inevitably in the front line where eating disorders are concerned. Teachers and others in the school community, including of course catering staff, occupy a key position. They can spot the warning signs and so secure early recognition and intervention, which are vital if young people are to gain access to the expert support that they need in the early stages of their difficulties. As we all know, eating disorders are ultimately not about food; rather, they are symptoms of underlying mental health needs that, through training the key people, can be recognised and addressed, so the resources must be adequate to provide the essential training in schools.

Public discussion and debate are essential too in helping sufferers overcome the shame and the need for secrecy that they often feel. Weight loss is only one of the possible symptoms. No less important can be indicators such as mood and behaviour. Irritability, restlessness and difficulty in concentrating in class can all too easily be explained away if school staff have not received the training that is needed to probe the real difficulties successfully, so equipping school staff with the skills to encourage children in the most sensitive way to talk openly about their feelings must be a central part of any training.

It is so very important to combat the stigma that still attaches to eating disorders, the stigma that treats them as a sign of vanity or a means of gaining attention. The Government’s recognition that more needs to be done in training schools to banish stigma and identify the early signs of trouble is to be warmly welcomed. The funding announced last year for the national mental health programme, working with the NHS, is an important start, although the target of training a senior member of staff to lead on mental health issues in all schools over the next four years is not perhaps as ambitious as many hoped.

More thought needs to be given to the long-term improvement of clinical referral services for children. With more teachers trained to lead on mental health issues in schools, demand for early access to expert NHS clinical support will increase. At the moment services vary far too much in quality and extent across the country. Instances of children being turned away by the NHS because their condition has not become life-threatening are a cause for grave concern.

A mentally ill child faces an almost insurmountable barrier to learning. In view of the need for early intervention, and the large potential cost to the NHS and families of the growing number of severe cases, the vital work of charities such as Beat in schools should be recognised and supported.

Working in co-operation and in partnership with the Government, charities can help achieve the progress we all want to see accomplished. Beat’s Spotting the Signs training for schools is now available widely in the north and in some other parts of our country. It will be extended as further resources allow. Beat is also working with organisations such as the Independent Schools Association, which I mentioned at the outset, to make more teachers aware that a child’s mental health is just as important as their physical health. That surely is an absolutely fundamental point.

It is in schools that part—a significant part—of the answer to the urgent problems at the centre of this important debate can be found. I end by thanking the noble Baroness, Lady Parminter, again for initiating it.

Health: Eating Disorders

Lord Lexden Excerpts

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness, I know, has personal expertise in this area, and I thank her for her Question. As she knows, we have taken seriously trying to expand and improve eating disorder services in the country. We have invested the extra £30 million in community care and introduced the new waiting time standard, which we are on target to meet. But she is right to say that we need to improve in-patient care as well, and we are working hard to deliver on that.

[Lord Lexden (Con)]

My Lords, in view of the key role of schools in responding to mental health issues such as eating disorders, what progress have the Government made in giving schools the vital training support that they need in this area?

[Baroness Blackwood of North Oxford]

My noble friend is right that schools are important if we are to deliver on our commitment to the earlier diagnosis and prevention of mental ill-health, particularly in the area of eating disorders. We are introducing new school and college-based mental health support teams, the first of which are now becoming operational. We are also piloting four-week waiting times in 12 areas to improve access to children’s and young people’s specialist mental health services, which link to those schools, and we will evaluate performance on that.

The NHS

Lord Lexden Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Lexden (Con)]

It is an immense pleasure to follow my favourite Bishop. Fortunately, none of the others are here to learn that I care for them less.

I would like to offer a few reflections on the historical background to this important debate, introduced so memorably by the noble Lord, Lord Darzi. I am a historian and a few words about what happened in the 1940s would perhaps not come amiss. I should say at the outset that I take a view very different from that of the noble Lord, Lord Pendry.

In this very month 74 years ago, the then Minister of Health broadcast a message of historic importance to the nation about the Government’s plans for a national health service. He said:

“Whatever your income, if you want to use the service … there’ll be no charge for treatment. The National Health Service will include family doctors whom you choose for yourselves, and who will attend you in your … homes when this is necessary. It’ll cover any medicines you may need, specialist advice, and of course hospital treatment whatever the illness”.


It was with these words in July 1944 that Henry Willink, the Conservative Minister of Health in Churchill’s wartime coalition, heralded a new era in which comprehensive health services would be available to all, free at the point of use. It would be the fulfilment of the vision that Neville Chamberlain, a formidable Health Minister in the 1920s and the greatest of all Tory social reformers, had hoped would one day be accomplished.

Willink set to work. The British Medical Association swiftly assumed the role that was to become so familiar to British politicians over the years, putting the self-interest of its members before all other considerations. Willink was an able but emollient man. He made many concessions to the BMA, though without weakening the Tory commitment to the principles of universality and free delivery of services underlined in the 1945 Conservative election manifesto.

Today, no one remembers Henry Willink, who gave up politics in 1948 to become the master of a Cambridge college, while enduring fame is attached to his successor. Nye Bevan fought the BMA with vigour and panache, which Willink would never have done. He too made significant concessions but his ferocious public rows with the BMA dominated the headlines, while his concessions attracted much less notice. This worked hugely to Bevan’s advantage. As his perceptive biographer, the leading historian Dr John Campbell, has observed,

“it was politically useful to Bevan that the BMA made such a fuss. It seems clear that Bevan privately welcomed, if he did not positively encourage, the BMA’s help in making the NHS appear a more socialist measure than it really was”.

There was not a great deal in Bevan’s plans that the Tories found wholly objectionable; after all, they shared the same objectives. But Bevan, consummate party politician that he was, exploited the Tories’ decision to oppose the complete nationalisation of hospitals. He relished blackening their name as the enemies of a great national reform. It was on the evening before the NHS came into operation that he made his notorious speech denouncing them as “lower than vermin”.

One of the great tragedies, perhaps, of the fierce partisan wrangling that took place over the structure of the NHS is that no one thought about its cost, even in Whitehall. Finance was not discussed as the legislation went through Parliament. As a result of this omission, politicians of both parties would be plunged into recurrent funding crises over the next 70 years. Bevan’s achievement was prodigious. Nevertheless, as John Campbell has pointed out,

“it must be said that too much can be claimed for him, and in Labour mythology often is”.

There was wide cross-party support for the NHS at its inception, just as there is today on its 70th birthday. It is perhaps a time for remembering Sir Henry Willink, as well as the great Nye Bevan.

Children: Oral Health

Lord Lexden Excerpts

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

That is one idea that I will certainly take away. Some of the impact that we are having is on reformulation, which is perhaps even more preventive than putting toothbrushes in cereals. There is a plan to reduce sugar in key foods by 20% by 2020, specifically for the benefit of children.

[Lord Lexden (Con)]

Does not part of the answer to this problem lie in that attractive four-letter word “milk”? Does not research evidence show that milk helps to protect the teeth of young children, as well as combating obesity?

[Lord O'Shaughnessy]

I am sure that milk does have those benefits. I should also point out that one of the best things one can do for all bone health is to have vitamin D and calcium supplements, which are recommended for young children.

Health: HIV

Lord Lexden Excerpts

Monday 5th September 2016 Lords Chamber

[Lord Lexden (Con)]

My Lords, it is a great pleasure to follow my noble friend Lady Bottomley, who is as enthusiastic today as she was when she held office, with such distinction, as Secretary of State for Health.

In the last few years, the House has become accustomed to returning, from time to time, to this grave public health issue. So often the impetus has come from the noble Lord, Lord Fowler, an unwavering friend to all of us, regardless of party, who believe strongly that, though very significant progress has been made, not least as a result of his courageous work in the 1980s, much remains to be done. Above all, the country at large needs to be made aware that the disappearance of stories of heart-rending agony from the front pages of our newspapers does not mean that a great crisis has been almost entirely resolved and that the political agenda no longer needs to make much provision for it. As we have heard, HIV continues to spread rapidly. Public opinion requires a wake-up call. In these circumstances, it surely must be right for us to press the Government to commit themselves firmly to the objective of eliminating this terrible scourge.

My noble friend Lord Black, a close personal friend for exactly 30 years, has performed a signal service by securing this most timely debate. Concerns about the prospects of steady further progress are accumulating to such an extent that serious anxiety now exists among the valiant organisations that work so hard on behalf of actual and potential HIV sufferers. Wide publicity has been given to one of the principal concerns, the delay in introducing a miraculous new drug. It is tragic that protracted action in the courts should have become necessary. It is tragic, too, that some have sought to create tensions between those dedicated to the relief of HIV and others suffering grave hardship from other sources. As my favourite Times columnist, Janice Turner, put it recently, at its heart, the PrEP controversy shows where tolerance of gay lives ends.

I will touch briefly on another of the many sources of concern. It is becoming evident that, as a result of the Health and Social Care Act 2012, the provision of HIV and other sexual health services is in danger of becoming seriously fragmented. The crux of the problem seems to be that the division of commissioning responsibilities between NHS England, clinical commissioning groups and local authorities is confusing and unclear. The damaging implications have been the focus of a detailed inquiry by the All-Party Group on HIV and AIDS. Its report will be published shortly. In the light of it, the Government will surely need to consider how they can ensure that HIV prevention and testing are not set back, particularly at a time of falling local authority budgets. They will also need to clarify where the responsibility for commissioning HIV support services actually rests.

Finally, I will say a word about Northern Ireland, for this debate relates to the whole United Kingdom. I have always been particularly interested in all that happens there, including during the time that my noble friend Lord Prior’s father was its deeply committed Secretary of State, more than 30 years ago. The greatest concern of Positive Life, Northern Ireland’s only HIV-specific charity, is the heavy stigma that still attaches to HIV in the Province. It is pressing for investment in education and the raising of greater awareness in both schools and the wider community. It states:

“There has been little communication with the public since the 1980s and a recent public health advertising campaign did little to address the misinformation and myths that surround the condition”.

There could be no more telling reminder of the continuing need to combat prejudice wherever it arises, a point made repeatedly by the noble Lord, Lord Fowler, and emphasised in his book AIDS: Don’t Die of Prejudice. Policy in Northern Ireland is, of course, determined at Stormont, but its leaders must always be able to look to the Government here for an unwavering, resolute approach to combating HIV and for encouragement to emulate it.