Eating Disorders Awareness Week

Barbara Keeley Excerpts

Thursday 5th March 2020 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this debate with you in the Chair, Mr Rosindell. I congratulate my right hon. Friend the Member for Knowsley (Sir George Howarth) on securing this important and timely debate, and for the excellent way he opened it, which was very helpful. It has been a compact debate, but he covered a wide range in what he said.

I welcome the contributions of the hon. Member for Broxbourne (Sir Charles Walker), particularly when he spoke about the moving case of his young constituent who took her own life, which is always sad to hear; the hon. Member for Strangford (Jim Shannon), and the SNP spokesperson, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). I agree with her about using the debate today as a starting point. There is much that we should be talking about.

As we have heard, eating disorders are serious mental illnesses that affect too many people in this country. It is estimated that there are currently 1.25 million people in the UK with an eating disorder. It is a serious issue that we should be talking about, even more so because that is only an estimate as we do not have reliable data on the prevalence of eating disorders in the UK. The hon. Member for Strangford talked about that; it is an issue that we must take forward from the debate today. It is part of a broader problem with our data on mental health conditions, although we must acknowledge that some of it comes down to the stigmatisation of eating disorders.

Eating disorders can affect people of all ages, from instances among children as young as six years old, which should alarm us, to women in their seventies. Around three quarters of people with an eating disorder are women but, as we have heard in the debate, eating disorders also affect men. We need to be careful not to stereotype when we describe people affected by eating disorders because it can deter men and young men from seeking help.

Anorexia has the highest mortality rate among all psychiatric disorders because of the severe medical complications that it can cause, but all eating disorders have an impact on the daily life of people who live with them. It is vital that eating disorder services are there to support people when they need it. It is my belief that too often people with eating disorders are being let down by our NHS, and those of us who are interested in this must take that forward from here.

Someone with an eating disorder will currently wait an average of three and a half years before receiving treatment. Too often someone goes to their GP to ask for help, but simply does not get it, as we have heard. The eating disorder charity Beat, which we have all rightly mentioned in our speeches, found that nearly one in three people who seek a referral to an eating disorder service did not get one from the first GP to whom they spoke. These delays clearly go against the NICE guidance on ensuring prompt access to specialist services, and they come with an enormous emotional toll for the person involved. The hon. Member for Broxbourne talked about where that emotional toll can take somebody. Imagine having finally built up the confidence to go and ask for help only to be told, “You won’t get to see a specialist”.

Earlier this week, I spoke to people who are now recovering or recovered from eating disorders, who told me about their struggles to get support. I thank Beat for organising that meeting with MPs. One person was told by a doctor that she weighed too much to have treatment for an eating disorder, despite weighing only 38 kg, which is less than 6 stone. Let us imagine that weight. I also heard about a doctor praising over-exercising, as if that were a good thing. We heard from my right hon. Friend the Member for Knowsley that Mel C had the problem of obsessively exercising, which is another way people can seek to lose weight. Finally, a person was told that she needed to find the willpower just to eat. My right hon. Friend rightly criticised the attitude of underestimating the difficultly of the condition and the danger of the “just get a grip” attitude. We have to get over that and clearly it is even more damaging when it comes from clinicians.

People with bulimia have been denied treatment based on the frequency, or lack of frequency, of their bingeing and purging episodes. The continued focus on weight that we have talked about is particularly concerning as bulimia, along with other over-eating disorders, does not always lead to excessive weight loss. My right hon. Friend and the hon. Member for Strangford talked about Hope Virgo, the campaigner who leads the Dump the Scales campaign. That campaign tells us that clinicians are still using measures such as BMI to assess whether someone is eligible for eating disorder treatment, as I was told by the young person I met this week.

That is another instance where NICE guidelines are not being correctly followed, meaning people are being turned down for the support they should receive. Is someone who has been told they are ineligible for help after visiting their GP really going to go back and ask again and again, until they get the help they need? Or are they going to struggle with their eating disorder, potentially deteriorating to the point where they need to be admitted to hospital?

We should emphasise that the situation is not necessarily the result of medical professionals not caring about eating disorders, but a reflection of the fact that medical schools have less than two hours’ training on eating disorders across the average medical degree. In fact, one in five medical schools do not cover eating disorders at all and, where they are covered, the subject is not in the final exam, meaning students will give it a lower priority.

We see doctors who think people cannot have an eating disorder if they have a healthy BMI, family GPs who are not confident that they should make an urgent referral to a specialist service and many doctors who have never seen a patient with an eating disorder before. The Parliamentary and Health Service Ombudsman and the Public Administration and Constitutional Affairs Committee have both recognised this and call for all doctors to receive proper training on eating disorders. The General Medical Council has said that it will engage with medical schools on the lack of training, but that is a long way from guaranteeing that all newly-qualified doctors will have basic levels of knowledge on eating disorders.

Will the Minister act as a champion for improved training on eating disorders, so that patients can see a doctor who has a basic understanding of what an eating disorder is and of how important it is that a patient sees a specialist? That would be a first step in ensuring that the NHS gives people with eating disorders the support they need. I say a first step, because even when people can secure a referral to a specialist eating disorder service, there is no guarantee that they will then get the help they need.

Colleagues have brought a number of statistics into the debate. In 2017-18, an adult referred to a specialist eating disorder service could expect to have to wait an average of nine weeks to start treatment. That is clearly not good enough. In no other area of mental health would we accept a wait of more than two months to see a specialist. The Government seem to have accepted that in the case of children and young people, where we are finally seeing the introduction of waiting time targets, but waiting time targets for adult services are still being piloted. Can the Minister tell us why that is the case and when the Government will introduce waiting time targets for adult eating disorder services, to ensure that everyone can access timely support?

Simply setting targets will not solve this problem. I am afraid we are seeing that in services for children and young people where, despite some progress since the introduction of targets, people with eating disorders still face a postcode lottery up and down the country. In my constituency, 97% of young people referred to a specialist eating disorder service are seen within a month, but if they live just yards away, across the border in Wigan, the chances of their being seen in that timeframe fall to 66%. That is not good enough. We need all areas of the country to be given the resources they need to give people with eating disorders appropriate and timely support.

Sometimes the right support can mean the person with an eating disorder getting hospital treatment, but there are only 649 specialist in-patient beds for people with eating disorders in England, and just 249 of those are for children and young people. According to NHS data, the most common age for admission to hospital for eating disorders is 13 to 15. More than 4,400 children were admitted to hospital for eating disorder treatment last year.

When their local hospital does not have enough beds, children are being sent miles away from their families for special treatment, because the NHS does not have the resources to treat them closer to their homes. My right hon. Friend the Member for Knowsley also raised the issue of the use of private healthcare companies and private hospitals; too often, in the case of beds not being available, the NHS relies on private healthcare companies to deliver the services. My concern is that many of those services have been falling well below the standards expected. Some 28 privately-run mental health units have been rated as inadequate by the Care Quality Commission in the past three years. Vulnerable people with mental health conditions deserve much better.

Another issue worth mentioning is that the available treatment does not match the length of duration of adult eating disorders, even when a patient can have treatment. Two thirds of adult eating disorders last for three years or longer, but the current NICE-recommended adult out-patient therapies span only one year, or something like 20 to 40 sessions, 30% of which will be in-patient services. Fewer than 20% recover. There is a mismatch in the resources, there is a mismatch in the number of beds and there is a mismatch in the length of time that therapies last. If we catapult somebody out of a service before they are recovered, then clearly there will be a relapse. We need more research on that, and the NHS needs more mental health beds to cope with demand.

My final point is that services also need to be properly funded. The Minister will know that for too long we have seen money intended for mental health services diverted to meet other short-term financial concerns in the NHS. Given the pressure on NHS services now that we have the coronavirus to deal with, one can see that there will be even greater pressure not to spend money on mental health, but to spend it on other services.

Until mental health funding is both increased and ring-fenced, mental health services will remain a lower priority than patching up buildings, meeting demand for physical health services or even increasing services to deal with coronavirus. If we want to see eating disorder services improve, we must do everything we can to ensure that mental health services are properly funded, starting with increasing and then ring-fencing the funding.

--- Later in debate ---

[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.

[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.

[Ms Dorries]

Sorry, yes, I will reply to that.

[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—