Asked by: Nadia Whittome (Labour - Nottingham East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether he has had recent discussions with NHS England on the adequacy of guidance issued to patients with severe and enduring eating disorders.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
No such recent discussions have been held. NHS England continues to work with systems and healthcare professionals to support the adoption of guidance from the Royal College of Psychiatrists on medical emergencies in eating disorders. This guidance includes severe or enduring eating disorders.
Asked by: Emma Lewell-Buck (Labour - South Shields)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many hospital admissions were there for (a) scurvy, (b) rickets and (c) vitamin D deficiency in England in the latest period for which data is available, broken down by age groups (i) 0-5 years, (ii) 5-10 years, (iii) 10-16 years and (iv) over-16 years.
Answered by Neil O'Brien
The following tables show activity in National Health Service hospitals and NHS-commissioned activity in the independent sector in England. NHS England has provided a count of Finished Admission Episodes with a “primary” or “primary or secondary diagnosis” of scurvy, rickets, vitamin D deficiency and malnutrition by age group for 2022/23.
| Primary Diagnosis | |||
Patient Age (years) | Scurvy | Rickets | Vitamin D Deficiency | Malnutrition |
0-4 | 1 | 29 | 47 | 12 |
5-9 | 3 | 4 | 21 | 8 |
10-16 | 1 | 2 | 60 | 24 |
17 or over | 9 | 2 | 752 | 741 |
Primary or Secondary Diagnosis | ||||
Patient Age (years) | Scurvy | Rickets | Vitamin D Deficiency | Malnutrition |
0-4 | 5 | 317 | 2,052 | 71 |
5-9 | 5 | 30 | 1,757 | 45 |
10-16 | 5 | 56 | 5,251 | 153 |
17 or over | 151 | 77 | 176,317 | 10,301 |
Source: Hospital Episode Statistics (HES), NHS England
The root causes of malnutrition may be clinical (for example disease-related), social and/or economic. These problems often interact in a complex cycle. Some health conditions can lead to malnutrition including eating disorders, although malnutrition itself is not an eating disorder.
Asked by: Emma Lewell-Buck (Labour - South Shields)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many hospital admissions for malnutrition in England were there in the latest period for which data is available, broken down by age groups (a) 0-5 years, (b) 5-10 years, (c) 10-16 years and (d) over-16 years.
Answered by Neil O'Brien
The following tables show activity in National Health Service hospitals and NHS-commissioned activity in the independent sector in England. NHS England has provided a count of Finished Admission Episodes with a “primary” or “primary or secondary diagnosis” of scurvy, rickets, vitamin D deficiency and malnutrition by age group for 2022/23.
| Primary Diagnosis | |||
Patient Age (years) | Scurvy | Rickets | Vitamin D Deficiency | Malnutrition |
0-4 | 1 | 29 | 47 | 12 |
5-9 | 3 | 4 | 21 | 8 |
10-16 | 1 | 2 | 60 | 24 |
17 or over | 9 | 2 | 752 | 741 |
Primary or Secondary Diagnosis | ||||
Patient Age (years) | Scurvy | Rickets | Vitamin D Deficiency | Malnutrition |
0-4 | 5 | 317 | 2,052 | 71 |
5-9 | 5 | 30 | 1,757 | 45 |
10-16 | 5 | 56 | 5,251 | 153 |
17 or over | 151 | 77 | 176,317 | 10,301 |
Source: Hospital Episode Statistics (HES), NHS England
The root causes of malnutrition may be clinical (for example disease-related), social and/or economic. These problems often interact in a complex cycle. Some health conditions can lead to malnutrition including eating disorders, although malnutrition itself is not an eating disorder.
Asked by: Rupa Huq (Labour - Ealing Central and Acton)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether he is taking steps to improve access to (a) technological and (b) psychological support for people with diabetes.
Answered by Will Quince
The latest technological support for people with diabetes, the hybrid closed loop system (the ‘artificial pancreas’) is currently progressing through the final stages of a Technical Assessment by the National Institute for Health and Care Excellence. Ensuring that these technologies can be provided on the National Health Service at a cost-effective price increases access to these technologies for all eligible people.
The latest data shows over 60% of people with Type 1 diabetes were prescribed flash glucose monitoring, against an NHS Long Term Plan target of 20%. When the programme commenced, Flash was twice more likely to be prescribed to patients living in the most affluent areas. The current ratio between most and least affluent is now down to less than 1.2 times more likely, with many areas reporting complete parity.
As of October 2022, 97% of pregnant women living with type 1 diabetes were offered continuous glucose monitoring. The latest figures indicate that there is equitable access to the technology across deciles and ethnicities in the Indices of Multiple Deprivation.
NHS England has commissioned digital support programmes for people with diabetes. People with type 1 diabetes can self-refer to ‘MyType1 Diabetes’ and people with type 2 diabetes can self-refer to the online Healthy Living Programme.
Approximately 72% of children and young people living with type 1 diabetes have registered with the Digibete app, a free online service to support children and young people to manage their type 1 diabetes.
The Spring 2023 Budget contained a package of over £400 million to support the long-term sick, and disabled. This includes approximately £200 million for digital mental health – to modernise NHS Talking Therapies services in England. NHS Talking Therapies services provide evidence-based psychological treatments for people with depression and anxiety disorders, and comorbid long-term physical health conditions such as diabetes.
Building on Type 1 Disordered Eating (T1DE) pilots the NHS Diabetes Programme approved funding for five additional T1DE sites.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 17 July (HL8936), when updated guidance will be available from NHS England; how the "transformation" of adult eating disorder (AED) services will be defined and its effectiveness assessed; and by what date integrated care systems will be expected to have transformed AED services.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
To support services to plan and implement improvements, NHS England has developed a community mental health roadmap intended to set out the different elements which make up the delivery of the NHS Long Term Plan commitments on community mental health transformation, including eating disorders. A transformed adult eating disorder service is defined as:
- Specialist teams that are able to provide support to a spectrum of severity and different types of eating disorders;
- Able to embed lived experience in service development and delivery;
- Supporting early intervention using models such as First Episode Rapid Early Intervention for Eating Disorders (FREED) and not employing body mass index or weight thresholds;
- Working with primary care to provide clear arrangements for medical monitoring;
- Working jointly with children and young people’s services, particularly to support smooth transitions; and
- Able to accept self-referrals and referrals from primary care and voluntary, community and social enterprise organisations.
NHS England routinely monitors performance returns from integrated care systems to track progress against these deliverables.
Since April 2021, all integrated care systems have received fair-share funding to transform their adult community mental health services, including eating disorders, with the expectation that all will have transformed adult eating disorder services in place by March 2024.
Asked by: Baroness Parminter (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government how many inpatient beds are available to the NHS for eating disorder patients in (1) England, (2) the North of England, (3) the Midlands and East of England, (4) London, and (5) the South of England; and, for each of those regions, how many are available for (a) children and young people, and (b) adults.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The following table shows the information requested on specialised inpatient beds for eating disorder patients:
| England | North of England | Midlands and East of England | London | South of England |
Children and young people | 238 | 27 | 125 | 50 | 36 |
Adults | 400 | 129 | 97 | 99 | 75 |
Total | 638 | 156 | 222 | 149 | 111 |
Source: NHS England
Notes:
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the effectiveness of specialist day care provision and home-based treatment for eating disorders, as compared to inpatient treatment for (1) children and young people, and (2) adults.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
NHS England is refreshing guidance on children and young people's eating disorders, with an increased focus on early identification and intervention. Updated guidance will highlight the importance of improved integration between community eating disorder services, wider children and young people's mental health services, schools, colleges and primary care. This will improve awareness, provide expert advice and improve support for children and young people presenting with problems with eating.
In 2019, NHS England published an addendum to the national Children and Young People’s Eating Disorder Guidance to include guidance on integration between community eating disorder services and inpatient and day care services, noting that “children and young people should be treated as close to home as possible, at the earliest opportunity, to substantially reduce the need for admission and length of stay”.
In 2022/23, 47% more children and young people have started National Institute for Health and Care Excellence concordant evidence-based treatment in the community, compared to 2019/20.
For adults, National Health Service guidance on intensive day patient treatment and home-based treatment outlines that intensive day patient treatment provides step-down care from inpatient treatment or an alternative to admission.
It may be provided by either an inpatient unit or a community eating disorder (CED) service, at least four to five times a week, and should include support around main meals as well as encouraging people to learn skills and engage in activities that contribute towards their recovery. Integrated working across day patient and CED services can help support people to live in the community and prevent relapse or readmission.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the commissioning of integrated services for eating disorders for (1) children and young people, and (2) adults.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
NHS England is refreshing guidance on children and young people's eating disorders, including to increase the focus on early identification and intervention. Updated guidance will highlight the importance of improved integration between dedicated community eating disorder services, wider children and young people's mental health services, schools, colleges and primary care to improve awareness, provide expert advice and improve support for children and young people presenting with problems with eating, whilst ensuring swift access to specialist support as soon as an eating disorder is suspected.
Improving adult eating disorder (AED) services is a key priority for NHS England and a fundamental part of our LTP commitment to expand and improve mental health services.
The NHS Long Term Plan sets out an ambition to give 370,000 adults and older adults with severe mental illness, including eating disorders, greater choice and control over their care and support them to live well in their communities by 2023/24. This includes creating integrated pathways of care across primary care, mental health services, VCS organisations, and social care, for people with severe mental illness. This programme will deliver just under £1 billion of additional funding per year for transforming community mental health by 2023/24.
Since April 2021 all integrated care systems (ICSs) have received fair-share funding to transform their community mental health services, including eating disorders, with the expectation that all ICS will have transformed AED services in place by 2023/24.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether they will publish the data for waiting times for adults needing treatment for eating disorders; and if so, when.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
We are working with NHS England on the introduction new waiting time standards for mental health as part of its clinically-led review of NHS access standards. One of these is that adults and older adults presenting to community-based mental health services, including eating disorder services, should start to receive help within four weeks from referral. A date for its introduction has not yet been set.
Asked by: Lord Weir of Ballyholme (Democratic Unionist Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of any increase in the number of cases of people with eating disorders since the COVID-19 pandemic.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Whilst we do not hold information on the numbers of adults requiring treatment for eating disorders, we know there has been a rise in demand amongst children and young people.
Around 12,500 children and young people started eating disorder treatment in 2021/22 – an increase of 16% on the previous year (around 10,700) in 2020/21.