NHS Eating Disorder Services
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.
Baroness Wheatcroft (CB)
My Lords, I thank the noble Baroness, Lady Parminter, for securing this important debate. I welcome the Minister to his position and hope that he finds this a congenial setting in which to make his maiden speech.
I start on a positive note. My daughter, like Rose, suffered from anorexia for a long time. She was in a secure unit for nearly a year, and I shall be for ever indebted to Professor Janet Treasure, who ran the unit and who recognised that Lucy was not going to recover unless she was really taken in hand—she is a strong personality—and she was absolutely right about my daughter. However, the good news is that, at the end of September, Lucy will produce her third child. So recovery is possible, but it is not easy.
Anorexia nervosa is the most pernicious of diseases. It is the psychiatric illness that produces the highest number of deaths. At the moment, the number of cases is growing, but support is not. That is why this is such an important debate. We are all now encouraged to talk about mental health issues, but the problem is that not very much is being done about them, and the two need to be equated. It is no good being open about the problems unless we can be competent in dealing with them.
The charity Beat, which does a fantastic job, tells us that around 1.25 million people are suffering from eating disorders. A growing trend is that some of them are men. Beat reckons that around a quarter of that number are men. Money is short—we all know that—but it could be spent better on dealing with mental disease generally and eating disorders in particular.
The ombudsman report that the noble Baroness referred to is a frightening document, not least because it was produced in 2017 after a death that occurred in 2012. The fact that nothing very much has occurred even since then to put things right shows just how slow progress is in this area. The coroner’s report that was produced three years after the ombudsman report said that concerns raised in that report had simply not been addressed. That largely remains the case.
In the meantime, the waiting lists for treatment have got longer. The Lancet tells us that during the time of Covid the number of people identifying with eating disorders rose almost 50% above the levels that had been predicted. It was slightly lower than that in the older age group, but there was a huge leap in eating disorders among teenage girls aged 13 to 16—and that does not appear to have reduced.
The Government have promised more money, but a survey by Stem4, another charity dealing with teenage mental disorders, found that some youngsters were having to wait more than a year for treatment. That is after diagnosis, and we all know that getting a GP appointment is not an easy matter. Getting a GP appointment in person is even harder and, for somebody who is potentially suffering from an eating disorder but refusing—as many children do—to admit it, that GP in-person appointment is crucial for any diagnosis to be made. So the waiting time is now really dangerous, to the extent that sufferers are ending up in A&E because they are just too ill and have no option but to seek treatment.
I had hoped that by the time we met today we would be able to discuss the NHS workforce plan. On Sunday, the Prime Minister said that it would arrive this week, so time is getting short. Without that, it is hard to know exactly what plans the Government are making to deal with psychiatric illnesses. It is worth remembering that it takes 15 years to train a psychiatric consultant. It is a great shame we did not have that workforce plan a little earlier: there might have been more psychiatric consultants coming on stream rather sooner. Let us hope that tomorrow is the day the plan arrives, at long last. I look forward to the Minister enlightening us on that front—it was indeed promised.
The subject of online pornography came up in the previous debate. It is impossible to discuss eating disorders without acknowledging the pernicious effect of online sites, which definitely encourage youngsters to see it as an ideal to get thinner and thinner. I have talked to the Googles of this world and they know that those sites are there and that they are doing damage, but they are highly reluctant to take them down. Their answer is that on the top of these really dangerous pages they refer to Beat and suggest that the people who have gone out of their way to visit these sites because they want to get thin contact the charity, which will stop them doing what they want to do. The operators of those sites know that will not work, but they continue to do it. I like to think that some of the legislation that we are working on in this House at the moment will put paid to that sort of activity, because it encourages people, particularly children, into completely crazy body images.
There are other factors that impinge on them. Some noble Lords may have visited a shop called Brandy Melville, but I doubt that many will have purchased what it sells: teenage clothing that is very popular among a certain age group. The brand prides itself on providing that clothing in only one size: small. The message is clear: if you want to have this wonderful, fashionable clothing, you have to fit into it. Brandy Melville will not change its model; it has had plenty of criticism. That is the sort of message that continues to pervade. It affects our young people and we need to do something about it. We cannot shut down a clothing chain, but we can certainly tell it what we think, and I think it is despicable that that sort of message is sent to our youngsters. Small is not good enough.
The messages are everywhere, so it is really important that we get treatment out quickly. We should not forget—I speak from experience, as does the noble Baroness, Lady Parminter—that it is not just the sufferer who is affected by an eating disorder; it is the entire family. Some wonderful work goes on. There are support groups that help, but it is extremely difficult for people with late-teenage children who are suffering from anorexia. I believe that may well have impinged on the Hart case, in which the victim, in the end, was 19 when she died.
We have to respect, of course, that adulthood brings a degree of privacy. Doctors are often very reluctant to talk to parents of 18 or 19 year-olds about the medical problems that their youngsters may be suffering from, even though we know that that 18 or 19 year-old is simply not functioning like an adult because they are ill. But the doctors are worried about personal privacy and, in many cases, will not talk to the parents. The department could and should address that. I would very much appreciate it if the Minister could take that away and see whether there is a way of finessing it, because I know it has caused agony in some families. We were very lucky; others, not so much.
One of the things that came up in the coroner’s report and was first flagged up by the ombudsman was the need for co-ordination between the various bodies that help to address these issues. That is another issue which I would be grateful if the Minister could address, because organisations need to talk to each other if people are going to be healed.
Baroness Janke (LD)
My Lords, I too thank my noble friend Lady Parminter for securing a debate on an area that is of huge importance yet receives little public attention. I too welcome the Minister to his post.
In looking at the lack of progress on the parliamentary ombudsman’s report, I will highlight the importance of eating disorders in the lives of individuals and families. As the noble Baroness, Lady Wheatcroft, and my noble friend have said, eating disorders can be devastating not just for the individuals themselves but for the families and carers. My own knowledge is also of anorexia and I recognise many of the experiences that they mentioned.
Given the relentless responsibility that it places on families of trying to keep their loved one alive as the disease becomes embedded, parents and carers can feel like prison guards as they rigorously police the behaviour and everyday life of the person for whom they are responsible while trying to negotiate specialist treatment, often where little is available. As my noble friend Lady Parminter said, many families end up travelling huge distances to get specialist treatment for their child. Worse still, that devotion and care may be for someone who has become completely unrecognisable: transformed into a poor, suffering victim who will stop at no subterfuge or deception to achieve their compulsive desire to not eat. As their weight diminishes, the desire to reject food becomes ever stronger and rational argument has no effect whatever.
Treating anorexia early is essential to have any chance of recovery, as has been said, yet the availability of treatment is widely disparate across the country. The Government recognised the increasing number of referrals by allocating £11 million nationwide in 2018-19 yet, despite this, total spending rose by just £1.1 million. Only 15% of CCGs increased their spending in line with the increase in funding. Spending per capita on children’s and young persons’ community eating disorder services continues to vary widely across the country. Median spend was £4 per capita, with seven CCGs reporting a spend of less than £2 per capita. All this is despite the fact that 2019-20 marked the fourth year of the implementation of the access and waiting time standards for children and young people with an eating disorder, with the express object of ending the postcode lottery in services for those disorders. I hope the Minister will tell us what action he is going to take on this.
As has been said, post-pandemic hospital referrals of children and young people under 20 have massively increased. The lack of specialist services available has meant that young people diagnosed have been put into general wards, as has already been said. This is not just poor treatment; it is actually damaging and makes the condition worse.
Even worse, it is being reported that in the light of inadequate specialist services a new definition has been created, SEED, meaning severe and enduring eating disorders. This is reported now as providing grounds for rationing and, in some cases, withdrawing treatment because the patient is not getting well quickly enough. This shows a devastating lack of understanding on the part of medical staff and health providers of how these illnesses progress and factors such as weight loss and starvation affect the patient’s ability to think rationally and be motivated. It is, in effect, blaming the patients for the illness.
As we heard, the recommendations in the ombudsman’s reports have made little progress and in the latest report there is a particular emphasis on the need for political leadership from the Government to ensure that recommendations are taken forward in terms of staff training, improving leadership from the NHS and NHS England, and using the forthcoming serious incident framework to review learning from serious incident investigations. The report highlights that these do not appear to form the basis of learning for future action.
I, too, underline the need for political leadership from the Government. We particularly need a nationwide strategy to include medical and community services working together to provide a co-ordinated specialist approach for the growing numbers of sufferers and to end the postcode lottery. I would also like to see a public health campaign to spread public knowledge and awareness—not just for children and young people’s services but for schools, parents and families—to ensure early recognition and referral to specialist and medical services for sufferers before the disease becomes embedded, intractable and often, tragically, lethal.
There needs to be realistic investment of resources to provide the specialist care needed but also to further develop the understanding of the causes and the potential solutions to this growing, complex area of mental health. People should not be dependent on the devotion and specialism of certain practitioners who have devoted their lives to this; it should be part of training for general medical staff and providers of medical services and not a Cinderella service as far as research is concerned.
The failure to address these issues amounts to negligence, as we have seen from the ombudsman’s reports and the follow-up. It cannot be allowed to continue. I look forward to the Minister’s response.
Baroness Merron (Lab)
My Lords, I am very grateful to the noble Baroness, Lady Parminter, and congratulate her on securing what is, as we all acknowledge, a very important debate. As I am sure everybody did, I appreciated her openness in speaking about her experiences and those of her daughter, Rose. Her thorough introduction set up the debate strongly, particularly the emphasis on the need for auditing. Where are we in order that we should know where we need to go? I am sure the Minister will refer to that.
I very much welcome the Minister’s response to this debate, because he will be making his maiden speech, which I am sure we are all looking forward to. From these Benches, I welcome him to your Lordships’ House and to the Front Bench. I am sure we all look forward to many interesting and fruitful exchanges across the House.
This has been an enlightening debate not least because we have heard personal experiences, including from the noble Baroness, Lady Wheatcroft, who spoke about her daughter Lucy, and the noble Baroness, Lady Janke, who drew on her personal experience. She made the very good point—that has been made many times and she is right to make again—that it is not just the sufferer; their friends, their family and communities are also deeply affected.
I say to the Minister that that does not require a joined-up response across government because, again as the noble Baroness, Lady Wheatcroft, said, this is an assault, in so many ways; it is all around us, including online and through clothing stores. We have to bear that in mind and take the necessary action.
What is the backdrop to this debate? It is that we have some 1.25 million people in this country living with an eating disorder. As we have heard, eating disorders have high mortality rates, with anorexia claiming the most lives of any mental illness. Yet, with timely and appropriate treatment, people can live healthy and fulfilling lives. This important debate calls on the Government to up their game in both the prevention and treatment of eating disorders. Sadly, however, the pace of change has not been what it needs to be or what is called for by experts and by the evidence before us. It has been called for by sufferers and campaigners, yet the response has been somewhat wanting. The reality is that the number of people waiting for treatment following an urgent referral for a suspected eating disorder has increased considerably over recent years—not just for children and young people but for adults, and not just for women but for men. All are being affected; all are waiting.
NHS England data published for the first quarter of 2022-23 shows that, of the 229 children and young people currently on the waiting list for urgent treatment for eating disorders, 45% have been waiting for more than 12 weeks. This figure has risen substantially from 11% in the first quarter of 2021-22, and from 5% in the first quarter of 2020-21. That is the trajectory before us.
Since 2020, the NHS has had a national waiting time target for children and young people with an eating disorder—that 95% of urgent cases should receive treatment within one week and 95% of routine cases should receive treatment within four weeks—but the target has never been met. As the noble Baroness, Lady Parminter, asked, why is it that we only have a waiting time target for children and young people, important though that is? Why do we not have waiting time targets for adults? Perhaps the Minister could refer to that.
It is very likely that your Lordships’ House will hear from the Minister that the pandemic is at the root of this. Undoubtedly, the pandemic has had an impact, not least as eating disorders increased during that time—understandably, given the conditions created by the pandemic. However, despite us being way past the pandemic, the trajectory is only one way: waiting times for these treatments are on the up. Perhaps the Minister could tell your Lordships’ House why that is so.
We heard a very good introduction to the report of the Parliamentary and Health Service Ombudsman entitled Ignoring the Alarms. As we heard, it focused on the very sad case of Averil, who died having had a history of anorexia nervosa at 19 years old. She died in 2012 because of the failures of four NHS organisations that should have cared for her. The fact is that her death and other deaths were avoidable, because there had been multiple missed opportunities in the months before those deaths.
I was very struck by the briefing from the ombudsman, to which I paid great attention in preparation for this debate. The ombudsman says upfront that almost six years on, little progress has been made on children and young adults with eating disorders, who are still experiencing avoidable harms. The ombudsman says there was a problem before lockdown and that that, combined with the additional pressure on National Health Service mental health services, has meant there is a continuing struggle with demand. The ombudsman called for lessons to be learned to improve the necessary services, including a cultural shift and work across government to ensure that people are listened to, that services are joined up and that care plans are properly constructed. I hope your Lordships’ House will hear from the Minister today what assessment there has been of the progress on these points. Perhaps there could be an audit, as the noble Baroness referred to earlier, of what is in place to deliver the necessary improvements.
The workforce plan has one working day in which to arrive. I shall be positive and say that I look forward to it, after many years of anticipating it. Medical students get only two hours of training on eating disorders in their whole career, and this is wholly inadequate. I hope that, when we see the workforce plan, it identifies the whole team that is necessary to deal with eating disorders, deals with their recruitment, retention and remuneration, and ensures that we have the right mix and the right numbers as soon as possible.
Today, the ombudsman published a new report, which Members of this House have just received, entitled Broken Trust: Making Patient Safety More Than Just a Promise. The report is not specific to eating disorders, but its themes are crucial to reducing the risks faced by people with such disorders. Will the Minister confirm that the Government will respond to this report and, if so, how and when?
In closing, I ask noble Lords to think about where we are. In 2019, the Public Administration and Constitutional Affairs Committee found that insufficient action had been taken on every one of the recommendations made. It is true that there has been some progress—that has been acknowledged today and I too wish to acknowledge it—but I ask the Minister to tell us how progress and its impact will be assessed, and how we will ensure that the right changes and improvements are made and that they save the lives, and improve the quality of life, of many. With that, I very much look forward to the noble Lord’s maiden speech and welcome him once again.
Lord Mott (Con) (Maiden Speech)
My Lords, I thank the noble Baroness, Lady Parminter, for bringing forward a debate on this important topic. I know she has been a long-standing champion of those living with eating disorders. I also thank the noble Baroness, Lady Merron, for her kind welcome today and for her reassuring words in the Lobby earlier this week.
As this is my maiden speech, I believe it is customary to start with a few personal remarks, and I beg the indulgence of your Lordships to do this before I respond to the debate. I thank my fellow Peers, particularly those who do not sit on the Government Benches, who have been generous with their welcome and advice. I thank Black Rod and the officers and staff who have made me feel so welcome. In particular, I thank the doorkeepers, who have helped guide me so far; I am sure that will be required for some time to come. On a personal note, I have a supportive family who proudly watched my introduction last week. My parents and my sister gave me the most loving home life growing up and continue to support me, together with my two daughters, Olivia and Phoebe.
My hometown of Chatteris in Cambridgeshire is situated in the Fens, between Huntingdon, March and Ely. As a youngster, I enjoyed playing cricket with my local team—although not that well—and I was a member of our local swimming club. I would like to mention two businesses which still exist in my hometown: Stainless Metalcraft, which runs an incredibly successful apprenticeship scheme and has existed for many years; and Petrou Brothers, which is our local fish and chip shop. I mention it because growing up, my mum and my nan often worked there. It was always a good way to see them on a Friday evening.
I attended my local comprehensive school, Cromwell Community College, in Chatteris, then studied A-levels at Neale-Wade Community College, in March. My journey through school was a challenging one as I have dyslexia, but the challenges I faced, the determination and resilience that I needed to get through those school years, set me up incredibly well for a future career in politics.
I am humbled that a lad from the Fens who wanted to follow his father and become a bricklayer is now here in this historic Chamber. It was an accident that I started my career in politics. I began working as an apprentice in the Conservative Party over three decades ago. I am immensely proud to have started in that role and to have gone on to become the director of campaigning and then CEO, my last role. After deciding against the building site, my ambition was to become a pastry chef but, as you can tell from today, that failed as well. I ended up working in politics, being inspired, guided and motivated by my first boss, Geoffrey Harper, and later in my career by Alan Mabbutt.
On my political journey I had the pleasure of working with several of your Lordships, including my noble friend Lord Patten of Barnes, who was the candidate in my first election campaign, and my noble friend Lord Clarke of Nottingham, in 2001. While working in Rushcliffe I witnessed how politicians can debate robustly in the council chamber, as it was then; I now look forward to sitting opposite and listening once again to the noble Lord, Lord Coaker.
The next generation is so important to politics and democracy. I am immensely proud to have worked closely with the Patchwork Foundation, a UK-based charity committed to strengthening democracy. It focuses on communities and individuals who are traditionally under-represented and seeks to engage young people from those communities. It is our responsibility to support the next generation in order for our democracy to thrive.
Turning to the debate, I assure noble Lords that improving eating disorder services is a key priority for this Government and a vital part of our work to improve mental health services. Having an eating disorder can often be utterly devastating, and not just for those suffering with the condition but for family and friends, as has been mentioned in this debate. That is why we want to ensure that people have access to the right support at the right time.
I thank the noble Baronesses, Lady Parminter and Lady Wheatcroft, for giving us their very personal stories; I am very grateful. My noble friend Lord Markham, the Health Minister, is committed to continuing to make progress, and we had extensive conversations on the steps being taken when preparing for this debate. On the audit point that was raised very early on, not only when I first met the noble Baroness but again today, financial arrangements and timescales for delivery of the audit are being discussed. NHS England is awaiting details and expects to have clarity this summer. The noble Baroness asked me for a response when we met, and while it might not be quite what she was looking for, hopefully we can continue to monitor this and work together.
Noble Lords asked about progress on NHS eating disorder services, and about the report by the Parliamentary and Health Service Ombudsman, which described the service failings that led to the avoidable and tragic death in 2012 of 19 year-old Averil Hart. I express my sincerest sympathies to Averil’s family and thank her father, Nic Hart, for his campaign to help prevent those with eating disorders and their families suffering a similar tragedy.
In response to the report, NHS England has convened a working group with the department and other partners to address the recommendations. Progress is reported to the NHS England board throughout the year. The report highlighted a number of areas of focus to improve services. The first was improvements to workforce and training, informed by research conducted by the Faculty of Eating Disorders Psychiatry at the Royal College of Psychiatrists. The PHSO delivery group has worked to procure training courses that will increase the capacity of the existing workforce. The NHS England long-term workforce plan is due to be published very soon. It will set out the NHS’s workforce demand and supply requirements over the next 15 years and the actions to address, support and grow the workforce accordingly. The Royal College of Psychiatrists has also published comprehensive guidance on the management and identification of medical emergencies in eating disorders. This provides an overview of the latest evidence associated with eating disorders, including highlighting the important role of healthcare professionals.
Secondly, the PHSO report recommended that the department and NHS England work together to ensure that adult eating disorder services achieve parity with child and young people services. The noble Baroness, Lady Parminter, talked about FREED. In 2019-20, the NHS piloted specialised early intervention and treatment for young adults, referred to as the FREED model. This model, which has been shown to reduce waiting times and lead to better outcomes, is now being adopted more widely. We are working to increase capacity for eating disorder services through increased funding. Under the NHS long-term plan, we will invest almost £1 billion extra in expanding community mental health care by 2023-24. This will give an additional 370,000 adults with severe mental illnesses, including eating disorders, greater choice and control over their care, and support allowing them to live well in their communities. Since 2016, investment in children and young people’s community eating disorder services has risen every year, with an extra £54 million per year from 2022-23. This extra funding will increase capacity across the country, although I have made a note to take back to the department the point that the noble Baroness, Lady Janke, raised about whether funding is getting through to make a difference. I will discuss that with my noble friend Lord Markham.
As a number of noble Lords mentioned, we know that the pandemic has resulted in a large increase in demand for eating disorder services. The number of children and young people requiring urgent eating disorder treatment more than doubled from 2019-20 to 2021-22. As part of the £500 million Covid funding for the mental health recovery action plan provided in 2021-22, we invested an extra £79 million to significantly expand young people’s mental health services, including allowing 2,000 more children and young people to access eating disorder services. I am pleased to say that this target was achieved, with more than 4,000 additional young people entering treatment compared to the previous year.
We have set up the first waiting times standard to improve access to eating disorder services for children and young people, with the aim that 95% of children with an eating disorder will receive treatment within one week for urgent cases and within four weeks for routine cases. Prior to the pandemic, significant progress had been made towards achieving this ambitious target. While the increase in demand since the pandemic, as mentioned by the noble Baroness, Lady Wheatcroft, has affected performance against the waiting time standard, we remain committed to delivering it, with local areas asked to prioritise service delivery and investment to meet the needs of these vulnerable young people. We are also working with NHS England on the potential introduction of a four-week waiting time standard for adults presenting to community-based mental health services, including eating disorder services. This was something that the noble Baroness, Lady Merron, raised in her contribution to this debate.
In closing, I extend my thanks once again to the noble Baroness, Lady Parminter, for securing this debate, and to all noble Lords for their thoughtful comments and questions. I will go back to the department and raise all the issues that they have brought to my attention. The department, NHS England and other partners will continue to work to implement the recommendations from the PHSO report with the aim of preventing further tragedies. We are well aware that eating disorders are serious, life-threatening conditions. That is why we remain committed to improving services to support those affected and their families.
Lord Harlech (Con)
My Lords, I am aware that some noble Lords wishing to speak in the next debate might not have been able to enter the Chamber due to my noble friend’s maiden speech—a very fine one it was too, and I welcome him to his place. Therefore, I suggest we adjourn for two minutes.