Eating Disorders: Provision of Care

Baroness Parminter Excerpts

Tuesday 4th February 2020 Lords Chamber

Asked by

[Baroness Parminter]

To ask Her Majesty’s Government what steps they are taking to improve the care offered to sufferers of eating disorders.

[The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)]

My Lords, since this business is time limited, I draw noble Lords’ attention to the fact that the clocks that normally flash are not doing so, so we have reverted back to the older model which will require noble Lords taking part in the debate to exercise the customary discipline in recognising when their time is up.

[Baroness Parminter (LD)]

My Lords, I declare an interest: one of my daughters suffers from anorexia. We have experienced NHS eating disorder services both for children and young people and for adults in the community, and specialist in-patient care, and it is clear to me that while advances have been made, insufficient progress has been made to date in improving the care for people suffering from these life-threatening diseases. Noble Lords should be in no doubt that they are serious mental illnesses. They can cripple lives physically, emotionally, socially and can ultimately take them. Anorexia has the highest mortality rate of any mental illness and, like cancer, if eating disorders are not caught early, they are much harder to treat.

There are waiting-time targets for children and young people to access eating disorder services, but none for adults. The Royal College of Psychiatrists found that people can wait up to 41 months for treatment, with adults waiting up to 30% longer than those under 18 years of age. Those delays to get treatment have devastating and life-threatening results, like the death of Averil Hart aged just 19 from anorexia. Her death and those of two other young women were investigated by the Parliamentary and Health Service Ombudsman in 2017 and followed up by the House of Commons Public Administration and Constitutional Affairs Committee in 2019. Both those inquiries found that it was time to ensure that young people and children’s services were in parity with those provided for adults. I am delighted that the Government are now piloting a waiting time for adults to receive eating disorder services. But when those eight pilots end next year, there is no ring-fenced money in the budget for adult mental health up until 2024 to roll out a national scheme for adults for a waiting time standard. Given that it is now three years since the first inquiry said that this was a matter to be treated with urgency, will the Minister say when the Government think it will be possible to roll out a national waiting time standard for adults with eating disorders?

It is not just about having access to early treatment. It also about ensuring that when people go to their GP there are medics who know how to identify, manage and safely refer those patients. Research in 2018 by Dr Agnes Ayton showed that on average there is less than two hours of medical training on eating disorders, with one in five medical schools offering no training whatever. Ellen Macpherson, a final-year medical student in Manchester, says:

“I’ve had around 10 hours of teaching on schizophrenia, which affects one-fifth of the numbers affected by an eating disorder and has half the mortality rate.”


A survey of medical schools by the General Medical Council echoed Dr Ayton’s research. It concluded that doctors are not sufficiently prepared to manage patients with eating disorders. Recent initiatives by the GMC are welcome, but progress is painfully slow. When she responds, will the Minister tell us how the Government are ensuring that the GMC, medical schools and the royal colleges are undertaking their responsibility to ensure that medical professionals are teaching people properly about these life-threatening diseases?

There is also a need for more research. There are excellent examples of clinic-based treatment here in the UK. When I recently visited the South London and Maudsley NHS Foundation Trust I heard about FREED—first episode and rapid early intervention for eating disorders—and I was told about how early intervention and evidence-based treatments can work, but we still do not have a full understanding of, or know how best to treat, eating disorders.

Research levels for mental health are woefully low. Analysis from the charity MQ recently identified that just 96p per person affected is spent on eating disorder research, whereas a physical health condition which affects twice the number of people receives £228 per person affected. When will the Government review the level of funding given to mental health research? Only by looking at funding as well as services will we deliver the parity of esteem for mental health enshrined in legislation by the coalition Government, and the Government have made welcome signs that they are still committed to that.

Recruiting and retaining staff is also a real challenge, given the pressures, especially in adult services. The Royal College of Psychiatrists survey showed that vacancy rates for psychiatrists have more than doubled in the past six years and eating disorder services are among the most seriously affected services. In England, there are only 81 psychiatric posts in eating disorder services, and last year 12 of them were vacant. This directly impacts on the time people wait for treatment. While NHS England and NHS Improvement have been tasked with ensuring that local plans are drawn up to meet staffing requirements for mental health, they will not be able to deliver them unless some of the underlying reasons causing those shortfalls are addressed. This may be an issue that the noble Baroness, Lady Hollins, will touch on, so I shall not say much more: only two things. First, increasing the pipeline of medics by creating more psychiatric foundation training places with direct experience of eating disorders would help and, secondly, better resourcing eating disorder services would allow workloads to be managed better and stop people leaving as they are overworked and carrying risks that are too high.

Those risks are exacerbated by dangerously low in-patient capacity. As some Members of the House will know, 19,000 people needed hospitalisation in England last year for eating disorders. That figure has doubled in 10 years but no extra beds have been provided. There are only 649 beds in England. That means that patients with BMIs of under 12 are sent to units while they wait for hospital beds to become available and that patients, who are often children, are sent hundreds of miles away from their families for months on end. When our daughter needed specialist in-patient care there were no beds available anywhere in the country. She was kept alive by the local hospital for a month until a bed became available 144 miles away. She received excellent care, for which I am truly grateful, but I am in no doubt that the distances that people have to suffer at these very difficult times often make it an unbearable situation.

What makes it, frankly, shocking is that commissioning decisions about how many beds and services we have are being made without the NHS having even basic data on the number of people suffering from eating disorders in the UK. You cannot manage what you do not measure. I call on the Government to institute a review of eating disorder services, informed by accurate prevalence data.

While there is much more to do to improve the lives of sufferers of these diseases, there is much to be thankful for: the staff who care and battle on despite the workforce shortages and resource limitations; voluntary organisations, such as Beat and TasteLife; the families and carers who may rage in private but refuse to give up on their loved ones; campaigners, such as Hope Virgo and others, who use their lived experiences to offer much-needed hope of a better tomorrow; and—if I may say so—the Minister, whose willingness to listen is genuinely appreciated.

With the help of this Government, we can take the actions necessary to improve the lives of people suffering from these dreadfully cruel diseases. They deserve nothing less.