Health: Eating Disorders
Baroness Parminter Excerpts(4 years, 5 months ago)
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Baroness Parminter
To ask Her Majesty’s Government, further to The Health Survey for England 2019, published on 15 December 2020, and the finding that 19 per cent of women aged 16 and over screened positive for a possible eating disorder, what steps they are taking to support those with eating disorders.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, eating disorders are serious, life-threatening conditions, and we are committed to ensuring that people have access to the right support when they need it. We are growing our investment in community healthcare for adults year on year—almost £1 billion extra by 2023—with specific funding to transform adult eating disorder care and, for young people aged 16 to 25, to accelerate provision beyond existing growth and to transform plans.
Baroness Parminter (LD) [V]
The NHS health survey suggests that the prevalence of eating disorders is significantly higher than previously assumed, so will the Government commission a national, population-based study to accurately identify the number of people with eating disorders, as the Public Administration and Constitutional Affairs Committee recommended, to inform research and service-level provision?
Lord Bethell (Con)
My Lords, the noble Baroness is right: the statistics on eating disorders are shocking. The Mental Health of Children and Young People in England Survey identified 0.4% of 5 to 19-year-olds and 1.6% of girls aged 17 to 19. The NHS Digital Adult Psychiatric Morbidity Survey showed 6.4% of adults displaying signs of an eating disorder. There is the survey by Beat, and I could go on. I do not think it is an issue of surveys; we have to address the underlying statistics with measures that make a difference.
Mental Health Services: Young People
Baroness Parminter Excerpts(4 years, 9 months ago)
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Lord Bethell (Con)
We are deeply concerned about suicide; any suicide is too many. The noble Lord will be aware that the increased numbers recently are in part due to the recategorisation of suicide among the coroners’ courts. Nonetheless, we take this issue very seriously. The programme to help people identify those who show the markers of suicidal thinking has provided a very important impact on this issue. We are deeply concerned about Covid, and we continue to support suicide charities.
Baroness Parminter (LD) [V]
My Lords, calls to the eating disorder charity Beat’s helpline nearly doubled during lockdown, and at the same time fewer children and young people started treatment for eating disorders compared to the previous year. What are the Government doing to ensure sufficient funding for children and young people’s eating disorder services so that young people can access the help they need?
Anti-obesity Strategies
Baroness Parminter Excerpts(4 years, 9 months ago)
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Lord Bethell (Con)
My Lords, I completely endorse my noble friend’s views. When it comes to mental health challenges and connections between obesity and mental health, the resources need to be put in place and the sensitivity she speaks of applied. I return to my earlier comments: 87% of the country is involved in this. Not all have mental health issues; some simply need to take responsibility for their weight.
Baroness Parminter (LD) [V]
The National Audit Office’s report last week on tackling obesity confirmed that there is limited evidence that calorie labelling in restaurants reduces total calories consumed. How will the success or otherwise of the Government’s proposed calorie labelling in restaurants be evaluated? Will it take into account the potential harm caused, given that the ability to track calories can be highly triggering for those with or vulnerable to developing an eating disorder?
Lord Bethell (Con)
My Lords, we are tracking the success of this obesity strategy, although it should be understood that this is generations in the making and may well take a while to work through. I come back to my previous comments: calorie labelling is a very important element of people’s education about the content of their food and often their drinks, including alcoholic drinks. We support that measure as an important part of our strategy.
Eating Disorders: Provision of Care
Baroness Parminter Excerpts(5 years, 5 months ago)
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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.
Health: Eating Disorders
Baroness Parminter Excerpts(5 years, 6 months ago)
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Baroness Parminter
To ask Her Majesty’s Government what steps they are taking following the reported rise in hospital admissions for eating disorders.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, the latest figures show that young people with an eating disorder are getting more of the support and treatment that they need than ever before. As part of the NHS long-term plan’s investment of an extra £2.3 billion a year by 2023-24, eating disorder services are being ramped up across England. This is on top of the £30 million each year announced in 2014, supporting 70 teams delivering care to thousands more young people with eating disorders.
Baroness Parminter (LD)
NHS figures show that 19,000 people required hospitalisation for eating disorders in England last year. That figure is more than double what it was a decade ago. With only 649 in-patient beds in the NHS in England to treat people with eating disorders, does the Minister agree that the resources to tackle this worrying mental health crisis are too scarce?
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.
Health Service Safety Investigations Bill [HL]
Baroness Parminter ExcerptsTuesday 29th October 2019
(5 years, 8 months ago)
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Baroness Parminter (LD)
My Lords, my interest in this Bill was drawn by my concern to stop more avoidable deaths of sufferers of eating disorders—sufferers such as Averil Hart, who died aged 19 and whose death, and that of two other women sufferers, was investigated by the Parliamentary and Health Service Ombudsman. The title of the ombudsman’s 2017 report says it all: Ignoring the Alarms: How NHS Eating Disorder Services are Failing Patients. It concluded:
“Our investigation found that Averil’s tragic death would have been avoided if the NHS had cared for her appropriately”,
and it went on to make five recommendations for improvements in NHS eating disorder services.
Eighteen months later, in June this year, the Public Administration and Constitutional Affairs Committee in the House of Commons followed up on that PHSO report and concluded that insufficient progress had been made on delivering its recommendations. I echo the comments of the chairman of the PACAC, Sir Bernard Jenkin MP, who said that,
“if the tragic circumstances which lead to avoidable in-care deaths and other serious incidents are to be avoided in the future, lessons must be learned”.
Moreover, the PHSO acknowledges many examples in its casework where poor investigations or fear of blame have hampered efforts to understand what went wrong in a patient safety incident and what can be done to prevent similar failings happening again. Therefore, like others, I welcome this Bill, given that investigations by this new independent body that do not attribute blame but ensure a statutory “safe space” for NHS clinicians, patients and their families to speak freely will be a key part of enabling such learning.
I have three issues to raise with the Minister, some aspects of which have been touched upon by other colleagues around the House. First, while helping the NHS to learn lessons is critical, so is supporting the patients and families involved, giving them confidence in the investigation process and thus the recommendations. That way, hopefully, they can move on with their lives or feel that something positive has come from the death of a loved one. Public confidence in the membership of the board is therefore key. As it stands—as the noble Lord, Lord Hunt of Kings Heath, has said—the Secretary of State appoints the chair and at least four other non-executive members of the body. I have the highest regard for the medical profession, and looking around this room I see many experts, but I would be concerned if all the members were from the medical profession or, indeed, were associated too closely with the party in power; let us not forget that this body has the power to make recommendations for the Secretary of State to implement. I therefore add my voice to those of the noble Lord, Lord Hunt of Kings Heath, and my noble friend Lady Walmsley, who asked what plans the Government have to achieve an appropriate level of independence for the body so that it can instil the highest public confidence.
The second issue is ensuring that lasting change happens. As we know, the HSSIB has the power to make recommendations for future action after an investigation, and addressees of the report must, by the deadline given, provide a written response setting out the action they will take in relation to the recommendations. That is welcome but, given the failure to implement recommendations in the PHSO report that I mentioned on eating disorder services, I worry. My understanding is that NHSE and NHS Improvement will be charged with monitoring the follow-up; I would be grateful if the Minister could confirm that in her concluding remarks. However, it would also be helpful if the HSSIB had the power to insist on follow-up reports on the actions and outcomes, to ensure that meaningful and lasting improvements to patient safety will be made.
The final issue concerns the relationship of the new body to other bodies which not only focus on the causes of incidents but provide accountability for individual incidents and, if necessary, apportion blame. This issue has been touched on by the noble Lords, Lord Hunt and Lord O’Shaughnessy, and the right reverend Prelate the Bishop of London, although I think we will all come to different conclusions.
I have talked about the valuable work of the PHSO, which was set up by Parliament to provide an independent service to handle complaints about the NHS in England, UK government departments and other UK public organisations. It is the final stage for complaints that have not been resolved through the organisation’s own complaints procedures. In the case of Averil Hart, Averil’s father Nic Hart went to the PHSO after making complaints to six organisations: four separate NHS organisations which had provided care and treatment for Averil, as well as a local clinical commissioning group and NHS England. The PHSO is the last resort for the public yet, as the Bill stands, it cannot have access to information held in a safe space by HSSIB, to carry out its own investigations into the complaints that it receives. This could lead to the ombudsman making incomplete or incorrect recommendations for either individual or systemic remedy.
I accept the value of the HSSIB carrying out investigations in a safe space to promote a culture of speaking up and learning from mistakes, but this cannot be the only aim when looking at why incidents in the NHS went wrong. If the PHSO cannot provide assurance that it is able to investigate all the relevant evidence, this could deny patients or families closure and reduce public confidence in the findings of the organisation. The PHSO has a statutory obligation to investigate in private and is protected from disclosure under the Freedom of Information Act, so there is strong assurance that any information given would not enter the public domain. Further, given the parallels between its work and that of coroners—who have been given exemption from restrictions on receiving information from this new body—and in the absence of compelling reasons from the Minister, I would support an amendment to this Bill to provide the PHSO with access to HSSIB information. We need both bodies to be able to do their jobs properly—yes, to deliver change in the NHS but also to give confidence to patients and families that the suffering and loss that they and their loved ones went through will not keep being repeated.
Mental Health: Eating Disorders
Baroness Parminter Excerpts(6 years, 4 months ago)
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Baroness Parminter
To ask Her Majesty’s Government what steps they are taking to ensure that those suffering from an eating disorder are able to access treatment and support.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, eating disorders are life-threatening conditions, and it is the priority of this Government to ensure that everyone with an eating disorder can access quick, specialist help when necessary. For children and young people we have waiting time standards to improve access to eating disorder services, and it is encouraging to see a reduction in waiting times compared with last year. Findings from a national review are being reviewed to inform future improvements to adult eating disorder services.
Baroness Parminter (LD)
I thank the Minister for that reply. Hospital admissions have more than doubled in the last six years, while out-patient services for adults are underresourced and unable to support people to be treated in the community. What do the Government intend to do to improve adult eating disorder services to treat, as the Minister rightly calls them, these life-threatening, severe mental illnesses?
Baroness Blackwood of North Oxford
First, at the beginning of Eating Disorders Awareness Week, I pay tribute to mental health professionals, charities, researchers and campaigners who have done so much to raise awareness, fight stigma and help the Government and the NHS improve mental health services over recent years. The noble Baroness is absolutely right that, while we have made a lot of progress with children’s eating disorder services, we must not forget adult services. That is why the NHS Long Term Plan has committed to test four-week waiting times for adults and older adult community mental health teams. We have not exactly pinned down what the scope of these pilots will be, but we expect that areas in receipt of new funding will be those that will expand those services.
Child and Adolescent Mental Health Services
Baroness Parminter Excerpts(6 years, 8 months ago)
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Lord O’Shaughnessy
I thank my noble friend for her question. The definition is a “diagnosable mental health condition”. That is the performance target, or threshold, we work against. At the moment, unfortunately, only around 30% of children and young people with a diagnosable condition access care and treatment but we are clearly trying to increase that figure.
Baroness Parminter (LD)
My Lords, have the Government made an assessment of the number of children and young people referred to community eating disorder services? Given that anorexia has the highest mortality rate of any mental health disease, how many of those referrals do not go on to get treatment?
Lord O’Shaughnessy
The noble Baroness makes a very important point. There are 70 new or enhanced community eating disorder services. The intention is that they should serve over 3,300 children and young people every year.
Lyme Disease
Baroness Parminter Excerpts(9 years, 8 months ago)
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Baroness Parminter (LD)
I add my thanks to the noble Lord, Lord Greaves, for calling this important debate. It is clear that cases of Lyme disease are increasing across Europe. As someone who, like the noble Lord, Lord Trees, is passionate about the countryside and encourages people to go out and enjoy it, I think we need to address the problems that this disease is causing but in a way that does not stop people going out and getting the health-giving benefits of being in the countryside. The noble Lord, Lord Greaves, is right to focus on the need for better understanding of the level of the disease, as many noble Lords have said, on the necessary improvements in diagnosis and testing, and on the critical importance of some speed in getting clear guidance for our health professionals.
I come to this debate today, with the short time allotted to us, to make one point, which was first raised by the noble Baroness, Lady Drake: the need for far better public awareness of this issue. In looking into the research for this debate over the weekend, I was at the same time packing my eldest daughter’s kitbag for her Duke of Edinburgh award. She was off to the South Downs. Like the noble Baroness, Lady Masham, I was looking at the lists of where the most infected ticks are: it is not just North Yorkshire but also the South Downs. I asked my daughter, as we were packing an increasingly large amount of kit into her bag, what she would do if she encountered a tick. My daughter is a fairly intelligent 15 year-old but she had no idea what to do. I asked her whether they had talked about it in her D of E training but they had not. When I went back through the information that I had been sent—you get voluminous lists of kit that you as a parent need to provide—there was nothing about ticks. We were sending off these girls for two nights and three days on the South Downs, and not one of them would have known what to do.
The great thing about the Duke of Edinburgh scheme is that it gets our children out into the countryside and teaches them great skills of leadership; it is growing, which means more children are taking part, and that is to be encouraged. However, it is quite clear that it has no engagement with a fundamental problem that these young adults, who are going to be the young parents and young leaders of the future, might encounter. It strikes me that we need to address that, and I urgently ask the Minister to talk to Public Health England about what it is doing to encourage greater public awareness, looking particularly at organisations. The noble Lord, Lord Greaves, mentioned organisations such as Ramblers; I would add the Duke of Edinburgh scheme, given the number of children going out into areas that might be affected.
It amazed me, when I was looking through the fantastic pack that the Library has provided, to find that there is the Big Tick campaign. I thought, “Fantastic! Someone is doing something”—and it is the vets. They have a high-profile celebrity, Chris Packham; they have a very good website; and they have resources going out to the veterinary profession that are then being cascaded down to pet owners, telling them all about the dangers. There is nothing with an equivalent status for parents. So while I applaud the work of LDA, which does a good job on very limited charitable resources, it is time, given the scale of this problem, that we did more on this subject and had far better public awareness.
EU: Food Labelling
Baroness Parminter Excerpts(13 years, 8 months ago)
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Earl Howe
I take the noble Baroness’s point. Obviously, the Government would like to see greater consistency in front-of-pack labelling. We know that, if we can achieve it, that is likely to increase consumer understanding and indeed the way that consumers use the information. Now that the regulation is finalised, we have the opportunity to discuss with all stakeholders the way to achieve that. It is advantageous that there is the flexibility available for us to do that.
Baroness Parminter
My Lords, this country has one of the highest rates of obesity in Europe. France is taxing sugary carbonated drinks and Denmark is taxing fatty foods. Regulation is one thing, but can the Minister confirm that the Government are looking seriously at the potential of such fiscal measures to address this ballooning health problem?