Eating Disorders: Provision of Care

Baroness Thornton Excerpts

Tuesday 4th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I congratulate the noble Baroness, Lady Parminter, on securing this debate and on her moving opening remarks, as well as all other noble Lords who have participated in the debate today on this important and growing challenge.

As we have heard today, eating disorders are complex mental illnesses. I absolutely agree with my noble friend Lord Brooke that we need to see progress. I spent a few minutes looking on my iPad to see whether I had answered the debate in 2013 from this Dispatch Box. I am sure that I would have remembered if I had, and indeed, I did not—one of my colleagues dealt with that issue. But it is remarkable that that debate very much reflected the things that have been said this evening, and it is a bit depressing that we still need to make some progress today.

The thing about eating disorders is that you can develop one no matter your age, gender or background. Some examples of eating disorders have been mentioned: bulimia, binge eating, anorexia and obesity. There is no single cause of this, as noble Lords have said; it can be very complex, and people might not have all the symptoms for any one eating disorder. I echo the thanks expressed by other noble Lords to the General Medical Council and Beat in particular for their information about this matter.

The General Medical Council noted at one of the round tables that it organised on this in November 2019 that there is a lack of eating disorder specialists in the UK. There are only 70 posts, mostly in child and adolescent mental health, with some in adult, and approximately 15% of posts are vacant. Coupled with the lack of beds and the stories that noble Lords have recounted, that makes this situation very serious indeed.

We know that there is an important link between obesity, mental health and eating disorders. My noble friend Lord Giddens definitely expressed this eloquently and in greater depth, but this relationship is often neglected. Awareness of this is neglected as well, as several noble Lords said. Medical training across the board does not adequately recognise the seriousness of this condition.

I think we all welcome that the NHS long-term plan and related initiatives which emphasise mental health provide a unique opportunity to make progress on improvements to eating disorder services and the relationship with education and training. For example, I am pleased to hear that the General Medical Council is now working with the Faculty of Eating Disorders Psychiatry and other key stakeholders. That is some comfort, but I was very disturbed by the contribution by the noble Baroness, Lady Hollins, when she addressed the workforce situation; she posed some serious questions to the Minister.

In December 2017, the Parliamentary and Health Service Ombudsman published Ignoring the Alarms: How NHS Eating Disorder Services are Failing Patients. The report made five recommendations for improvements in NHS eating disorder services. Indeed, the Public Accounts Committee went on to say that this was important and needed to be acted on. We all know, as noble Lords have said, that collaboration is needed at both service level—as the PHSO report highlighted in terms of, for example, handover and continuity of care—and at system-wide level with regulators, commissioners and others working jointly to identify and implement improvements. The PHSO also recommended a public health campaign, which would help to raise awareness of the impact of this condition. Is that likely to happen?

Noble Lords will know that a Guardian investigation established that coroners in England and Wales have served a prevention of future deaths notice in at least 12 cases, identifying problems that have been mentioned tonight, including a lack of staff or beds. Coroners were so alarmed by these failings that they sent official warnings to 11 trusts that provided care for people with anorexia and bulimia between 2013 and 2019. Grace Freeman, a policy and campaigns officer for the mental health charity Mind, said that the cases were a

“shocking reminder of the poor quality of care too many young people receive from mental health services, particularly those living with eating disorders.”

The noble Baroness, Lady Parminter, made a plea, saying that science and research needs investment to provide the evidence base that the Government want, to make sure that eating disorders are dealt with with the seriousness they deserve. For example, there is no official data on deaths due to eating disorders; at a recent inquest, a doctor said cases were not being properly recorded by the NHS. As we know, suicide is one of the biggest risk factors for people with the condition, with between one-fifth and one-third of patients taking their own lives.

As far as I, aged 67, can see, if I develop an eating disorder, it depends on where I live but I would not be eligible for treatment in one of the 49 adult eating disorder clinics in England and Wales. According to an investigation by the “Victoria Derbyshire” programme, three have a cut-off age of 65, with older patients referred to general geriatric mental health units, which are likely to be unable to provide the same level of tailored care as would be required.

Finally, I agree with the noble Baroness, Lady Brinton, that it is awful that our clinicians face rationing treatment for eating disorders. It is completely unacceptable. This condition requires more investment, more choice and more money being available to combat it.