Eating Disorders: Provision of Care

Baroness Brinton Excerpts

Tuesday 4th February 2020 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I too offer my thanks to my noble friend Lady Parminter for securing this important debate. For many years, this has been an invisible disease without enough resources to ensure that those who present to doctors get the vital support that they need immediately. I pay tribute to my noble friend for her tireless work on eating disorders, based on her own family’s experience. I also pay tribute to my noble friend Lady Janke for speaking of her family experience. My noble friend Lady Parminter talked about the lived experience of sufferers who are champions but my noble friends both showed, through their contributions, the effort it takes to hold a family together while supporting a child going through this terrible disease. I remember a friend of mine disappearing from school some 50 years ago at the age of 14 and never returning to mainstream school. Until I met her sister, some 30 years later, we never knew that she had had anorexia. It was not spoken about and there was hardly any treatment at all.

It is important to recognise that support and treatment have improved substantially in recent years, including the extra £30 million for young people with eating disorders, but it is clear from this debate that the context of resources is vital. Clinical approaches to eating disorders have changed, but the number of patients and the support they need is at crisis point. We have heard that in 2018-19 there were more than 19,000 patients admitted to hospital with eating disorders but only 649 beds in England. That is an astonishing two patients per hour per day, yet we know that resources are so scarce that patients are now routinely turned away for not being sick enough.

The noble Baroness, Lady Murphy, spoke about Hannah on “Woman’s Hour” today. I suspect it was the same Hannah whom the Sunday Times talked to last Sunday; she was turned away from the Greater Manchester Mental Health NHS Foundation Trust because she was not ill enough and her BMI had not dropped to the point at which it would automatically guarantee entrance, even though in her experience of the disease there was evidence that she was deteriorating rapidly. She is very brave in speaking up. We need to know the reality of what is happening. I am afraid that one of the reasons for this—other noble Lords have been discreet, but I will not be—is that clinicians are having to ration support for eating disorders. The parity of esteem enshrined in legislation under the coalition is still a pipe dream.

A further problem is touched on in some of the helpful briefing we have had, including that from the GMC and the Library: the transition of young people from CAMHS to adult services. In my family’s experience of CAMHS—everyone should recognise that there is usually some experience of mental health services—the transition period was a complete nightmare, even though we got an extra year after the age of 18 to transition through. The attitude and approach were completely different and led to a crisis within a year. That problem of transition, which has been recognised and understood in education and children’s services for the most vulnerable young people who are looked after or have learning disabilities, also needs to be applied to children with mental health problems, particularly those with eating disorders since we know that this disease targets those aged between 15 and 25. To suddenly change everything at 18 is an extremely traumatic experience for the young people and their families. What plans are there to extend access to children and young people’s mental health services up to the age of 25, obviously transitioning as is best for the individual concerned?

While the Government discuss abolishing the four-hour accident and emergency targets overall, what plans are there to introduce waiting time targets for adults as well as children in accessing mental health services, and specifically for eating disorders? Currently only a third of young people with diagnosable conditions get NHS treatment without long delays. Liberal Democrats believe that we should ensure that 50% of children and young people with diagnosable conditions should have treatment by the end of this year, improving to 100% by 2025. Currently, only four in 10 adults get access to treatment. We believe that seven in 10 adults should get access to treatment by 2022. We must set an ambition that everyone who needs treatment gets it by 2025. That will be the point at which we can believe that we have parity of esteem in mental health services.

Other noble Lords have spoken about the importance of early diagnosis. Currently, medical students receive on average less than two hours’ teaching on eating disorders throughout their undergraduate training. By improving training, we will be able greatly to improve early intervention, especially for those on the front line—GPs and more general physicians. Other noble Lords, including the noble Baroness, Lady Hollins, have spoken with experience and expertise on this.

There are other workforce issues. The helpful briefing from the GMC pointed out that there are only 70 posts, mainly in CAMHS, of which a substantial number are vacant. Both the noble Baroness, Lady Hollins, and the noble Lord, Lord Brooke, talked about the practicalities of gaps in the rota, which inevitably impact on patient care. How on earth can you attract young medics to psychiatry if candidates know that resources are not just scarce but will rely on them turning away those patients they know need urgent intervention?

The noble Lord, Lord Lexden, spoke about the importance of educating school staff in recognising the difficulties that some young people face and in helping to signpost them to their families to get help. I too pay tribute to Beat and other charities that provide that expertise to those who can help. However, above all, it is the patients and their families who need help and support. We are overcoming the burden of secrecy in eating disorders, which is good, and the voice of Hannah and many others who have a lived experience of eating disorders is vital. However, we also have a duty to provide the resources for beds, access to clinics, staff and support staff to help people overcome this disease. None of that can happen without money. Therefore, my final question to the Minister is to ask about the increase of funding for adult services and treatment of eating disorders more generally in this area over the next five years.