Eating Disorders: Medical Training

Baroness Manzoor Excerpts

Wednesday 12th September 2018 Lords Chamber

[Baroness Parminter]

To ask Her Majesty’s Government, following the publication of research in the Postgraduate Medical Journal that on average medical students receive less than two hours of training on eating disorders, whether they plan to make representations to the General Medical Council on conducting a review of the training on this subject provided to medical students and junior doctors; and if so, when.

[Baroness Manzoor (Con)]

My Lords, diagnosing and treating eating disorders is an important area for medical practice. It is included in the curriculum for training all doctors, including GPs, where most eating disorders initially present, and in more depth in training psychiatrists, particularly those who specialise in children and adolescents. However, Health Education England, or HEE, is considering how the existing workforce can be used more innovatively and whether any workforce planning interventions can increase specialism in the treating of eating disorders.

[Baroness Parminter (LD)]

The Parliamentary and Health Service Ombudsman’s recent report, How NHS eating disorder services are failing patients, concluded that the GMC should conduct a review of all medical training for junior doctors on eating disorders. Does the Minister agree with the independent ombudsman?

[Baroness Manzoor]

My Lords, yes, I do agree. Indeed, the undergraduate curriculum is reviewed by medical schools to standards set by the GMC. Health Education England is currently undertaking a review of the two-year foundation programme, and the curricula for speciality training are currently being reviewed by the GMC and Health Education England and their counterparts in the devolved Administrations. The review is expected to be completed by 2020-21.

[Lord Naseby (Con)]

My Lords, bearing in mind the enormous costs of training medical students, is it not time we looked at the system in Singapore, where it is a requirement that all junior doctors, once they qualify, must stay in the health service or otherwise repay the costs of part or the whole of their medical training?

[Baroness Manzoor]

I thank my noble friend for that question. I am afraid that I do not know about the scheme in Singapore, but I will certainly look into it. However, many of our undergraduates stay in the NHS, and we value very much the work that they undertake.

[Baroness Boycott (CB)]

My Lords, following on from the very valuable Question about eating disorders and training, I ask the Minister what is being done now to retrain the medical profession in areas of diet generally, given the increase in diet-related disease. Some GPs estimate that it accounts for 80% of the people who come through their door, and they obviously cannot just be given a pill. The medical profession in America and, indeed, some individual GPs here are retraining doctors in this vital area, and I would like to know whether the Government are proposing to do something similar.

[Baroness Manzoor]

My Lords, HEE, along with the Royal College of General Practitioners, is encouraging GPs to undertake further enhanced primary care mental health skills by doing an extra qualification in psychiatry and eating disorders, and hopefully this will bear fruit. However, I take the point the noble Baroness makes about nutrition and health. I agree with her that better education in this area is vital, and Public Health England is doing a lot of work in that regard.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the Minister agree that, while diagnosis and treatment are obviously very important, so is prevention? There are certain key indicators—such as adverse life events, including bullying—that can, if not accurately predict then certainly give rise to a presumption that an eating disorder could follow. It is important that health professionals and others, including teachers, are aware that that is a possibility when young people, particularly but not exclusively girls, are in distress of various kinds.

[Baroness Manzoor]

I entirely agree with the noble Baroness. The Government recognise that poor body image is a common problem—approximately 70% of adolescent girls and 45% of adolescent boys want to change their body weight or shape, and body image dissatisfaction can be a factor in relation to mental health problems. As such, the department is taking clear steps to improve outcomes. Back in 2014, we made available £150 million to ensure that we can put more money into these kinds of services.

[Lord Balfe (Con)]

My Lords, will the Minister widen her reply? It is not just eating disorders: the amount of medical education on all dietetic areas is woefully inadequate. I would like to see a commitment to a much wider and broader education on the implications of diet for all medical students, so that they have a better understanding of how to tackle obesity and the many other dietary matters that are brought into day surgeries today.

[Baroness Manzoor]

Yes, my noble friend makes an interesting point. HEE is working very closely with the health profession and the General Medical Council to ensure that the curriculum set meets the needs of today’s population.

[Lord Watson of Invergowrie (Lab)]

My Lords, many people with an eating disorder suffer in silence without receiving a diagnosis, yet research by the Postgraduate Medical Journal found that half of the universities that responded did not include questions on eating disorders in their final undergraduate exams, and only two universities included a specific requirement to assess clinical skills in eating disorders before graduation. So there is a real need for a review to consider the extent to which eating disorders are covered in the assessment of medical students and junior doctors. It was not clear from the Minister’s reply whether she accepted the premise of the Question from the noble Baroness, Lady Parminter. Will she clarify the Government’s position on a review and further undertake to ensure that other key health professionals such as nurses, dieticians and occupational therapists also receive sufficient training to enable them to diagnose and support those with eating disorders?

[Baroness Manzoor]

My apologies to the noble Lord if I was not clear. In addition to medical school training at undergraduate level, there is a further two-year training at foundation level where students undertake a four-month rotation in psychiatry and a four-month rotation in general practice. Then there is further training at speciality level in psychiatry, and there are modules to do with diet, further education and eating disorders. As I have already mentioned, HEE is working very closely with the devolved Administrations to ensure that the review is completed by 2021 on what further can be done.

[Lord McColl of Dulwich (Con)]

My Lords, can we have some compulsory education—