Eating Disorders Awareness Week

George Howarth Excerpts

Tuesday 28th February 2023 Westminster Hall

[Wera Hobhouse]

I completely agree. Indeed, the all-party parliamentary group on eating disorders inquiry on research funding found how crucial it is, and in particular that eating disorder research should be ringfenced. Some progress has been made, and the eating disorder charity Beat has made good progress on the issue, but more research needs to be done.

For too long, sufferers have been left feeling trapped and alone. Here in Parliament, we have been raising the alarm for some years about this rising epidemic, which still needs more urgent action from the Government. However, I want to acknowledge the good working relationships the eating disorders APPG has had with various Ministers. I hope that will continue, and that today’s debate helps us to make progress together.

The theme for this year’s Eating Disorders Awareness Week is eating disorders in men. Eating disorders do not discriminate. Many people think that eating disorders affect only women, but at least one person in four affected by an eating disorder is a man, and 89% of men and boys aged 16 to 18 in my county of Somerset worry about how they look. Those experiences are often overlooked.

Toxic stereotypes are pervasive, and half of respondents to a recent survey of men’s experience carried out by Beat did not believe that someone like them would develop an eating disorder. One male sufferer in five has never spoken out about their struggle. That is why the debate is so important. We must encourage men to speak up and get the help they need.

Other rigid perceptions of eating disorders persist. Eating disorders are frequently misunderstood and viewed as a lifestyle choice. Contrary to popular belief, eating disorders are most common among people with severe obesity. Too many people are still being turned away from treatment because their body mass index is too high. To imply that someone seeking help for an eating disorder is not skinny enough is a terrible mistake that can lead to added suffering, and I commend Hope Virgo for her tireless campaign, Dump the Scales, which has made a significant difference.

Owing to those perceptions, people with eating disorders face a postcode lottery in trying to access specialist treatment. Beat has found large inconsistencies in the availability of treatment for binge eating disorders. Only 12 of the 51 providers in England that responded to Beat’s freedom of information request offered all three services for binge eating disorders recommended by the National Institute for Health and Care Excellence.

In some areas, treatment for people with bulimia is being rationed according to the frequency of binging and purging episodes. In others, treatment is simply not available. The Somerset and Wessex Eating Disorders Association, also known as SWEDA, has seen a 150% increase in people seeking help for eating disorders compared with pre-pandemic figures. Its children’s service has been overwhelmed with young people and their parents desperately trying to get support.

Eating disorders can take years to recover from, and many children and young people need to continue their treatment into adulthood. Young people miss out on so many educational and social opportunities. These years are stolen from them, and that is not to mention the potentially irreversible effect on their physical health. Again, this affects girls and boys, men and women—eating disorders do not discriminate.

[Sir George Howarth (Knowsley) (Lab)]

I thank the hon. Lady for securing this important debate. She will be aware that the variation of eating disorders called T1DE—type 1 diabetes with disordered eating—is a growing problem that affects young men as well as young women. The right hon. Member for Maidenhead (Mrs May) and I have been co-chairing an inquiry into that variation of eating disorders. I will not pre-empt what our report will say, but one thing is clear: professional support, both psychological and physical, is vital to these young people, who could otherwise end up seriously ill if they do not take their insulin—in some cases, it is fatal.

[Wera Hobhouse]

I thank the right hon. Member for his intervention. As I mentioned, eating disorders manifest themselves in different forms. We need to increase our understanding of the different types of eating disorders, and much more specialist treatment needs to be available to cater for people’s different needs. I thank him for mentioning that specific form of eating disorders among people who are suffering from diabetes.

As I mentioned, eating disorders result in years being stolen from young people, and they can take many years to recover from. Some of the figures are just staggering. A third of people with eating disorders recover fully, a third never really recover, and a third get worse. For the third that never really recover, it is a lifetime sentence of a life that is not as good as it could be. That is why early intervention and understanding the symptoms of eating disorders are so crucial. The earlier someone receives intervention for their eating disorder, the more likely they are to make a full recovery. The longer symptoms are left untreated, the more difficult it is for the person to recover.

Healthcare should focus on prevention before cure, and early access to the right treatment and support can be life-changing. Some 75% of SWEDA’s staff and volunteers have lived experience of an eating disorder, which is another aspect of this issue that is so important: we need to hear from more people who have lived experience of an eating disorder. Their speaking up and leaving behind the stigma that is still associated with eating disorders is so important, and I commend everybody who has come forward and talked about their lived experience. I understand how difficult that can be, but we need them to do it. All those working for SWEDA say that they wish they could have accessed help long before they were offered it. That is why such organisations are so important: they offer specialist therapy and support to people with eating disorders and body image issues before they become ill enough to need more intensive treatment.

However, those organisations cannot cope on their own. Waiting times for eating disorder patients are out of control, and waiting lists for children’s eating disorder services have doubled since March 2020. From 2021 to 2022, only 61% of urgent cases started treatment within a week—well below the current NICE standard of 95%. I hope the Minister will be able to respond to that. For adults, there are not even targets in place. The Independent has revealed that more than 80,000 adults with eating disorders are waiting to be seen for therapy—a record number—while just 30% of adults got treatment within four weeks of their referral. Again, I hope that the Minister will refer to adult eating disorder services, where we do not have any waiting list targets or targets for support. It is very important that adult services get the same support as children’s services, where we have made progress because there are targets.

Data from the eating disorder charity Beat showed an average delay of three and a half years between someone’s eating disorder symptoms emerging and their accessing treatment. That is simply not good enough. Targets are crucial if we are to tackle this epidemic. An access and waiting time standard for adults would provoke significant extra funding and focus. If we want to encourage people to seek help, we need to give them a guarantee that they will be seen.

Having clear standards can facilitate service improvements. Standards introduced in 2015 for waiting times for children and young people’s eating disorder services have been crucial in driving service improvements. However, similar standards have been lacking in adult services. Shockingly, sufferers are reaching the point of emergency hospitalisation before they can access care. Again, that is not good enough. It also costs a lot more money if we reach people only at that crisis point.

Clinicians have reported a significant increase in the proportion of young people first presenting when they are already severely ill. NHS figures show that hospital admissions for people with eating disorders in England have risen by 84% in the past five years. For children and young people, there was a 35% increase in the past year alone—and among men and young boys, hospital admissions have risen by 128%. There is an increasingly alarming picture that eating disorders in men and boys are being overlooked and not treated early enough. That is why today’s debate is so important.

Tragically, people are losing their lives. Take the terribly sad death of Zara Taylor after two years of struggling to get the right treatment for her eating disorder. An investigation by the Health Service Journal found that at least 19 lives were lost to eating disorders in England over the past five years. At least 15 of those were deemed avoidable and resulted in coroners issuing formal prevention of future deaths reports. Coroners described patients’ safety risks being missed or poorly managed because of limited knowledge of eating disorders among doctors and health professionals, and delays in accessing appropriate treatment. That is why it is so important to have more research into eating disorders, and focus on the more specialist and rare forms of eating disorders. Those same failings were among the key issues identified five years ago by the Parliamentary and Health Service Ombudsman in its report “Ignoring the Alarms”. Surely, we need to do more and to do better.

I was disappointed that the Government decided against publishing a 10-year cross-Government mental health and wellbeing plan for England. Instead, they have developed and published a major conditions strategy that would include mental health alongside other groups of conditions, including cancers, cardiovascular disease and dementia. That is not helpful. Compared with physical health, mental health has been a Cinderella service; for years, we have been asking for parity. If everything is put together again, we run the risk of losing special attention to mental health.

Can the Government not see that for targeted and varied issues we need targeted and varied strategies? I point them to Hope Virgo’s eating disorder manifesto, which calls on the Government to implement an evidence-based national eating disorder strategy, with a plan outlining how they will tackle the huge rise in people affected by eating disorders.

I want to single out Hope Virgo for her tireless campaign. She has made such progress in helping us to understand what it is to suffer an eating disorder and access services. She has continually engaged with us and Government in order to achieve improvements. She has done fantastically well. The strategy that she calls for should integrate obesity and eating disorder prevention plans, given the overlapping factors between the two. The Government should also look at reforming treatment approaches. I hope they are looking seriously at Hope Virgo’s manifesto and strategy.

A recent University of Oxford study found that using the integrated CBT-E—enhanced cognitive behaviour therapy—approach over the current in-patient approach reduced readmission rates for people with anorexia by 70% over a year. That means that we need to treat this as a mental health condition first and foremost, and to treat people’s physical health as a result of the mental health issues. If we do not tackle the mental health issues, we will not cure the physical problems.

The strategy should also include better training. According to Beat, 20% of medical schools do not include eating disorders in their teaching at all, while those that do provide less than two hours on the topic. Training should be compulsory in order to spot early signs of eating disorders. Many participants in a 2021 Beat survey reported having a negative experience when they first sought help from a GP. There are many brilliant practitioners in the NHS delivering excellent care, but I want every doctor to complete their training with the knowledge and skills to best support people with eating disorders.

The crisis in the NHS has decimated mental health services. Staff shortages are growing. According to the National Audit Office, between 2021 and 2022, 17,000 staff left the NHS mental health workforce. The Royal College of Psychiatrists 2021 workforce census shows that since 2017 there has been a 30% increase in the number of vacant or unfilled consultant posts in England. That is not good enough. How we can encourage specialists into services is a big question that the Government need to answer.

Eating disorder psychiatry has one of the highest numbers of vacancies, with just 28 full-time consultants. We need significant investment in staff retention. The RCP’s members report high workloads and poor work-life balance. NHS trusts should be supported to meet important improvement targets for retention. I hope that the Government will keep their commitment to publish an NHS workforce plan and that they will bring that forward early, along with adequate investment.

Mental health services need proper funding. This financial year, only 13.8% of local health spending has been allocated to mental health services, although mental illness accounts for 21.3% of the total disease burden in England. The money spent on young people’s eating disorder services has not kept up with the number of young people who need treatment. I support the NHS Confederation’s call for £12 million of additional funding to be made available over the next year to get children and young people’s eating disorder services back on track.

The funding that is provided needs to reach frontline services. An inquiry by the APPG on eating disorders, which I am proud to chair, found that 90% of the additional NHS funding given to clinical commissioning groups for children’s services did not reach the services to which it was pledged. We wrote to CCGs at the time, and the answers that we received were not satisfactory. The Government must ensure that their funding pledges are not empty words and that money is getting where it is needed. A one-off boost for children’s mental health services is not enough. Soaring demand for underfunded services will lead to children missing out on care.

We are all aware that the NHS is in crisis. We hear harrowing stories about ambulance and A&E delays, but the impact on mental health services has received little attention. I hope that today’s debate will make a difference and that we will hear more about the crisis in mental health service provision.

The Liberal Democrats firmly believe that physical and mental health should be treated equally in the NHS. Eating disorders are an epidemic. The sooner we realise that, the sooner we can treat them with the attention they deserve. No one should be condemned to a life of illness, nor should anyone be dying from an eating disorder in 2023.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Harris. I thank the hon. Member for Bath (Wera Hobhouse) for securing this important debate. Both as an MP and as chair of the all-party parliamentary group, she has long been a champion of those with eating disorders.

Improving treatment for eating disorders is a key priority for the Government and a vital part of our work to improve mental health overall. We have heard from right hon. and hon. Members from across the political divide about how urgent this issue is and how many of our constituents are affected by it. It is national Eating Disorders Awareness Week, and raising awareness is an important part of improving the outcome for those suffering with this serious and often life-threatening condition. It can affect anyone of any age, gender or background.

As has been mentioned numerous times, Beat has done tremendous work in this space. It estimates that 1.25 million people live with an eating disorder in the UK. Of those, one in four is a man. I am really pleased that this year’s national Eating Disorders Awareness Week is focusing on eating disorders in men. I think that every Member who spoke in the debate covered the fact that men are often reluctant to come forward and ask for help. There is a stigma around eating disorders, particularly for men. It is important that healthcare professionals recognise that this is also an issue for men, so that if a man or a young boy seeks help, that is taken seriously.

It is vital that we recognise that these issues affect men, so that we can break down the stereotypes and help men to speak up and get help, because having an eating disorder is devastating, and not just for the individual. As the hon. Member for Strangford (Jim Shannon) highlighted, it can also be devastating for those around them, whether family or friends. We know that recovery is possible, which is why it is so important that people come forward to ask for help and support, and get timely access to the right treatment that can save their lives. That is why, under the long-term plan for the NHS, we are investing £1 billion extra in community mental healthcare for adults with severe mental health illness, which includes treatment for eating disorders. The extra funding is being used to enhance capacity for new and improved community eating disorder teams, covering the whole of England.

Hon. Members have raised concerns about long waiting times in their communities. Integrated care boards, which were set up in July, now commission services. We will hold them to account for their timelines, but hon. Members can also hold their local commissioners to account. The funding is given to them for mental health services. We do not dictate how it is spent, because that will be different for different communities, and the prevalence of eating disorders will be different in different parts of England. We expect commissioners to commission those services and to ensure capacity and timeliness for their local population, but if Members of Parliament feel that is not being done, we are happy to meet them to discuss how we can improve things locally.

Since 2016, investment in children and young people’s community eating disorder services has risen every year; there has been an extra £53 million per year from 2021. As my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) highlighted, the pandemic continues to have an impact on the mental health and wellbeing of many people, and has caused a large increase in demand for eating disorder services. Services were almost closed, or certainly severely reduced, for nearly two years during covid, and covid itself had an impact, and there is now a tsunami of people coming forward. Data shows that the number of children and young people entering urgent treatment for an eating disorder in 2021 increased by 11% on the previous year, to over 2,600, and in the year before that it increased by 73%, from around 1,300 to close to 2,400, so there are more referrals than ever before.

A number of Members, particularly my right hon. Friend the Member for Romsey and Southampton North, mentioned online safety. I reassure colleagues that we are working with Ministers from the Department for Culture, Media and Sport on the online safety legislation, but also on other issues, because there is so much work that needs to be done to ensure that online influence is reduced where it is causing significant harm.

To return to the funding being made available, this is the first Government to really put mental health on the same footing as physical health. I am proud that we are creating parity of esteem, not just in planning services but in funding services. As part of the £500 million covid recovery plan funding for the mental health recovery action plan, we have invested an extra £79 million to expand young people’s mental health services, which has allowed 2,000 more children and young people to access eating disorder services. We have delivered this, with over 4,000 more young people entering treatment for an eating disorder than did in the previous year.

A number of Members talked about setting targets for children. We have indeed set targets for children’s eating disorders services. For adults, NHS England has consulted on setting a target for mental health services. I am particularly keen for that to be introduced as quickly as possible. I am meeting NHS England’s clinical lead for mental health services in the coming days and hope to be able to update Members on progress on that, because what gets measured gets done. While we may not be meeting the target for children yet, because of the sheer scale of demand, at least we have a target, and we know which parts of the country can and which cannot meet it, and I am keen that we do the same for adults.

The issue of BMI was raised, and I take the points made extremely seriously. Let me be clear: rejection for treatment on BMI grounds should not occur. If there are instances where that has happened, I am happy to address them; that practice is not in line with any guidance, including National Institute for Health and Care Excellence guidance, so it should not be happening. If there are examples of it happening, we are very keen to hear about them. If it is happening at a local level, I urge hon. Members to contact their local commissioners to find out why, because the guidance does not recommend that practice at all.

The hon. Member for Sheffield, Hallam (Olivia Blake) raised the issue of restraint, which I was concerned to hear about. We introduced new legislation in 2018 on restraint in mental health in-patient settings. If there are loopholes in that legislation, I am very keen to look at them. Restraint should not be happening at in-patient mental health settings, but if someone is outside of that setting and it is happening, we need to look at that. The rapid review across in-patient mental health settings is looking at the safety of those services. We will be looking at the results of that review in the coming weeks. I am clear with hon. Members that this Government sees mental health services as a priority.

[Sir George Howarth]

The Minister may recall that I intervened on the hon. Member for Bath (Wera Hobhouse) about the problem of type 1 diabetics with eating disorders. Is the Minister aware of the two trials taking place, one in London and the other in Bournemouth in the west country? Once an evaluation of the success of those integrated approaches is available and published, will she undertake to look at it, because it could have some indications as to how to treat other kinds of eating disorders as well?

[Maria Caulfield]

Absolutely; I will look out for the results of those trials. I am keen that we use evidence-based medicine, and if something has proven to be effective in clinical research, it absolutely needs to be rolled out. An hon. Member touched on the lack of research into eating disorders. The National Institute for Health and Care Research does have funding available, so I would encourage clinicians, researchers and charities that want to undertake research into eating disorders to apply for funding for those trials. We need more research into eating disorders, particularly around men and high-risk groups, such as diabetics.