Backbench business

George Howarth Excerpts

Thursday 14th February 2013 Westminster Hall

[Mr George Howarth (Knowsley) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Osborne.

I congratulate the hon. Member for Romsey and Southampton North (Caroline Nokes) on raising this issue and in particular on her comprehensive survey of some of the problems experienced mainly by young people but, as she said, not exclusively so. She presented her case clearly and did a very good job.

It is important for us to send a message from this place today: quite naturally, human beings come in all shapes and sizes. There is no perfect body or shape, each one of us is different; we are genetically predisposed to look a certain way. It is important for us to say that as loudly and as often as we can, to counteract the loud noises often experienced in the media by young people about what they should look like.

Before I move on to the specific area that I want to cover, it might be worth giving an example not of a constituent but of someone I know through my family friendships: a young woman who is now in her 20s and has been studying violin since the age of five. She is a talented and well trained young musician and was offered a contract to play at an international festival in, as it happened, the south of France. The contract specified what body size she should aim to be—that says so much about where we have gone with the issue—by the time of the event. That was outrageous, and agents who become involved in such contracts should be ashamed of themselves.

I want to speak about an eating disorder that affects young people with type 1 diabetes. It is informally known as diabulimia, but the medical profession does not recognise that title and, to be fair, it is not an accepted name. In so far as I use it, I do so as shorthand to describe a quite complex phenomenon. I pay tribute to Diabetics with Eating Disorders—DWED—and particularly Jacqueline Allan who provided me with briefing to enable me to take part in this debate. Diabulimia is a condition, although not officially recognised as such, that affects mainly but not exclusively young diabetics. For clarity, I emphasise that I am talking about type 1 diabetes, which people are born with a predisposition to, and which has nothing to do with lifestyle. Some people are born with something that is likely to trigger diabetes at some stage, and too often we confuse type 1 with type 2 diabetes when they are absolutely not the same.

Sufferers of type 1 diabetes are exclusively prone to suffer diabulimia. If a young diabetic does not take their insulin, their level of blood sugar—glucose—increases, as medical science has known for a long time. However, young people have discovered that when that happens, the glucose cannot be converted into energy, and in turn the glucose is removed through the natural process of urination. Consequently, necessary calories are also lost, so manipulating their insulin intake may lead to rapid weight loss. If the intake of insulin, which is needed to stay alive, is manipulated, diabetics can achieve rapid weight loss. That information is circulated all the time in the social media on Facebook and Twitter, and young diabetics who want to lose weight are learning from other young diabetics how to lose weight rapidly. I will move on shortly to the consequences for those young people.

First, it is important to give some context for diabetes and associated problems. Young female diabetics aged 15 to 30 have a nine times higher death rate than their non-diabetic counterparts, which is an alarming statistic. According to a BBC report last year, of the 26,000 avoidable deaths from diabetes, the highest increase is among young women in that age range, which bears out the point made by the hon. Member for Romsey and Southampton North. According to the Joslin Diabetes Center and DWED, having type 1 diabetes increases the chances of developing an eating disorder twofold, and 40% in that age range regularly manipulate or omit taking their insulin, which they need to survive, in order to lose weight.

At first glance from the perspective of young people who want to lose weight, that seems like a way of using their condition as a means of doing so easily. However, the problem for people with type 1 diabetes is that deliberately increasing their blood sugar levels may have serious consequences and lead to early death. In the long term, as the hon. Lady said, there is a risk of fertility problems, which are common in relation to other eating disorders, but for diabetics there is also a risk of loss of limbs, kidney damage, blindness, heart damage and many other serious complications.

There may also be serious short-term consequences. When a type 1 diabetic stops taking sufficient insulin to balance their blood sugar levels, the body produces ketones, which are highly acidic and dangerous, and above a certain point might lead to diabetic ketoacidosis or DKA, which is always fatal if not treated quickly.

The health system is very poor at dealing with this problem because it is not officially diagnosable and the reaction of health professionals is often confused, at best, which might lead to courses of action that can have serious consequences, including death. Sufferers report being told that diabulimia does not exist—it does not exist as an official medical term—and consequently they have been discharged with no treatment. Sometimes they have been designated as non-compliant. If the health professional does not recognise what they are looking at, they assume that there is a problem with lack of co-operation from the patient and simply discharge them, which may have dangerous consequences. I will give an example in a moment.

In other cases, such people have been diagnosed as anorexic or bulimic, and treated for a condition that they do not have, often with fatal consequences. DWED reports that sufferers have sometimes been treated by eating disorder specialists who have little or no knowledge or understanding of diabetes, or by diabetes specialists who have little or no understanding of eating disorders.

[Caroline Nokes]

I welcome the right hon. Gentleman raising diabulimia, about which I knew absolutely nothing prior to calling this debate. A constituent of my right hon. Friend the Secretary of State for Communities and Local Government contacted me to inform me that treatment of the condition is incredibly rare, and they were aware of only one hospital in south London that specialises in it. Can the right hon. Gentleman confirm whether that is correct?

[Mr Howarth]

The hon. Lady is correct. I intend to address that issue when I bring my comments to a close, and I will make suggestions for what we need to do.

The consequence of people being treated either by a diabetologist who does not understand eating disorders, or by an eating disorder specialist who does not understand diabetes, is that they can be signposted to an unsuitable service altogether, or unforgivably, they will not be taken seriously when they have a serious problem.

An example I have been told about involved a young woman sufferer who was told that she was too heavy. That is not to say that she was heavy; she was very light, but she did not meet the criteria for being light enough to have an eating disorder, and was consequently told that she did not qualify for any support. The advice that she was given was that she needed to relax about food. Anybody who knows anything about diabetes knows that the relationship diabetics have with their carbohydrate intake is crucial to their well-being, so to say to a diabetic, “Go away and get more relaxed about eating”, could put them in a position where their life is threatened. Subsequently, the young woman concerned had to be admitted as an emergency case to hospital with ketoacidosis, which, had it not been treated quickly enough, would have been fatal. That was somebody who had presented themselves in the health system, looking for help, but was told to go away and get a better relationship with food.

DWED has some aims that I hope Ministers can address, and I shall go through those now. First, it wants to establish the principle, which I strongly support, that no diabetic with an eating disorder should be misdiagnosed or told, “There is nowhere to put you”, which is what is commonly said to them at the moment. That comes back to the point made by the hon. Member for Romsey and Southampton North.

Secondly, for type 1 diabetics with eating disorders—what I have termed as diabulimia—the condition needs to be properly recognised as a serious and complex mental health problem. I do not think that it is controversial for the hon. Lady to refer to it being a mental health problem, because although, in all the cases that she gave, there are serious physical consequences, the springboard often relates to mental health, relationship with body image, and so on.

Thirdly, those who seek treatment should receive the correct treatment with respect and compassion, on the basis of a multidisciplinary approach. In the example that I gave, there was not enough expertise in one specialism to be able to satisfactorily deal with the problem. Such an approach requires the Department actively to promote an understanding of the problem, so that health professionals catch on to what is happening. Protocols probably need to be in place, so that when somebody presents themselves with such a condition, health professionals know what to do.

The only people raising this problem, apart from me in today’s debate, are DWED, who work together with other bodies, such as Diabetes UK. DWED currently exists on an income, in the last financial year, of £9,000, which is not even enough to employ one full-time member of staff. DWED operates on the basis of having previous sufferers who are volunteers, under the co-ordination of Jacqueline Allan, who I mentioned earlier. I do not know whether it is more appropriate for support to come from foundations or the Government, or somebody else. I am not talking about needing hundreds of thousands of pounds, although I am sure that DWED would welcome that, but some way needs to be found to support the one organisation that is campaigning on, and raising and dealing with the problem. Given the importance of its unique role, I hope that the Government can find some support—not only for DWED, but for the issue as it exists across the health service.

Finally, just as it is vital that health professionals take a more multidisciplinary approach to this and other eating disorders, it is equally important that the Government take a more joined-up approach. I could have made the same criticism of the previous Government, and I realise how difficult it is to get a joined-up approach to eating disorders and many other things. However, on medical cases, there needs to be co-operation between different Departments, because a stronger push is required on the issue of body image and how that is dealt with. Perhaps it is not best dealt with by the Department of Health, but at the same time, some of the health issues involved need to be addressed.

[Jackie Doyle-Price]

Perhaps I can put an alternative view to the right hon. Gentleman. In my experience, people do not like being told what to do by the Government. If we acknowledge that the media are among the biggest perpetrators in pushing forward images that we should all aspire to, do we not need a good, populist campaign to educate the public that actually, curves are great?

[Mr Howarth]

The hon. Lady makes a good point. There is this idea of politicians wagging our fingers and saying, “This is what you should do”. For a couple of years in the previous Government, I had the responsibility in the Home Office for drugs policy, and one thing I know is that middle-aged men like me—perhaps I am flattering myself there—are probably the worst people to go into the media and say, “Actually, you should not be taking drugs.” A subtle, sophisticated approach is needed. A lesson from that, which applies equally here, is to provide information to young people so that they know the consequences of what they do. One problem we are dealing with is that people think there is an easy way to lose weight and to get to be the shape that they, or others, think they should be. Action has to be taken smartly, on the basis of real information about consequences, but it still has to be done.

The hon. Lady anticipated my next point, which is the responsibility of people in different industries. There is relentless media hype about what the perfect body shape should be, and the irresponsible attitudes often displayed by the fashion and entertainment industries need to be highlighted. Looking round the room, there might be one or two people who can remember what it was like to be a teenager—[Interruption.] I take that back. Several people around the room well remember what it is like to be a teenager, and one experience that we probably all share, and that every teenager in history has shared, is insecurity. They have not developed into who they are going to be, and they are insecure about everything, including their appearance—as is obvious, I have long since given up worrying about my appearance—the way they present themselves to the world, what it is to be cool, and all those things. A lot of that is dictated by what they read in magazines and see on cable channels—even on mainstream reality television shows.

It is wholly unrealistic for the industries that show those images to say, “Well, that’s a matter for the Government.” They have a responsibility to provide for young people role models that are realistic, that are just like the rest of the world, that show young people that they do not have to look like those images to be an acceptable, successful and attractive member of society. That responsibility is not just for Government or politicians, but for everyone who is in a position to influence how these things are presented to young people in particular, and to society in general. I hope that, as a result of this debate, we can at least move that agenda along a little further.

[Sandra Osborne (in the Chair)]

I call Heather Wheeler.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Walker. You are an appropriate Chair for this debate because of your interest in mental health and your willingness to speak out about your own experience, which meant an enormous amount to those who are fighting the stigma of mental health problems. Indeed, my hon. Friend the Member for Braintree (Mr Newmark) has done the same today. Such moments, when people are willing to speak out, are incredibly important in challenging and addressing the stigma of mental health problems in society.

I am deeply grateful to the members of the Backbench Business Committee for convening this important debate. It is good that Parliament has recently been willing to debate a number of different mental health issues in a way that perhaps has not happened in the past. Mr Walker, before Christmas you raised the issue of schizophrenia, on which we had a useful debate. The great value of such debates is that they force people to think about an issue, just as my hon. Friend the Member for South Basildon and East Thurrock (Stephen Metcalfe) has today. His experience of recognising the problem, perhaps for the first time, and talking about it with his children demonstrates the great value of such occasions, because they force all of us to think about an issue. Indeed, they force officials in my Department to think about the issue, too. I am grateful.

I do not want to detain everybody unnecessarily, but I will devote a little time to responding to the specific issues that hon. Members have raised. If the hon. Member for Romsey and Southampton North (Caroline Nokes) does not mind, I will refer first to the speech by my hon. Friend the Member for Braintree. I am so grateful that she persuaded him to come speak in this debate, because he made an incredibly valuable contribution. I was struck by his remarks about the huge stress experienced by teenagers. As the father of two boys who have been through the teenage years, I am acutely aware of the pressure on teenagers and the impact that it can have on their mental and physical health. He discussed huge stress, fear of failure and anger. I was struck by what he said: unless the mind is healed, the body cannot heal. We must look at the problem holistically.

One problem with health care is that we have institutionalised fragmentation. We have managed to separate mental health from physical health, which is ultimately not a good thing. We must consider the whole person. I know that the Opposition have been talking about that. It should not be an issue for political disagreement; it is such an obvious thing to recognise.

My hon. Friend the Member for Braintree discussed the need for education and raising awareness, including among parents. The strain, stress and anxiety that parents go through must not be underestimated. Improved awareness is needed in society of this range of conditions. He said that mental health care was the orphan within the NHS, which is absolutely true. There is an institutional bias against mental health. The way that money flows within the NHS disadvantages mental health. There is an 18-week target for physical health care and a tariff, meaning that every patient takes money with them into acute hospitals. Money is sucked through into acute hospitals, and there is great political pressure from every side to maintain the 18-week target. There is no equivalent in mental health. There is no right of access. Waiting nine months to access care and treatment is completely unacceptable. We must challenge that, and he was absolutely right to raise it. He ended on a positive note. There can be life after anorexia, however tough it is to get through it. Some, terribly sadly, do not. I will return to that point in a moment.

The hon. Member for Romsey and Southampton North made some incredibly important points. She mentioned her local organisation, April House in Southampton, and the fantastic work that it does, and she spoke about the absolute importance of raising awareness in primary care. Some people are lucky enough to find a GP who understands mental health and is passionate about it, but some are not. Families with a GP who just does not get it can be desperate; they have nowhere to turn. There is a need to raise awareness.

In the first mandate, a set of priorities published by the Government for the new NHS Commissioning Board, mental health has been given a higher priority than it has ever had in the NHS. The mandate makes it clear that the NHS is under a legal obligation to deliver demonstrable progress towards parity of esteem by 2015. That means treating mental health on a par with physical health. By placing the commissioning board under that obligation and disseminating the message to clinical commissioning groups, we will start to make progress on forcing the system to recognise the importance of treating mental health and physical health equally. It will not happen overnight, but it is a journey that we must take to improve the condition of many people. The hon. Lady discussed the impact on families and the unfair sense of guilt that many experience. She also mentioned waiting times, which in many cases are simply unacceptable.

I am grateful to the right hon. Member for Knowsley (Mr Howarth) for his contribution informing me and others about diabulimia. He discussed the rapid weight loss that can occur with diabetes, and how some people use the condition to lose weight in a dangerous way. He also said that in too many cases, a wrong diagnosis is made and the wrong treatment given as a result, and urged me to ensure that the condition was recognised better at a national level and the knowledge disseminated through the system. I urge him to engage with the commissioning board. I am happy to work with him on that, and for him to write to me on the issue.

[Mr George Howarth]

I am grateful to the Minister for the helpful way that he is addressing the problem. I have written to one of his ministerial colleagues on the matter. I arranged a meeting with her that she had to cancel owing to diary commitments, but I would be more than happy to meet him and anybody else he wants, including Diabetes UK and Diabetics with Eating Disorders. I am sure they would be happy to accompany me.

[Norman Lamb]

I am nervous about treading on other ministerial toes, but I am sure that in one way or another we can get the issue addressed properly. I am grateful to the right hon. Gentleman for informing me so well.

The hon. Member for South Derbyshire (Heather Wheeler) made a helpful contribution and discussed the need to raise awareness of eating disorders. She mentioned personal, social, health and economic education in schools. All schools are encouraged to provide young people with good, age-appropriate education about sex and relationships, but we are reviewing PSHE to establish how teaching can be improved. There is clearly a need to improve the teaching in many schools.

The hon. Member for North Tyneside (Mrs Glindon) mentioned her local service, NIWE, and the important work that it is doing. She spoke about the number of people who are not diagnosed but who none the less suffer from eating disorders, and about the fact that they have the highest mortality rate of any mental illness. She said that early intervention was important.

I was struck by what the hon. Lady said about recovery groups. This morning I spoke at a conference on mental health. I spoke specifically about recovery and a new way of looking at mental health. We must move from trying simply to treat the condition to working collaboratively with professionals and people experiencing the condition, and we must focus on recovery. Fantastic results are being demonstrated from that shift in approach. It is frustrating that in some parts of the country, great things are happening, but it is patchy, as many hon. Members have said, and improvement is needed. She also made the point that mental health is the poor relation, as I have acknowledged. That must change.

I pay tribute to the hon. Member for Enfield, Southgate (Mr Burrowes), who has had to leave, for the work that he has done on addictions, focusing on treatment and recovery. He has been committed to improving the experience of people suffering from a range of addictions. He, like other Members, discussed the growing prevalence of the condition among teenage boys, which should worry us all. My hon. Friend the Member for Wells (Tessa Munt) spoke movingly. She mentioned the cult of celebrity, pressure on youngsters, variability of services around the country and access to those, the quality of care being variable and the need for much improved training and for multidisciplinary teams.

Interestingly, my hon. Friend mentioned issues of consent, a difficult area about which there are strong views on both sides. I am acutely aware of the horrible position of a parent wanting to help, but being unable to because of the legal constraints that prevent them from making an effective intervention. We need to think more about that, and the Children’s Minister is also involved in the discussion.

My hon. Friend the Member for South Basildon and East Thurrock got it right. Fascinatingly, he talked about his discussion with his children last night. I am so pleased that his television is broken, because it has led to our being given a valuable insight that we might otherwise not have had. He mentioned the increasing prevalence among males, including among gay men, which is a real concern. He also talked about the need for help for parents in understanding the condition much better.

The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), was right to talk about holistic care and the need to look at the whole individual. I will mention other things that he said as I go through my speech. I wish his son a happy birthday today, as he enters his teenage years.

The hon. Gentleman asked a couple of questions. On collating national statistics, we have a long way to go on the collection and interpretation of data relating to mental health. I have a fortnightly meeting on mental health in my office, so that we maintain an absolute focus on achieving tangible improvements. We talked specifically about data yesterday. The Health and Social Care Information Centre is getting more data but is not yet able, with the resources available, to interpret those. I want the same resources applied to mental health as to physical health. That is a challenge that I have made to the system.

The hon. Gentleman mentioned National Institute for Health and Clinical Excellence guidance. NICE is independent. I do not know whether there is a need for a review—a renewal—of the advice. I am happy to talk further to him about that.

This is an occasion on which we should not just raise awareness of the issue as part of eating disorders awareness week, but send a clear message to people with eating disorders, their loved ones and families: we hear you when you talk about your concerns. I am determined, as the Minister responsible for mental health, to do what I can to help.

I pay tribute to the work of Beat, based in Norwich in my county of Norfolk, which does brilliant work. Hon. Members have also mentioned Anorexia and Bulimia Care and the fantastic work that it does.

Eating disorders can be tremendously dangerous and damaging conditions. The UK has the highest rates of eating disorders in Europe. But it is a disease that is often hidden, as hon. Members have said. Sufferers are often unwilling to seek help or to recognise they have a problem. Reported cases are the tip of the iceberg. It is a disease that often strikes at the young. In 2009, the adult psychiatric morbidity survey showed that 20% of 16 to 25-year-olds admitted to having “a problem with food”. That is a significant percentage.

According to the Health and Social Care Information Centre, in 2011-12 the biggest increase in hospital admissions for eating disorders was among girls aged 10 to 15. The shadow Minister, the hon. Member for Denton and Reddish, mentioned admissions of those under 10, as well—shockingly, more than 50 children under 10 were also admitted.