NHS Eating Disorder Services

Baroness Merron Excerpts

Thursday 29th June 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I am very grateful to the noble Baroness, Lady Parminter, and congratulate her on securing what is, as we all acknowledge, a very important debate. As I am sure everybody did, I appreciated her openness in speaking about her experiences and those of her daughter, Rose. Her thorough introduction set up the debate strongly, particularly the emphasis on the need for auditing. Where are we in order that we should know where we need to go? I am sure the Minister will refer to that.

I very much welcome the Minister’s response to this debate, because he will be making his maiden speech, which I am sure we are all looking forward to. From these Benches, I welcome him to your Lordships’ House and to the Front Bench. I am sure we all look forward to many interesting and fruitful exchanges across the House.

This has been an enlightening debate not least because we have heard personal experiences, including from the noble Baroness, Lady Wheatcroft, who spoke about her daughter Lucy, and the noble Baroness, Lady Janke, who drew on her personal experience. She made the very good point—that has been made many times and she is right to make again—that it is not just the sufferer; their friends, their family and communities are also deeply affected.

I say to the Minister that that does not require a joined-up response across government because, again as the noble Baroness, Lady Wheatcroft, said, this is an assault, in so many ways; it is all around us, including online and through clothing stores. We have to bear that in mind and take the necessary action.

What is the backdrop to this debate? It is that we have some 1.25 million people in this country living with an eating disorder. As we have heard, eating disorders have high mortality rates, with anorexia claiming the most lives of any mental illness. Yet, with timely and appropriate treatment, people can live healthy and fulfilling lives. This important debate calls on the Government to up their game in both the prevention and treatment of eating disorders. Sadly, however, the pace of change has not been what it needs to be or what is called for by experts and by the evidence before us. It has been called for by sufferers and campaigners, yet the response has been somewhat wanting. The reality is that the number of people waiting for treatment following an urgent referral for a suspected eating disorder has increased considerably over recent years—not just for children and young people but for adults, and not just for women but for men. All are being affected; all are waiting.

NHS England data published for the first quarter of 2022-23 shows that, of the 229 children and young people currently on the waiting list for urgent treatment for eating disorders, 45% have been waiting for more than 12 weeks. This figure has risen substantially from 11% in the first quarter of 2021-22, and from 5% in the first quarter of 2020-21. That is the trajectory before us.

Since 2020, the NHS has had a national waiting time target for children and young people with an eating disorder—that 95% of urgent cases should receive treatment within one week and 95% of routine cases should receive treatment within four weeks—but the target has never been met. As the noble Baroness, Lady Parminter, asked, why is it that we only have a waiting time target for children and young people, important though that is? Why do we not have waiting time targets for adults? Perhaps the Minister could refer to that.

It is very likely that your Lordships’ House will hear from the Minister that the pandemic is at the root of this. Undoubtedly, the pandemic has had an impact, not least as eating disorders increased during that time—understandably, given the conditions created by the pandemic. However, despite us being way past the pandemic, the trajectory is only one way: waiting times for these treatments are on the up. Perhaps the Minister could tell your Lordships’ House why that is so.

We heard a very good introduction to the report of the Parliamentary and Health Service Ombudsman entitled Ignoring the Alarms. As we heard, it focused on the very sad case of Averil, who died having had a history of anorexia nervosa at 19 years old. She died in 2012 because of the failures of four NHS organisations that should have cared for her. The fact is that her death and other deaths were avoidable, because there had been multiple missed opportunities in the months before those deaths.

I was very struck by the briefing from the ombudsman, to which I paid great attention in preparation for this debate. The ombudsman says upfront that almost six years on, little progress has been made on children and young adults with eating disorders, who are still experiencing avoidable harms. The ombudsman says there was a problem before lockdown and that that, combined with the additional pressure on National Health Service mental health services, has meant there is a continuing struggle with demand. The ombudsman called for lessons to be learned to improve the necessary services, including a cultural shift and work across government to ensure that people are listened to, that services are joined up and that care plans are properly constructed. I hope your Lordships’ House will hear from the Minister today what assessment there has been of the progress on these points. Perhaps there could be an audit, as the noble Baroness referred to earlier, of what is in place to deliver the necessary improvements.

The workforce plan has one working day in which to arrive. I shall be positive and say that I look forward to it, after many years of anticipating it. Medical students get only two hours of training on eating disorders in their whole career, and this is wholly inadequate. I hope that, when we see the workforce plan, it identifies the whole team that is necessary to deal with eating disorders, deals with their recruitment, retention and remuneration, and ensures that we have the right mix and the right numbers as soon as possible.

Today, the ombudsman published a new report, which Members of this House have just received, entitled Broken Trust: Making Patient Safety More Than Just a Promise. The report is not specific to eating disorders, but its themes are crucial to reducing the risks faced by people with such disorders. Will the Minister confirm that the Government will respond to this report and, if so, how and when?

In closing, I ask noble Lords to think about where we are. In 2019, the Public Administration and Constitutional Affairs Committee found that insufficient action had been taken on every one of the recommendations made. It is true that there has been some progress—that has been acknowledged today and I too wish to acknowledge it—but I ask the Minister to tell us how progress and its impact will be assessed, and how we will ensure that the right changes and improvements are made and that they save the lives, and improve the quality of life, of many. With that, I very much look forward to the noble Lord’s maiden speech and welcome him once again.