Eating Disorder Awareness

John Milne Excerpts

Tuesday 1st April 2025 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered eating disorder awareness.

It is a pleasure to serve with you in the Chair, Mr Stuart.

Eating disorders are among the most serious and life-threatening of all mental illnesses, but they have been overlooked and underfunded for too long. Because of this, they have one of the largest treatment gaps in modern healthcare, and we must ask why that is. In the face of overwhelming need, why are we still ignoring this crisis, especially as it is a documented fact that recovering from an eating disorder is possible, no matter how long and complex the illness has been?

In the past decade, we have seen an alarming rise in eating disorders—a trend that only worsened during the pandemic. What was already a struggling support system for those affected by eating disorders has collapsed under pressure. Too many people are waiting, too many people are failed and too many people are feeling neglected by the system. The eating disorders all-party parliamentary group, which I chair, recently published its report, “The right to health: People with eating disorders are being failed”, which highlights the increasing neglect we are seeing across eating disorder services—but that is by no means to say that those who are working in eating disorder services are not working their socks off. People with eating disorders are being told that they are not thin enough, that they are too complex, and in some situations are being moved on to palliative care and identified as treatment-resistant. That is why we are pushing for a complete reformation of eating disorder treatment alongside the development of a stand-alone eating disorder strategy.

During Prime Minister’s questions on 19 March, the Prime Minister emphasised the NHS’s goal of bringing eating disorder care closer to home. This is an important goal, but it requires equitable access to intensive community and day treatment, as highlighted in Beat’s report, “There’s no place like home”. Such services can reduce the need for costly hospital admissions and shorten stays for those who need in-patient care. However, Beat’s report shows that only one in six NHS integrated care systems in England currently offer enough intensive community and day patient treatments for both children and adults. Alongside this, it is crucial that we do not focus on only one end of the spectrum. Day services cannot always meet the needs of those with extreme malnutrition, and in-patient care is critical for many people who need high levels of physical, behavioural and psychological support.

The strain on family carers, who often lack medical expertise, must be considered too. In-patient and day patient care must be part of a well-integrated, stepped care system. If those services are not co-ordinated nationally, gaps will form in the care pathway and patients may fall through the cracks. I agree with the Government that if people are treated in a timely manner in the community, there will be less need for costly in-patient care, but before we make any changes, we must ensure that all levels of care are adequately funded and can work in tandem to provide the best possible support.

I recently had the privilege of hearing Nicky Smith share the story of her courageous daughter, who has been in in-patient services for over a decade. Unfortunately, during her long stays, she has not always received the treatment she needs. Her current stay is now in its 21st month. For the last eight months, her team has been trying to find an alternative placement for her complex needs. Sadly, she has been rejected by every service she has applied to and now faces discharge. Nicky and her daughter acknowledge that although some in-patient units are better resourced than others, being in in-patient care has saved Nicky’s daughter’s life and continues to do so. Over the last 12 years, the community eating disorder teams provided limited, inconsistent support. That caused rapid relapse, sometimes in just a few weeks, leading to low body mass index and frequent readmissions, often to inappropriate units such as general hospitals or acute mental health wards. Ultimately, she was readmitted each time to a specialist eating disorder unit, under section 3 of the Mental Health Act 1983. That is the only way she can complete meals without the need for nasogastric feeding.

In addition to being deeply moving, this story drives home the importance of well-resourced specialist eating disorder units. We cannot cut back on those essential services and force those who are unsuited for discharge into community care. Specialist units are essential for keeping people alive, safe and supported, as they work towards recovery and reintegration into everyday life. That must continue, alongside investment in community and day-treatment programmes.

To tackle eating disorders and develop effective treatments we need to understand them fully. Worryingly, the International Alliance of Mental Health Research Funders found that eating disorders accounted for just 1% of the UK’s already severely limited mental health research funding between 2015 and 2019. That is despite people with eating disorders accounting for around 9% of the total number of people with a mental health condition.

Recent funding announcements are even more cause for concern. The Royal College of Psychiatrists found that 24 of the 42 integrated care boards planned real-terms spending cuts to children’s eating disorder services in the current financial year. That would result in real-terms cuts of well over £800,000. Those planned spending cuts come against a background of severely stretched children’s and young people’s eating disorder services: a 13% increase in referrals in the past 12 months; high thresholds to access services, resulting in more young people being in crisis; almost 800 urgent referrals still waiting for treatment at the end of December 2024; and a 30% true vacancy rate for all eating disorder consultant psychiatrist positions across England, as of March 2023. Following those troubling findings, will the Minister assure all of us here and across the country that all ICBs will invest sufficiently in those vital services in 2025-26 and beyond?

As well as providing an increase in funding, we must take a close look at measures to protect children from harmful online eating disorder content. There is growing evidence that social media is linked to an increase in eating disorders among young people. Algorithms are showing harmful content to vulnerable people. Those include posts promoting fasting non-stop for days on end as a healthy lifestyle. There is an online trend of “thinspiration” posts, which glorify unhealthy weight loss. There have also been cases where, even after users have blocked certain accounts, they still see content that promotes eating disorders.

In research conducted by the Center for Countering Digital Hate, a fictional UK-based 13-year-old user watched a video about eating disorders for the first time. Following the video, one in four suggested videos were for harmful eating disorder content. More than half were for content relating to eating disorders or weight loss. Under the Online Safety Act 2023, YouTube will have a responsibility to protect children from primary priority content such as eating disorders. Yet, YouTube still does not appear to be taking that seriously. In fact, algorithms are pushing the content in order to increase engagement.

Harmful content viewed online can push children further into eating disorders that have a drastic effect on their health, wellbeing and life chances. From the evidence I have seen, I am concerned that, even when the provisions of the Online Safety Act 2023 come into force, the actions of those media giants may not change, which truly worries me. Social media is not the cause of eating disorders. Users who post much of this content are unwell and are not doing so maliciously, but social media can lead those who are already suffering further down the path of disordered eating. More needs to be done to hold social media companies accountable to legislation such as the Online Safety Act.

Another issue of grave concern is the need for more accurate recording of eating disorder-related deaths, and a better understanding of the factors contributing to them. As we know, eating disorders are one of the most life-threatening mental illnesses, however, all too often they are not explicitly listed on death certificates, despite being a significant factor in the person’s death. For example, someone suffering from anorexia and severe malnutrition may have their cause of death recorded as organ failure, without any mention of the underlying eating disorder. That is a crucial gap that we must address.

The APPG has heard first hand from people who have experienced the heartbreak of losing a loved one to an eating disorder. One particularly moving example is that of the Laurence Trust, a Northern Irish charity founded by Laurence’s family after his tragic death. Laurence had struggled with bulimia and depression, and eventually suffered a fatal heart attack. His mother Pam shared with the APPG that his death certificate did not list the eating disorder as a contributing factor. Instead, the cause of death was recorded as undetermined. That misclassification not only deprives families of closure, but hinders our understanding of the true scale of eating disorder-related fatalities.

To better prevent such deaths in future, we must ensure that coroners’ reports accurately reflect eating disorders as contributory factors. Only by tackling these deaths can we gain a clearer picture of the impact of eating disorders, and take meaningful steps towards prevention and improved care. Accurate recording will raise awareness and ultimately save lives. It is high time that eating disorders are treated with the seriousness they deserve. We are all well aware of the many different parts of the NHS that require additional funding, but I have simply heard far too many harrowing stories about delays to treatment, inadequate care and premature inpatient discharge. Now is the time for change.

[John Milne (Horsham) (LD)]

In my constituency of Horsham, we had a particularly upsetting case of a constituent whose daughter had significant mental health and behavioural issues that were very difficult to deal with and, as a consequence of those not being dealt with, she also developed an eating disorder. The only place they could send her to that could cope with that combination of factors was in Yorkshire—my constituency is in West Sussex. That was an extraordinary burden on the family. We need provision across the country to deal with the cases that present.

[Wera Hobhouse]

I totally agree. Unfortunately, there is a massive postcode lottery. Services need to improve across the country so that everybody, like my hon. Friend’s constituent, can get the treatment they need as close to home as possible, because carers are so important, and so that families can see their loved ones.

In the last year alone, more than 30,000 acute admissions for eating disorders were recorded—that is a vast number. What was already an overstretched and under-resourced support system for those affected by eating disorders has now become a national emergency. Our APPG report sadly proved these systemic failures are costing lives. It is clear we need an urgent and comprehensive overhaul of eating disorder care and treatment in this country to ensure that we do not lose our important inpatient care, and to massively improve community and day treatments. I add to what my hon. Friend the Member for Horsham (John Milne) said, that if eating disorders, or the underlying mental health disorders, are not prevented or cared for early enough, everything becomes so much worse further down the line.

I repeat that we must address the role social media plays in promoting eating disorders and harmful content, especially to young people. We also cannot even begin to understand the depth of this crisis without accurate data regarding eating disorder-related deaths. I hope the Government have heard what I said today, and will act fast and decisively to ensure that eating disorder sufferers finally receive the treatment and care they all deserve. I have been chair and vice-chair of the APPG on eating disorders for the last six years. That is a long, frustrating time to see get worse something that one wants to get better, so I hope that today may be the start of us turning a corner.

Welfare of Doctors

John Milne Excerpts

Tuesday 21st January 2025 Westminster Hall

[Peter Prinsley]

I agree with my hon. Friend, as he will see.

There are odd shifts, night duties without hot food, and days and weeks that go by without an opportunity to meet supervising consultants. Short clinical attachments mean that the relationships previously created with senior mentors are rare. Just last week, I received an email from a surgeon who was my consultant in 1986. He had noticed in a surgical journal that I had become an MP, and I remembered him as the brilliant surgeon that he was. These are the relationships that make people feel as if they belong within a wider profession, but I doubt whether the young trainees of today would have the chance to make such lasting connections.

There is little security of employment, because doctors are obliged to apply every year or two for another post, probably in another place. The doctors’ mess used to be a place where young doctors could find a sort of surrogate family in an unfamiliar place, but that is now sadly a thing of the past. According to research from the British Medical Association, fewer than 10% of UK trusts or health boards offer hot food after 11 o’clock at night.

The demands of the job affect relationships. Many young doctors are in relationships with fellow doctors, but lucky indeed are the couple who can work and live in the same place, or even contemplate raising a young family together. Sadly, relationship difficulties and breakdowns are commonplace. Holidays must be taken at odd times, and rotas are inflexible. Doctors are left unable to take a day off to attend a wife’s graduation, a sister’s wedding or even their own wedding—all true.

Progression in a chosen career depends on a multitude of competitive interviews and hugely costly professional exams. There is no security of employment. In a survey called “Fight Fatigue” conducted by the Royal College of Anaesthetists, 50% of respondents said that they had had an accident or a near miss when driving home after a night shift—I recall fatalities like this in my own hospital; 84% were too tired to drive home after a night shift; and only 64% had access to any rest facilities. What would we say if the same were true of airline pilots, to whom anaesthetists are sometimes compared?

[John Milne (Horsham) (LD)]

Last week I met with a GP in my constituency, and she described very much what the hon. Gentleman is talking about: at the end of the day, after blitzing through 25 patients, back to back, she sometimes found herself sitting in her car, simply too tired to drive home for half an hour. Does he agree that we are expecting too much of our medical staff in relying on their dedication to go beyond the call of duty?

[Peter Prinsley]

I agree with exactly what the hon. Gentleman said.

In a recent survey, 29% of hospital doctors said they were unable to take any breaks at all during the working day; for GPs, the figure rose to 40%. That is simply not safe, for either doctors or patients. In a 2023 survey conducted by the Royal College of Surgeons, half of respondents cited poor working conditions as the main challenge in their job. It is no wonder that so many colleagues are retiring too soon. The average age for a radiologist to leave the NHS is now 56, yet we are desperately short of these vital specialists. This is happening across many specialties. Just in 2023, 23,000 English doctors left the profession prematurely.

We cannot afford to lose our most experienced doctors. Too often they are discouraged from continuing in practice by a bureaucratic and costly appraisal and revalidation process, and they simply throw in the towel. Their experience is a vital asset to the NHS, and we must think carefully about how we retain them or return them to the workforce. One solution will be to create simple routes for experienced doctors to practise flexibly.

Lobular Breast Cancer

John Milne Excerpts

Tuesday 10th December 2024 Westminster Hall

[John Milne (Horsham) (LD)]

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for raising this vital issue. Breast cancer is the leading cause of cancer death for women worldwide, and many, if not all, Members will know somebody who has faced the frightening prospect of breast cancer treatment, which is unfortunately all too common and impacts the lives of millions, whether directly or indirectly. What is fortunate is the progress in detection and treatment, which has provided many patients with positive outlooks and a healthy future life with their loved ones.

Sadly, this prospect is often not afforded to the 15% of breast cancer sufferers diagnosed with invasive lobular cancer. Survival prospects for those with ILC can be relatively good, but only for those who are diagnosed early, before the cancer has spread. I repeat the calls of other Members and Breast Cancer Now to publish the findings of the UK national cancer screening review into breast cancer risk stratification. If improvements are made so that we can detect more elusive forms of breast cancer, tens of thousands of lives could be saved. However, improved detection is not enough by itself. Women diagnosed with ILC face another issue: the treatments they are provided are not tailored or specific to their cancer. In short, they are treated for a disease they do not have.

One of those women, as has been mentioned, is Dr Susan Michaelis, who lives in my constituency of Horsham, where I met her earlier this year. Susan is an incredible woman who has campaigned tirelessly on invasive lobular cancer treatment and research. She was diagnosed with lobular cancer in 2013, but the treatment she then received was designed for ductal cancer, which is the most common form of breast cancer. As a result, Susan’s condition evolved and became resistant to the treatments now available.

Someone less determined might have given up looking for answers, but instead Susan went out and started the Lobular Moon Shot Project and, yes, I have already planted my Susan Michaelis rose. She met research experts to build an idea of the cost of research into the basic biology of invasive lobular cancer in the hope of improving outcomes for those yet to be diagnosed. The Institute of Cancer Research has deemed that £20 million is enough to make significant progress, and Rob Clarke of the Manchester Breast Centre will head up that work in conjunction with world leading experts. That is all agreed.

Since then, Susan and the Lobular Moon Shot Project have lobbied MPs and Government Departments. Hundreds of MPs have supported the application for funding. In the last Parliament, the number was 247; there have already been almost 200 in the current term, and I am sure that many more will join the call. The team at the project should be commended for all their hard work and amazing, ceaseless energy.

Given the Government’s recent announcements about taking a firm business approach to funding within Departments, research into lobular cancer makes for a strong business case as well. Breast Cancer Now research shows that the cost of breast cancer to the UK economy is £2.6 billion. That is set to rise to £3.6 billion by 2034. Ongoing cancer treatment is expensive, with each patient requiring approximately £10,000 a year, whereas the £20 million research request equates to £240 per lobular cancer patient over the next 10 years.

Early detection and better treatment can reduce the overall time the NHS needs to support patients. Put simply, research into lobular cancer saves both lives and money. If the human arguments are not enough for the Government to commit to this vital research, then let us talk about the money. The previous Government included lobular cancer research in their women’s health strategy for England 2024 and acknowledged that there was an urgent, unmet clinical need. I ask the new Secretary of State to renew that commitment and to fund the Lobular Moon Shot Project’s call for research, which will enable the NHS to offer specific treatment to lobular cancer patients and end the one-size-fits-all approach. Dr Susan Michaelis and the lobular ladies hope that they will be the last generation to go through the experience of insufficient treatment and poor outcomes, and I hope that this Government can make that a reality.

Access to Primary Healthcare

John Milne Excerpts

Wednesday 16th October 2024 Commons Chamber

[John Milne (Horsham) (LD)]

The ongoing crisis in GP access is as acute in my constituency as elsewhere. That is not simply because there are more patients, but because today’s patients have greater health challenges and need to see their GP more frequently. That is why simple comparisons with GP ratios from the past do not work. We need a health service capable of meeting today’s needs, not those of 20 years ago.

In Horsham, it has become routine for surgeries to fill all available appointments within minutes of opening. Relatively junior staff are obliged to spend the rest of their time saying no to frustrated, anxious and—not infrequently—angry patients. The danger is that we might enter a spiral of decline whereby demoralised staff leave, piling more pressure on to those who remain and scaring off replacements before they have ever had a chance to settle. We must get working conditions right, and that cannot be achieved in a state of permanent understaffing.

We must also get more from the services that we already have. Unleashing market forces on the NHS, and setting pharmacies, GPs and hospitals against each other, was a mistake. Effectively, they are in commercial competition to provide more of the treatments that pay well and less of those that do not. Only integrated care boards are in a position to take a holistic view of patient provision, but that is not really happening yet.

There are any number of alarming statistics relating to our health service, but I will conclude on one that is a bit more positive. As mentioned by one of my colleagues earlier, studies by the University of Cambridge and others suggest that where patients are seen by the same GP over 15 years, the average mortality rate declines by 25%. That is a remarkable level of improvement, more than could be expected from almost any other intervention. Let us give GPs the space to do their job properly, and let us support this motion.