Health: Eating Disorders

Lord Bethell Excerpts

Tuesday 19th January 2021 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, eating disorders are serious, life-threatening conditions, and we are committed to ensuring that people have access to the right support when they need it. We are growing our investment in community healthcare for adults year on year—almost £1 billion extra by 2023—with specific funding to transform adult eating disorder care and, for young people aged 16 to 25, to accelerate provision beyond existing growth and to transform plans.

[Baroness Parminter (LD) [V]]

The NHS health survey suggests that the prevalence of eating disorders is significantly higher than previously assumed, so will the Government commission a national, population-based study to accurately identify the number of people with eating disorders, as the Public Administration and Constitutional Affairs Committee recommended, to inform research and service-level provision?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right: the statistics on eating disorders are shocking. The Mental Health of Children and Young People in England Survey identified 0.4% of 5 to 19-year-olds and 1.6% of girls aged 17 to 19. The NHS Digital Adult Psychiatric Morbidity Survey showed 6.4% of adults displaying signs of an eating disorder. There is the survey by Beat, and I could go on. I do not think it is an issue of surveys; we have to address the underlying statistics with measures that make a difference.

[Lord Winston (Lab) [V]]

It is very helpful that the Minister recognises the seriousness of anorexia nervosa and other conditions. It remains puzzling, and the causes are not fully understood, but the long-term risks—for example, infertility or the loss of a child during pregnancy or childbirth—are very serious. Given that some of these patients require almost forced admission to hospital, is there any scope for reviewing this issue when we come to consider the mental health provisions that are due next year?

[Lord Bethell (Con)]

The noble Lord puts it extremely well. Instances of those in pregnancy who have eating disorders are particularly heartrending and disturbing. He is right: sometimes, the condition is so extreme that it needs virtual full admission. We have put six new beds in the south-east, five in the Midlands, five in the east of England and 10 in the north-east. We are putting a massive amount into mental health budgets and this provision covers exactly this kind of disorder because we recognise that more resources are needed. I look forward to further announcements of spending in this area.

[Lord Truscott (Ind Lab) [V]]

My Lords, as the Minister said, the statistics outlined by the health survey are of obvious concern, but the survey, published last December, does not cover the period of the Covid pandemic. Has the Minister any evidence that eating disorders have increased during the pandemic? If so, what is Her Majesty’s Government’s response?

--- Later in debate ---

[Lord Bethell (Con)]

The noble Lord is right: the pandemic will have added pressure, particularly on young girls. In-patient units are experiencing tremendous pressure, so it is difficult to see those instances working their way through primary care at the moment. We are studying the situation very carefully, but the noble Lord is entirely right: it is quite possible that incidents will increase, and we will put resources in place to address that.

[Lord Lingfield (Con)]

My Lords, is my noble friend aware that around a quarter of all sufferers of eating disorders are men, and that the number of males seeking help has gone up by 70% in the last decade? With the increasing emphasis on young men to attain a certain body type, does he agree that more males might need support in the coming years?

[Lord Bethell (Con)]

My noble friend is right to remind us that this is not a gender-specific condition and that many men have eating disorders of one kind or another. The culture we live in does nothing but encourage that and I think we have to address the underlying causes, both psychiatric and the pressure of social media. We will be putting in place the resources necessary to support that kind of initiative.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, NHS Digital has reported that admissions for eating disorders have almost trebled since 2007, but there has been very little investment into in-patient treatments since then. With only 400 NHS beds for adult eating disorder sufferers in England, and capacity currently further reduced by the pandemic, what are the Government doing about this chronic shortage of in-patient beds for those suffering from serious eating disorders, which particularly affect young women?

[Lord Bethell (Con)]

The noble Baroness may not have heard my answer to the previous question, where I cited the large number of beds opened in the last year, totalling more than 30 across the country. I recognise that more beds are needed for those who have particularly acute disease, but the large prevalence of the disease among hundreds of thousands of young girls and boys also means that community care has to be at the heart of our response to this condition.

[Baroness Fall (Con) [V]]

My Lords, this autumn, charities such as Place2Be have recorded a notable increase in issues of self-harm, suicidal thoughts and eating disorders. The impact of shutting schools has been huge, and we will not know the legacy of that for a long time to come. I am reassured to hear the Minister say that he is as concerned as I am to look at ways to deal with this, but will he and others consider making school teachers the first priority for receiving the vaccine, after the most vulnerable and aged in our population, so that schools can open as soon as possible?

[Lord Bethell (Con)]

My Lords, we recognise the contribution of charities to this mental health challenge, and £10.2 million of additional funding has been allocated to mental health charities. We also recognise the importance of keeping schools open: no Government could have tried harder to keep schools open than this one. However, the allocation of the vaccine is based on morbidity—we have to protect those whose lives are most threatened and that is why the JCVI has put the prioritisation list in the form it has.

[Baroness Bull (CB)]

My Lords, a recent literature review found that many GPs feel unequipped to identify and manage eating disorders, meaning that patients who could benefit from primary care are often passed on to specialist services and face long waiting lists. Given the importance of early intervention, can the Minister say what is being done to train and support primary care professionals in diagnosing and treating people with eating disorders, and to improve shared care across the primary and secondary care interface?

[Lord Bethell (Con)]

My Lords, NHS England is working with Health Education England to procure training courses that will increase the capacity of the existing workforce, to allow them to understand these challenging issues better and allocate people to the right course of treatment. It is a problem that we recognise, and resources in training are being put in place to address it.

[Baroness Thornton (Lab) [V]]

My Lords, following on from the last question, hospital admissions for bulimia rose 75% during lockdown, amid fears about the mental health impact of the pandemic. For children and young people, we also know that these figures have been rising every year for several years. We also know that there are regional disparities in waiting times for eating disorder services. What will the Government do to respond to what seems like an increase in eating disorders and rising regional disparities?

[Lord Bethell (Con)]

My Lords, I recognise the issue of regional disparities, but I reassure the noble Baroness that our ambition is to deliver swift access to treatment for 95% of children and young people with suspected eating disorders within one week. The good news is that in the second quarter of 2021, 83% of urgent cases were seen within one week and 89.6% of routine cases were seen within four weeks. Those figures can be improved but I think that they are impressive. They show that progress is being made and that we are taking this issue seriously.

[Baroness Walmsley (LD) [V]]

My Lords, the eating disorder faculty at the Royal College of Psychiatrists has recently reported that eating disorder teams are being asked to ignore the NICE guidelines for treatment as being unrealistic and too expensive. Will the Minister either justify this or condemn it?

[Lord Bethell (Con)]

The noble Baroness brings to my attention something concerning. I would be grateful if she would write to me with the details and will be very happy to look into it in more detail.

[Baroness Wheatcroft (CB) [V]]

My Lords, parents of adult children suffering from the most extreme eating disorders say they are often desperate to help but powerless because of an insistence on patient confidentiality. The desire to give autonomy to patients too often extends to those whose sickness with eating disorders makes them unable to take sensible decisions for themselves. Will the Minister agree to examine the conflict between these two wishes and how it could be resolved?

[Lord Bethell (Con)]

My Lords, the noble Baroness alludes to a conflict for which there is no easy answer. I completely sympathise with any parent whose child is exhibiting eating disorder issues. It is the most awful and frustrating situation for any parent to see their child in a self-destructive loop for which there seems to be no intervention possible, but patient safety is patient safety, and this is the conundrum that faces any mental health situation. The Mental Health Act is undergoing review at the moment—I am grateful to Sir Simon Wessely for his report, which we debated yesterday—and these are exactly the kinds of issues that we are looking at. I express profound sympathy for all those who find themselves in this awful situation.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the time allowed for this Question has now elapsed. I apologise to the noble Lord, Lord McColl of Dulwich, that there was not time for his question.