Eating Disorders

Question

Asked by

To ask Her Majesty’s Government, further to the report of the Parliamentary and Health Service Ombudsman Ignoring the alarms: How NHS eating disorder services are failing patients, published on 6 December 2017, what steps they are taking to ensure that eating disorders are taught appropriately in medical schools.

My Lords, following the Parliamentary and Health Service Ombudsman’s report regarding the tragic death of Averil Hart, the Department of Health and Social Care has been engaging with partners through a delivery group led by NHS England and NHS Improvement to continue to address the recommendations. This includes work with Health Education England to improve training for GPs and with the General Medical Council to ensure that eating disorders are included among outcome measures for newly qualified clinicians.

I thank the Minister for his reply. GPs receive on average less than two hours’ training for eating disorders. Inadequate training was identified by the PHSO report in 2017, as he says, and by numerous coroners’ reports since then, including the latest Prevention of Future Deaths report in Manchester in December following the tragic death of Nichola Lomax. What specifically is the Minister doing to hold the GMC, the Academy of Medical Royal Colleges, Health Education England, NHS England and NHS Improvement to account for their responsibility to ensure that trainee doctors graduate with the skills and the knowledge to be able to identify, safely manage and refer patients with eating disorders?

The noble Baroness raises a very important point about how we identify the issues and tackle them. It is two-pronged: one way is about the amount of investment into mental health services, including tackling disorders, and the other is training. NHS England and NHS Improvement have been working with Health Education England and other partners to look at training courses that will increase the capacity of the existing workforce to provide evidence-based treatment to more people. We are also working with the GMC and the Academy of Medical Royal Colleges as well as Beat representatives. In addition, Health Education England is looking to increase the exposure of doctors to eating disorders. The GMC’s Outcomes for Graduates states that

“Newly qualified doctors must explain and illustrate”

their understanding of

“the principles for the identification, safe management and referral of patients with mental health conditions”,

including eating disorders.

My Lords, the eating disorders charity Beat conducted a survey last autumn and found that 69% of those with eating disorders had found that their GPs did not know what to do with them. That result was, if anything, worse than the same survey conducted five years earlier. It is good the Government are acknowledging that medical students need to learn more about how to deal with eating disorders, but could the Minister give us a guarantee that those GPs already in practice who know nothing about eating disorders at the moment—and choose not to—can be helped to understand the issue better?

This is an opportunity to pay tribute to the work of Beat and to remind noble Lords that it is Eating Disorders Awareness Week, and we should be aware of these issues. One of those issues is understanding the different types of eating disorders. Eating disorders is a catch-all phrase and we have to understand that there is: anorexia nervosa, which is more common among people aged eight and over; bulimia nervosa, which tends to affect people at 12 or 13; binge eating disorders, which affect people in adolescence and also their later years—their 30s and 40s; and other atypical eating disorders. It is really important that we understand this and, when we look at training for the general workforce and specialist mental health workforce, that they are more aware of the issues of eating disorders.

My Lords, if a GP identifies that, for example, a child has an eating disorder, many times they want to refer them to see a psychiatrist. There is an acute shortage of child psychiatrists. What are the Government going to do to speed the process up? It is no use just identifying the problem if you cannot resolve it.

The noble Lord is absolutely right; it is not just about understanding the issue but resolving it. Before the pandemic, we were meeting the targets of ensuring that people with disorders were seeing a specialist. Sadly, as a result of the pandemic, we have fallen behind. One of the reasons we are investing extra money in community health for adults and children now is to ensure that we catch up and make sure that people who are suffering with eating disorders are seen by clinicians who understand the issues and the differences between types of eating disorders, so that they are not misdiagnosed or given inappropriate information.

My Lords, the Minister will know that, although we routinely associate eating disorders with adolescents in particular, they may have roots in adolescence but sometimes emerge very powerfully in later years. They are consequently a lot more difficult to diagnose and manage. The noble Baroness, Lady Parminter, used the word “manage” in talking about how these illnesses should be treated. It is a matter of concern that GPs in particular and hospital services are extremely overstretched. The long-term management of remitting and recurring eating disorders is very hard to sustain. Can the Minister tell us what the Government are doing about that?

As a result of the work that has been undertaken in response to the report, and in conjunction with Beat and many other stakeholders, we are looking at the issues. First, we are making sure that people are trained to understand the issues as part of their education. Secondly, we are looking at what we can do retrospectively for those who have already qualified. We are working with various bodies—the royal colleges and others—to see how we can make sure there is more awareness and training available, including e-learning resources.

My Lords, there is a need for urgency on this issue. We do not get the impression that the Government are treating this very urgently, but anorexia has the highest mortality rate of any mental illness. If it is not treated early, it becomes worse, much harder to treat and puts lives at risk. In view of the unprecedented growth in sufferers, what will the Government do to accelerate access to treatment for those in urgent need and prevent more needless deaths?

I think the noble Baroness is being unfair in suggesting that the Government are not taking this issue seriously. In the conversations that I have had in the lead-up to this Question, it has been quite clear that they are taking it very seriously. They recognise its granularity and the differences in types of eating disorder. As the noble Baroness rightly said, people quite often associate eating disorders with adolescents or young females and young men, but binge eating disorders in particular can occur among adults who are 30 or 40 years old. The Government are looking, first, at education. Secondly, they have made a number of investments in adult and children’s services relating to mental health, including eating disorders.

My Lords, there has been a 72% increase this year in the number of children and teenagers referred for urgent support for eating disorders, but a new, dangerous issue has emerged, that of specialist mental health services with no capacity having to bounce back even those who are at risk of suicide, self-harm and starvation to GPs, who, as we have heard, often have no specific training to deal with this. Can the Minister apprise your Lordships’ House of what assessment has been made of the incidence of this so-called bounce-back? Will he commit to tackling it by various means, including a recovery plan for mental health services that has a focus on children and young people and ensures that there is a trained workforce to deliver this support?

The noble Baroness’s suggestions are reasonable, and I think that many noble Lords would agree that it is important that we tackle this on a number of levels. For example, under the NHS long-term plan, extra funding has been going to children and young people’s community eating disorder services every year, with £53 million per year invested in 2021-22. That will increase the capacity of 70 new or improved community eating disorder teams covering the whole of the country. In response to Covid and to help meet the waiting time standard, we have invested an extra £79 million in 2021-22 to significantly expand children’s mental health services. In addition, as part of the additional £500 million that we announced in 2021-22, some of this is also being done via the mental health recovery action plan. NHS England and NHS Improvement have announced a further £40 million in 2021-22 to address the impact of Covid on children’s and young people’s mental health. These are some of the different ways in which we are addressing this very serious issue that a number of noble Lords have quite rightly raised.

My Lords, adolescence has been referred to repeatedly, but does the Minister recognise that there is a gulf between adolescent mental health services and those for adults? A young person reaches the age of 18, ceases to be dealt with through child and adolescent mental health services and is very lucky to get any sort of appointment thereafter. What are the Government going to do about that gulf?

There are number of areas—not only eating disorders but elsewhere—where people are often concerned about that transition from children’s services to adult services. We are looking at that holistically to make sure that healthcare is patient centred. It is one of the reasons why we want to make sure that the Health and Care Bill is completely integrated. It will be healthcare whereby the patient is looked after right from their birth all the way through their life, including that transition from children’s services to adult services.