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.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
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.
(LD)
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?
(Con)
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.
(CB)
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?
(Con)
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.
(Lab)
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.
(Con)
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.
of Hudnall (Lab)
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?
(Con)
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.
(LD)
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?
(Con)
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.
(Lab)
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?
(Con)
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.
(Lab)
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?
(Con)
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.
