PARLIAMENTARY DEBATE
Eating Disorders Awareness Week - 27 February 2018 (Commons/Commons Chamber)

Anorexia nervosa, a well-known eating disorder, has the highest mortality rate of any mental health condition. When eating disorders are not fatal, they can still lead to significant and long-lasting health issues. An estimated 1.25 million people in this country suffer from an eating disorder. Of course, it affects not just them but their families, yet eating disorders are all too rarely discussed in public.

We discuss with comparative ease physical illnesses that may devastate people’s lives, but when it comes to mental illnesses this is too often not the case. That is also true of eating disorders. Despite the ever-increasing pressures of daily life leading to increased instances of poor mental health, we still do not speak about these issues enough. These illnesses can thrive on secrecy. The longer they go unchallenged and unacknowledged, the harder it is to beat them. It is only by talking about them, bringing them out of the shadows that we can reduce the power they hold over those who suffer. To really improve the lives of those with eating disorders and prevent those at risk from falling victim to these illnesses, we must bring eating disorders, as with all mental health issues, to the forefront of the collective deliberations and consciousness of our society. That is why, in this Eating Disorders Awareness Week, I am very pleased to have secured this important debate so that we in this House, the centre of our national debate, can talk about it and play our part, however small, in raising awareness and making it that bit easier for others to talk about it. I am very pleased that this Minister is responding to the debate, because I know she is a lady of compassion, dedication and determination to improve people’s lives. May I also say, Mr Speaker, that with all the pressures on your time, I am pleased that you are in the Chair for the start of this debate, because I know the close interest you have taken in these issues as well?

Will my hon. Friend join me in commending the outstanding compassion and professionalism of the community team and other professionals at the Brownhill Centre in Cheltenham, who provide such a vital lifeline for those suffering with eating disorders?

I will. My hon. Friend is absolutely right to raise this issue. Indeed, my hon. Friend the Member for South Ribble (Seema Kennedy) highlighted earlier today the work of the SEED—Support and Education for Eating Disorders—organisation in Penwortham in her constituency. They are both absolutely right to highlight the work of such organisations.

As hon. Members may know, since my election to this House I have on a number of occasions raised health and mental health-related issues on behalf of my constituents and more widely. In this case, last year I accepted an invitation from Beat, the national eating disorder charity, to the launch of its important report, “Delaying for years, denied for months”, which focuses on how long it takes from someone developing an eating disorder to their receiving treatment for it. It is a piece of research I will draw on extensively today.

I congratulate the hon. Gentleman on securing the debate. Over the years, a number of my constituents have had these problems. Through the good work of the NHS and the Beat organisation, to which he has just referred, they have been able to pull through to the other end. In Northern Ireland, we have some 20,000 people who suffer from eating disorders at any one time. Given that fact, does he feel that the Government could enter into discussions with the regional assemblies across the whole of the United Kingdom of Great Britain and Northern Ireland to agree a strategy that can accommodate where we are in the UK?

The hon. Gentleman makes a very important point. This is one of those issues on which I would hope we can see the widest engagement across the UK, across all involved in government and the provision of services, to come up with a coherent and common approach to beating eating disorders.

My hon. Friend is making a very good point. I wonder whether he has a feeling for how much extra training GPs will require to be able to spot the signs of these disorders.

My hon. Friend makes a very important point and if he will perhaps be patient for a few more minutes, I will turn to, among other things, exactly that point.

At the launch that I referred to, I met and heard from some impressive and inspiring people, who had grappled with eating disorders and who wanted to share their experience and raise awareness. I subsequently met Beat to discuss its work and what more needs to be done. The people I met at Beat’s launch event did something important and brave in speaking out, but they had already done something brave in seeking help for their illness in the first place.

One of my constituents is an ambassador for Beat, and I met her recently. Does the hon. Gentleman agree that one of the organisation’s strengths is that it draws on people who have been through the experience, so they can speak knowingly and convincingly to people they recognise as being in the same situation that they were in not that long ago?

The hon. Lady is absolutely right. It is always true in any situation that someone who has been there can speak with much more power and in a much more compelling way than someone who has not, however empathetic they are. The reality is that the recognition of an eating disorder for what it is—an illness—and getting the help and treatment for it is, all too often, still too slow. With an eating disorder, as with illnesses generally, the earlier an intervention and treatment take place, the easier it is to treat and the better the outcome for the patient.

Does the hon. Gentleman agree that mental health services require the ability to provide advice and counselling, especially to younger people, and that in many cases that is lacking?

The hon. Gentleman makes a very important point. Mental health services, whether they are statutory mental health services or supported services from the voluntary sector, have to be able to address the needs of the individual as an individual. I will come shortly to funding and the provision of those services.

Beat’s report last year found that the average cycle of relapse and recovery could be six years, and that it took an average of three and a half years, or 176 weeks, between someone getting an eating disorder and their getting the treatment that they need. That average of 176 weeks goes across people who are under 19 and adults. For those under 19, the average is 130 weeks, and for those over 19, the average is 256 weeks.

Those statistics are worth unpicking a little. It is important to be clear that 91 of the 176 weeks come before an individual or those around them recognise that they have an eating disorder, and a further 58 weeks come after that point, before they seek professional help. Increasing awareness of the symptoms of eating disorders is vital. As a recent YouGov survey found, 79% of the people who were surveyed could not list a single psychological symptom of eating disorders, and 34% were unable to name any correct sign or symptom. Alongside that, however, it takes real bravery for someone to admit to themselves that they need help. It is incredibly hard for someone to talk about an eating disorder.

I congratulate my hon. Friend on bringing this important debate to the Floor of the House. He says that it takes a lot of encouragement for people to say that they need help, and I commend the Government for their four-week target of 95% of patients to be seen within four weeks of referral. Will he join me in urging the Scottish Government to reduce the number of weeks from 18 weeks to four?

I certainly join my hon. Friend in urging that. I daresay that were the Speaker to express a political opinion, he might, too, but of course, he cannot.

It will always take courage to talk about an eating disorder, but by talking about them in this House and in our communities, we can help to make it easier and to reduce the 149 weeks that I talked about. I hope that in the Minister’s response, she will set out what is being done to raise awareness and to help the national conversation to take place, working alongside charities such as Beat.

The remaining 27 weeks of the total come from an average of 11 weeks between someone first visiting a GP and receiving a referral, often with three visits to a GP taking place before that happens; eight weeks between referral and formal assessment; and eight weeks from assessment to receiving treatment. We can and should be able to further reduce this 27-week period.

Let me be clear: this is not, and should not be, a partisan or party political issue. Governments of different political colours have all made significant progress, but of course there remains more we can all do. When someone has made the important leap to talking about their illness and seeking help, it is at this time that they are most receptive to engaging with that help when offered. When they make that leap of faith, we must meet them with action.

I want to unpack what my hon. Friend has just said and pay tribute to the work done by all Governments on this important issue. Ultimately, however, pressure on resources sometimes means that people who seek help are effectively told to come back when they weigh less. That is at the heart of the challenge we have to address.

My hon. Friend makes an important point. One of the key themes drawn out from this and related research is that it should not just be one symptom or factor that determines when someone needs help; there is a basket of factors and considerations that demonstrates when that need is there and when treatment is needed. He is absolutely right, therefore, to highlight that point.

As we know, GPs do an amazing job, but, as my hon. Friend the Member for Henley (John Howell) said, we need to ensure that doctors’ medical training gives them the tools they need in this area, as in others, to recognise all the symptoms of an eating disorder; and to ensure that that training is kept up to date and that medical professionals are familiar with and follow National Institute for Health and Care Excellence guidelines on eating disorders, including its guidance that single measures—this touches on the point my hon. Friend the Member for Boston and Skegness (Matt Warman) has just made—such as body mass index and duration of illness alone should not be used to determine whether to offer treatment or what treatment to offer.

The Government have made huge strides in focusing on reducing delays through investment and funding and waiting-time targets, but these targets are not always fully applicable to everyone. As my hon. Friend the Member for Angus (Kirstene Hair) set out, the Government have a target of 95% of non-urgent cases involving under-19s being seen for treatment within four weeks. I understand from the latest figures that that target is now being met in 79% of cases. That is good progress, but there is still more to do. It is vital, however, that these waiting-time standards for accessing treatment also apply to over-19s. I would welcome the Minister’s reflections on that, and, of course, I reiterate what my hon. Friend the Member for Angus said and hope that the Scottish Government will follow the very positive lead set in this respect.

More broadly, I would also highlight the waits experienced for child and adolescent mental health services and adult mental health services more generally. In some parts of the country—I have highlighted this in my county of Leicestershire—delays in treatment can have a profound effect on individuals and the families who care for them. I hope that the Minister will touch more broadly on that bigger picture.

I attended an NSPCC event yesterday where we were made aware that young people, despite accounting for 20% of mental health need, receive only 9% of the mental health budget. Does the hon. Gentleman agree that more needs to be spent on meeting young people’s mental health needs?

I will come very shortly to overall spending, but part of that is not just the overall size of the pot, but how that money is spent and works its way through the system to reach the frontline. In 2016-17, we spent a record £11.6 billion on mental health services, and that amount will continue to rise year on year until 2020-21, by which point 21,000 new mental health posts will be in place. This is all very welcome, and I commend the Health Secretary and his colleagues in the Department for it. Funding is vital. However, although £30 million per annum will be available over the next five years to fund eating disorder services, the way in which such funds are spent by clinical commissioning groups sometimes lacks transparency. At times it is hard to follow the funding from its source to ensure that it reaches the frontline. Implementation is key, and I hope the Minister will tell us how the Government are working to ensure that every penny reaches the frontline eating disorder services for which it is needed.

Community-based mental health services are often the most effective local services to help people, but they and in-patient mental health services are commissioned separately, by the CCG and by NHS England respectively. That can lead to a sense of a lack of joined-up care, and it can mean that people have to receive treatment many miles from their homes and families. That can place a huge strain on families, and, indeed, on family finances. Beat’s report suggests that in some instances the cost can be up to £32,000 as a result of lost earnings, travel and a range of other expenses. I believe that funds for eating disorder treatment should be held locally by the same budget holder in the same pot to create incentives for the development of improved treatment and reduced costly in-patient care, with CCGs working to extend their focus on early intervention to include the earlier stages of the illness.

Very briefly.

That is indeed very important. A key issue is the need to ensure that, as far as possible, there can be school referrals or, indeed, self-referrals as well as referrals made via a professional medical route. Some people may choose those ways of reaching out for the help that they need.

I hope that the Minister can update us on the progress of NHS England’s “Testing New Care Models in tertiary mental health services” pilot, which I understand is currently under way, and can tell us whether any initial findings are emerging in respect of the opportunity to put in-patient and community funding into a common pot.

I cannot end my speech without highlighting the impact that eating disorders have on the families and loved ones of those with the illness. Many of them care for people patiently and lovingly, and delays in securing the help that is needed can have devastating consequences for them. While in some cases it may not be appropriate, for good reasons, in many others, engaging those who are caring for someone receiving treatment—the “whole family” approach that I understand is used in Leicester, which will serve some of my constituents—can be hugely positive. I would welcome any reflections on that from the Minister.

Finally, I pay tribute to the work of Beat, which has campaigned tirelessly to highlight this issue, and to the work of those who operate its advice helpline. I commend its report to the Minister, and to all colleagues. However, I pay the greatest tribute to all those who suffer from an eating disorder and have had the bravery to talk about it, to seek the help that they need, and to face down an illness that depends on secrecy, isolates sufferers, and affects every aspect of their lives and those of their families. We must ensure that we match the courage of those who face it, determined to beat it, with an equal determination to give them the support, treatment and investment that they deserve. We must continue to drive down the delays and waiting times, raise awareness, and strip this disease of some of the power that it has over people by talking about it. We must stand shoulder to shoulder with all who face it, with the clear message that, together, we will beat eating disorders.

I congratulate my hon. Friend the Member for Charnwood (Edward Argar) on initiating an extremely important and timely debate. I commend the sincerity and passion with which he has made his case. He has given me quite a long “to do” list, and I suspect that I shall have to come back to him, given the lateness of the hour.

You and I have attended many Adjournment debates together, Mr Deputy Speaker, and it is nice to see so many fellow Members here.

In fairness, the hon. Member for Strangford (Jim Shannon) is always here.

Indeed, and it is always a pleasure to see the hon. Gentleman in his place.

It illustrates the very real interest colleagues have in this important issue. I am grateful for the opportunity to discuss the work of the Department and NHS England in delivering on our commitment to better support people with eating disorders. As my hon. Friend the Member for Charnwood said, eating disorders are both complex and devastating, and are serious life-threatening conditions with some of the highest mortality rates of any mental health disorder for many of the reasons he outlined: people often become so ill that they and their families do not realise how ingrained the problem is. These conditions can also have severe psychological, physical and social consequences, and they often start, and are prevalent in, young people, which is why early intervention is so crucial.

I will set out what we are doing to support children and young people, but that is not to diminish what my hon. Friend said about adults’ needs, which I will come to later. Having said that early intervention is vital, everyone with an eating disorder must have access to timely treatment. That is why we have set up the first waiting times to improve access to eating disorder services for children and young people, so that by 2020 some 95% of children with an eating disorder will receive treatment within one week for urgent cases and within four weeks for routine cases. I am pleased to be able to report to the House that we are making good progress towards that goal. The latest figures published in the mental health “Five Year Forward View” dashboard indicate that the NHS is on track to meet that standard, with almost 77% of all patients starting urgent treatment within one week and 83% of patients starting routine treatment within four weeks. That information is for the third quarter of 2017-18. We are making progress, but we still have to meet that goal. The number of people seeking treatment is rising, so we will need to make sure there is a commensurate increase in the ability for patients to get the care they need, as well as continue with our reduction in waiting times.

It is a testament to the work done by Members and Beat, and to the fact that there is greater general awareness, that more people are seeking treatment. Raising awareness and improving the understanding of eating disorders is important. My hon. Friend referred to community treatment, and it is our view that in-patient treatment should be seen as a last resort, which is why the Government announced in 2014 that we would invest £150 million to expand eating disorder community-based care. We are making good on that promise, and as a result 70 dedicated new or extended community services are now either open or in development. That will mean that at least 3,350 children and young people a year will receive swift, effective eating disorder treatment in the community.

The services are designed to give young people with eating disorders and who self-harm early access to services in their communities with properly trained teams. That reflects the fact that there was a lack of consistency, which needs to be tackled on a concerted basis so that we have fewer out-of-hours placements, recognising that the road to recovery is often quicker when people have access to their immediate family networks.

The services available include access to talking therapies, so that children and young people have a choice of evidence-based therapies, and a treatment plan agreed with their therapist and recorded outcomes, thereby avoiding the need for hospital stays. By improving care in the community, we can improve outcomes and recovery, and reduce rates of relapse or the numbers of young people transferring to adult services, which is another area of risk. We and NHS England want to make sure we have consistency in provision, and are investing in new in-patient care where there is seen to be a lack.

I am pleased that my hon. Friend highlighted the great work of Beat, and it is worth noting that the Secretary of State spoke at the launch of the Beat report and paid tribute to the young people who speak out. The bravery of those young people probably does more to raise awareness of eating disorders than anything any of us can do, despite our best intentions. Beat found that one in three adults in the UK could not name any signs or symptoms of eating disorders, which again shows we have a long way to go in raising awareness.

The Government understand the importance of increasing understanding and raising awareness. I will highlight some of the things we are doing in this area. First, we have published NICE guidelines on managing and treating eating disorders for everyone over the age of eight, including adults, children and young people. That guidance is available for healthcare professionals and commissioners who provide public services to people with eating disorders.

Secondly, we have set out ambitious plans in the children and young people’s mental health Green Paper, partly to address the point made by the hon. Member for Enfield, Southgate (Bambos Charalambous). We are trying to create new mental health teams in schools, perhaps the earliest of early interventions, recognising that the earlier we can intervene, the more likely we are to avoid longer-term damage and crisis and to achieve better outcomes with people who are struggling. Some 8,000 new NHS staff will work closely with those teams in schools to deliver that enhanced support.

As my hon. Friend the Member for Charnwood said, we talk a lot about children but what about the adults? To further improve adult eating disorder care, we have developed a pathway, together with detailed implementation guidance for providers. That is in development by the National Collaborating Centre for Mental Health, in partnership with NICE. It is being fully informed by the available evidence and the views of experts, and will increase healthcare professionals’ awareness of the early signs and symptoms of eating disorders so that they too can refer their patients without delay.

Central to all this is the data collection that is being done by NHS England. My hon. Friend wanted to make sure that the moneys we are making available are actually being spent on the services on the ground, and that all clinical commissioning groups are delivering against their obligations. We are collecting that data. NHSE is undertaking a very close CCG-by-CCG analysis of exactly the pattern of care in each area so that we can make sure that everyone has access to prompt treatment and that we have consistency in access to provision.

Later this week, as it is Eating Disorders Awareness Week, I will be visiting the Bristol eating disorders health integration team—weather permitting, that is. This is a team of psychologists, academics, commissioners, care and support providers, and people with lived experience of eating disorders who are all working together to improve care and quality of life for people with eating disorders in Bristol. The team focuses on both prevention and treatment. If we can find examples of good practice and share them, we will go a long way towards achieving consistency of provision. I very much look forward to meeting those clinicians and experts-by-experience to see what we in Government can do to support them.

Again, I thank my hon. Friend for bringing this debate to the House. I am sure that this is not the last time that he will speak to me about this issue, because it is not the first time he has spoken to me about it either. I thank everyone for participating in the debate. I know that everyone here has a significant interest in mental health and those suffering with eating disorders. We all know that this can be the most fatal of all mental illnesses, and that every death is a tragedy. That is why we are very much committed to doing everything we can to combat this terrible illness.

Question put and agreed to.