The NHS must improve its care for patients with eating disorders
How can our health service expect to marshal its care for eating disorder sufferers if it doesn’t even know the scale of the challenge it faces? writes Bernard Jenkin
When it comes to patients with eating disorders, the NHS has a catalogue of failings in care. The Public Administration and Constitutional Affairs Committee (PACAC) has been examining what progress has been made since the Parliamentary and Health Services Ombudsman (PHSO) made a series of recommendations to reform back in 2017. The PHSO recommended more training for doctors, improved coordination of services and regular investigations into potential failings in previous serious incidents. Unfortunately, PACAC has found that a lack of understanding of eating disorders among doctors persists, resulting in too many avoidable deaths. Not enough action has been taken to fully implement the PHSO recommendations and until there is, eating disorders will continue to needlessly claim lives.
PACAC has been disappointed to find that since the PHSO concluded that eating disorder services are an area of care that is at risk of failing its patients, the Government has not made swift progress on the PHSO’s recommendations. At the bare minimum, the NHS should know how many people are suffering from eating disorders throughout the UK – some studies put the figure as high as 1.25m people, but the NHS has no reliable data on this. How can our health service expect to marshal its care for eating disorder sufferers if it doesn’t even know the scale of the challenge it faces? The NHS urgently needs to commission a national population-based study to properly assess how many people have an eating disorder.
It is not just at this macro level that the NHS fails to understand eating disorders. PACAC heard significant evidence that doctors do not have sufficient understanding of eating disorders – unsurprising considering their training is limited to just a couple of hours at medical school and little more after that. Some doctors still use body mass index as an indication of whether someone should be offered care despite NICE recommending a more multi-faceted approach that takes into account a person’s mental state. The General Medical Council has made some progress on assessing the serious lack of training for doctors, but to make a real difference it needs to capitalise on its influence and make eating disorder training a priority in medical schools and beyond.
"PACAC heard significant evidence that doctors do not have sufficient understanding of eating disorders - unsurprising considering their training is limited to just a couple of hours at medical school"
When patients are determined to be in need of care, the care they receive – or indeed whether they receive any at all – is subject to a ‘postcode lottery’. A skills gap in the NHS means there aren’t enough eating disorder specialists to go around and some patients are left with inadequate care that doesn’t reflect the complexity of the illness they suffer from. The Government needs to find a way to upskill current medical staff to address this deficiency in care and guard against any future skills gap by ensuring that all junior doctors undertake a four month-month psychiatric placement to equip them with the experience they need to identify and treat eating disorders.
Perhaps the most vulnerable patients we heard about are those who are in limbo between child and adult care. Young adults often have to wait months for care while they make the transition from child to adult care – this was the case for Averil Hart who tragically died aged only 19 following a struggle with anorexia. For many people, the move from home to university can be challenging enough without the added complication of delayed care for an eating disorder. The NHS needs to address these ‘cliff-edges’ in care urgently – PACAC is calling for a quicker and smoother transition to protect the lives of young people. Worryingly, the NHS claimed it had already done in evidence to PACAC but we found little supporting evidence that transitions in care have been improved.
Addressing the complex illnesses of eating disorders is no easy task, but the NHS is currently failing its patients. This is not good enough over 18 months after the PHSO published its crystal-clear report. The NHS needs better training, dedicated support staff and a willingness to learn from past mistakes. I hope the Government will seriously consider PACAC’s report and commit to its recommendations.
Sir Bernard Jenkin is Conservative MP for Harwich and North Essex and chair of PACAC