Eating Disorders Awareness Week 2023 in Parliament

Eating Disorders Awareness Week - Hansard - UK Parliament

Wera Hobhouse (Liberal Democrat): The theme for this year’s Eating Disorders Awareness Week is eating disorders in men. Eating disorders do not discriminate. Many people think that eating disorders affect only women, but at least one person in four affected by an eating disorder is a man, and 89% of men and boys aged 16 to 18 in my county of Somerset worry about how they look. Those experiences are often overlooked. Toxic stereotypes are pervasive, and half of respondents to a recent survey of men’s experience carried out by Beat did not believe that someone like them would develop an eating disorder. One male sufferer in five has never spoken out about their struggle. That is why the debate is so important. We must encourage men to speak up and get the help they need.

Caroline Nokes (Conservative): Stigma is still a huge challenge and it is undoubtedly worse for men and boys. When we look at the statistics, we see that one in five does not ever even say to anybody else that they think they might be suffering from an eating disorder. How on earth can someone get help if they cannot even talk about it?

It is incredibly difficult for young men to find their way in the world. They are under massive pressures through body dysmorphia or through the images they see, which are wholly unrealistic and unachievable. I am particularly aware that we need to find mechanisms to support young men, through the education system, so that they recognise the challenges around over-exercising, the dangers of steroid abuse and, frankly, the wholly unrealistic male body image that is being promoted to them.

Gregory Campbell (DUP): Even though men are in the minority of those affected, an important issue, and one that I too struggle with in my gender, is that many males, and young males, fail to get help, and fail to admit and acknowledge their problems. That is not the case in every other walk of life—if the car is not working, we take it to the garage; if the television is not working, we get the TV repair man—but we sometimes struggle to get males to understand that if help is needed, they should seek help and get it.

Danny Kruger (Conservative): This is a totally cross-party issue, as we have heard, because this condition affects all our constituents and all our constituencies. It affects people of all ages and, of course, of both sexes. I recognise and agree with the points that have been made about unhelpful stereotypes. Some stereotypes are, of course, helpful in the sense that they point to a general truth, from which there will be many exceptions.

I want to speak up for the men who come forward and identify themselves as suffering from eating disorders. That is a very brave thing to do. The other stereotype that we have discussed, which is entirely true, is that not enough men talk about mental health and their own mental health conditions. As we have heard, a fifth of male eating disorder sufferers have never spoken about their condition to anybody. We therefore need to raise awareness. I pay tribute to Beat, Hope Virgo and other campaigners for their commitment during this Eating Disorders Awareness Week to the cause of men’s mental health and eating disorders in men.

We know that the result of not coming forward early is that diagnosis comes later, and therefore treatment is so much harder. It is also disappointing to read in the research that the majority of men who receive treatment for eating disorders or ask for help are disappointed with the service they receive. I dare say that that is the same for women. There is obviously a fault in the provision of services.

Tim Farron (Liberal Democrat): It is right that we focus on men, who are less likely to come forward and yet make up a huge proportion of those in need, but help should be there for everyone, and I urge people to come forward and access it.

Carol Monaghan (SNP): One in four of those affected by an eating disorder is a man. We have heard some statistics today, including that there has been an increase of 128% in hospital admissions of men for this issue, so it is right that we should highlight it this morning. We have also heard that men are notoriously poor at asking for help, so it is important that we have so many male MPs here this morning, speaking out and raising awareness.

Dr Rosena Allin-Khan (Labour): We have heard that one in four people with eating disorders is a man. It is staggering that it is still so difficult for boys and men to come forward and talk about their issues with eating. In my work in A&E, I see younger and younger people—especially boys—talking about their struggles with food and body image. They often cite social media and peer pressure as the source of those struggles.

Wera Hobhouse (Liberal Democrats): For too long, sufferers have been left feeling trapped and alone. Here in Parliament, we have been raising the alarm for some years about this rising epidemic, which still needs more urgent action from the Government. However, I want to acknowledge the good working relationships the eating disorders APPG has had with various Ministers. I hope that will continue, and that today’s debate helps us to make progress together.

Eating disorders can take years to recover from, and many children and young people need to continue their treatment into adulthood. Young people miss out on so many educational and social opportunities. These years are stolen from them, and that is not to mention the potentially irreversible effect on their physical health. Again, this affects girls and boys, men and women—eating disorders do not discriminate.

Wera Hobhouse: Tragically, people are losing their lives. Take the terribly sad death of Zara Taylor after two years of struggling to get the right treatment for her eating disorder. An investigation by the Health Service Journal found that at least 19 lives were lost to eating disorders in England over the past five years. At least 15 of those were deemed avoidable and resulted in coroners issuing formal prevention of future deaths reports. Coroners described patients’ safety risks being missed or poorly managed because of limited knowledge of eating disorders among doctors and health professionals, and delays in accessing appropriate treatment. That is why it is so important to have more research into eating disorders, and focus on the more specialist and rare forms of eating disorders. Those same failings were among the key issues identified five years ago by the Parliamentary and Health Service Ombudsman in its report “Ignoring the Alarms”. Surely, we need to do more and to do better.

Olivia Blake (Labour): The tsunami of eating disorders that health workers warned the Government about during the pandemic is not going away; if anything, it is getting more severe. That is because this crisis is not new. In 2017, the Parliamentary and Health Service Ombudsman for England published a damning report, which concluded that

“NHS eating disorder services are failing patients”.

Yesterday, six years later, the same ombudsman concluded that urgent action is still needed if the Government are to prevent more people from dying—a stark condemnation.

Dr Rosena Allin-Khan (Labour): With timely and appropriate treatment, people can go on to live healthy and fulfilling lives, so how many of those deaths are avoidable? That is the truth that we have to face.

It has been agonising to listen to the recent reports of the death of 19 eating disorder patients in in-patient settings; serious concerns were raised about their care. Lives should not be needlessly lost because of poor care and a lack of understanding of eating disorders. My heart goes out to their friends and families. Far too many families—not just the families of those with eating disorders—have lost loved ones in mental health hospitals. How many more people will lose their life before the Government get a grip on safety in in-patient settings? We need a Government who will get serious about mental health and eating disorders. As we have said time and again, access to proper treatment can be life-changing. Prevention is important, and early intervention provides the best chance for recovery. Think of those families who have lost loved ones, knowing that it could have been prevented, and that we in this place have not yet done enough to save these lives.

You can sign our petition on this here.

Wera Hobhouse (Liberal Democrats): Early intervention and understanding the symptoms of eating disorders are so crucial. The earlier someone receives intervention for their eating disorder, the more likely they are to make a full recovery. The longer symptoms are left untreated, the more difficult it is for the person to recover. Healthcare should focus on prevention before cure, and early access to the right treatment and support can be life-changing.

Caroline Nokes (Conservative): Early intervention is crucial. When somebody with an eating disorder asks for help, that is the time to give it to them, not 12, 24 or even more weeks later. We know there is a huge challenge with transfers from children’s to adult services. Too often, sufferers will fall through the cracks and be forced to go back to the beginning of a waiting list.

Danny Kruger (Conservative): What to do? I endorse the points that have been made about the need to raise general public awareness, which is the purpose of this debate as much as anything. People need to be able to recognise the signs and symptoms in their loved ones and friends, school friends, students and colleagues. We need more training for doctors, particularly GPs, to recognise the symptoms and signpost to good treatment. We need more services before hospital.

Olivia Blake (Labour): To truly address the crisis, we need a root-and-branch review of eating disorder provision. We need a holistic approach, with preventive, community-based, tailored support centred around the needs of each individual patient. We need to adopt innovative forms of treatment and to launch well-funded research programmes into the most effective treatment.

This crisis could, and should, be an opportunity to rebuild our approach to how we support and treat the 1.25 million people in the UK who suffer from an eating disorder. I therefore urge the Minister to look at the transformative work groups such as SYEDA are doing to help build an alternative framework for care nationally.

What needs to change? First, services must no longer be forced to choose between investing in early intervention and emergency support. NHS figures show that hospital admissions for people with eating disorders have risen by 84% in the last five years. Meanwhile, more than 8,000 adults are waiting to be seen for therapy—the highest figures since records began. Early intervention is the most effective form of treatment, so it is no surprise that, as it becomes harder to access, the number of critical cases is increasing. Investing in early intervention would be transformative for patients and services.

Wera Hobhouse (Liberal Democrat): Waiting times for eating disorder patients are out of control, and waiting lists for children’s eating disorder services have doubled since March 2020. From 2021 to 2022, only 61% of urgent cases started treatment within a week—well below the current NICE standard of 95%. I hope the Minister will be able to respond to that. For adults, there are not even targets in place. The Independent has revealed that more than 80,000 adults with eating disorders are waiting to be seen for therapy—a record number—while just 30% of adults got treatment within four weeks of their referral. Again, I hope that the Minister will refer to adult eating disorder services, where we do not have any waiting list targets or targets for support. It is very important that adult services get the same support as children’s services, where we have made progress because there are targets.

Targets are crucial if we are to tackle this epidemic. An access and waiting time standard for adults would provoke significant extra funding and focus. If we want to encourage people to seek help, we need to give them a guarantee that they will be seen.

Having clear standards can facilitate service improvements. Standards introduced in 2015 for waiting times for children and young people’s eating disorder services have been crucial in driving service improvements. However, similar standards have been lacking in adult services. Shockingly, sufferers are reaching the point of emergency hospitalisation before they can access care. Again, that is not good enough. It also costs a lot more money if we reach people only at that crisis point.

Clinicians have reported a significant increase in the proportion of young people first presenting when they are already severely ill. NHS figures show that hospital admissions for people with eating disorders in England have risen by 84% in the past five years. For children and young people, there was a 35% increase in the past year alone—and among men and young boys, hospital admissions have risen by 128%. There is an increasingly alarming picture that eating disorders in men and boys are being overlooked and not treated early enough. That is why today’s debate is so important.

Olivia Blake (Labour): Finally, we must be consistent in having a fully funded access and waiting time standard for adults seeking help, as we now have for children. We also need a treatment pathway specifically for avoidant/restrictive food intake disorder so that people are not left undiagnosed and untreated. That needs to be commissioned through the NHS.

Tim Farron (Liberal Democrat): Let us be positive: it is important to welcome the access waiting time standards. They are a good thing. However, they are mostly not being met. In north Cumbria, 26% of routine referrals of young people and 11% of urgent referrals of young people are not being treated in that timescale. In south Cumbria, 23% of routine referrals are not being seen within the four-week standard. While there is better news for those meeting the standards for urgent referrals, the total declared for Morecambe Bay hospitals trust is 12 individuals with an urgent eating disorder need. That is baloney. I personally know more people than that who are struggling, which tells us either that the data is faulty or that it is hard to get into the system because BMI is used as a gateway to access those services.

We mentioned the waiting time standards for young people and children—I am glad we have them, although I wish we met them—but there are no standards for adults, and it is about time that there were.

Dr Rosena Allin-Khan (Labour): Targets on accessing treatment are being routinely missed. In 2016, a clear standard was set that 95% of children and young people experiencing the most urgent eating disorder cases should receive treatment within one week. Since then, however—I accept that the Minister has not been in post that entire time—the Government have missed the target; I hope the situation will improve. Disappointingly, only 60% of urgent cases were seen within one week last year. That means that four in 10 children and young people were not seen at the point of desperation. Children and young people are being left on lengthy waiting lists, unable to access support. Meanwhile, their families are helpless, and are trying their best to support their children without vital help from mental health professionals.

Wera Hobhouse (Liberal Democrat): Mental health services need proper funding. This financial year, only 13.8% of local health spending has been allocated to mental health services, although mental illness accounts for 21.3% of the total disease burden in England. The money spent on young people’s eating disorder services has not kept up with the number of young people who need treatment. I support the NHS Confederation’s call for £12 million of additional funding to be made available over the next year to get children and young people’s eating disorder services back on track.

The funding that is provided needs to reach frontline services. An inquiry by the APPG on eating disorders, which I am proud to chair, found that 90% of the additional NHS funding given to clinical commissioning groups for children’s services did not reach the services to which it was pledged. We wrote to CCGs at the time, and the answers that we received were not satisfactory. The Government must ensure that their funding pledges are not empty words and that money is getting where it is needed. A one-off boost for children’s mental health services is not enough. Soaring demand for underfunded services will lead to children missing out on care.

We are all aware that the NHS is in crisis. We hear harrowing stories about ambulance and A&E delays, but the impact on mental health services has received little attention. I hope that today’s debate will make a difference and that we will hear more about the crisis in mental health service provision.

Eating disorders are an epidemic. The sooner we realise that, the sooner we can treat them with the attention they deserve. No one should be condemned to a life of illness, nor should anyone be dying from an eating disorder in 2023.

Danny Kruger (Conservative) : We need more acute services. I pay tribute to the Cotswold House unit at the Savernake Hospital in my constituency, which is a tremendous in-patient unit. In practice, it is under-resourced, because there are not enough beds.

Tim Farron (Liberal Democrat): At the other end of the spectrum, at tier 1, and particularly for young people, what are we doing to build resilience so that people do not develop eating disorders in the first place? In Cumbria, there is nearly nothing in terms of provision for adults, while we spend a grand total, through our public health, of 75p per child and young person on tier 1 resilience support, and that is for all mental health conditions, not just eating disorders. We need to prevent people from getting into these circumstances in the first place—for their sake and for everyone else’s.

We need to ensure that money allocated to integrated care boards for eating disorder support is actually spent on that. Finally, services must be commissioned adequately and close to home.

Wera Hobhouse (Liberal Democrat): The crisis in the NHS has decimated mental health services. Staff shortages are growing. According to the National Audit Office, between 2021 and 2022, 17,000 staff left the NHS mental health workforce. The Royal College of Psychiatrists 2021 workforce census shows that since 2017 there has been a 30% increase in the number of vacant or unfilled consultant posts in England. That is not good enough. How we can encourage specialists into services is a big question that the Government need to answer.

Eating disorder psychiatry has one of the highest numbers of vacancies, with just 28 full-time consultants. We need significant investment in staff retention. The RCP’s members report high workloads and poor work-life balance. NHS trusts should be supported to meet important improvement targets for retention. I hope that the Government will keep their commitment to publish an NHS workforce plan and that they will bring that forward early, along with adequate investment.

Wera Hobhouse (Liberal Demcrat): 20% of medical schools do not include eating disorders in their teaching at all, while those that do provide less than two hours on the topic. Training should be compulsory in order to spot early signs of eating disorders. Many participants in a 2021 Beat survey reported having a negative experience when they first sought help from a GP. There are many brilliant practitioners in the NHS delivering excellent care, but I want every doctor to complete their training with the knowledge and skills to best support people with eating disorders.

Olivia Blake (Labour): We must increase training for all healthcare professionals. On average, UK undergraduate medical students receive less than two hours on eating disorders. I welcome the fact that the ombudsman is now encouraging pharmacies to take part in training programmes, as they play a crucial role in preventing more harm.

Margaret Ferrier (SNP): Increasing awareness and our understanding of the causes of eating disorders are crucial to providing the right care. Eating disorders are still hugely misunderstood. Does the hon. Member agree that Ministers must fund more research on that, because just 1% of mental health research funding is directed to eating disorder studies?

Wera Hobhouse (Liberal Democrat): The all-party parliamentary group on eating disorders inquiry on research funding found how crucial it is, and in particular that eating disorder research should be ringfenced. Some progress has been made, and the eating disorder charity Beat has made good progress on the issue, but more research needs to be done.

Tim Farron (Liberal Democrat): Research funding needs to be increased so that we can understand the causes and cures and tackle this range of diseases head on.

Margaret Ferrier (SNP): Social media algorithms will serve to those with eating disorders more and more content that encourages harmful and dangerous behaviours. That is particularly worrying for younger and adolescent sufferers. Does the right hon. Member agree that platforms cannot be allowed to continue to profit from that via advertisements, and that the Online Safety Bill provides the perfect opportunity to address that?

Caroline Nokes (Conservative): Can we please make sure that the online safety legislation is used as a tool to oblige social media platforms to clean up their acts when it comes to profiting from legal but undoubtedly extremely harmful forms of advertising to people who are already suffering from very serious medical conditions? When it comes to eating disorders—specifically anorexia nervosa, which is the most lethal mental health condition there is—we have to make sure that we do not trivialising or dismiss them.

On social media content and algorithms, what does the Minister believe we can do to better protect young people? What can we do to give them the tools they need to be more resilient and to understand, when they are being pushed social media content, what is good and what is not—what is harmful and what is less harmful?

Tim Farron (Liberal Democrat): We need to be utterly intolerant of dangerous images and things that lead people into this dangerous area and cause such ill health.

Carol Monaghan (SNP): We need action on social media companies that target vulnerable individuals.

Patricia Gibson (SNP): One innovation, or new measure, that has not helped the charities and those on the frontline seeking to support people living with this condition or in danger of developing an eating disorder is calorie information on menus, which has become mandatory in England. Although we all understand the good intentions behind it, I believe it is a misguided measure. The eating disorder charity Beat is urging the Scottish Government not to follow suit on that, for very understandable reasons.

Tim Farron (Liberal Democrat): When tackling obesity, for example, we need to remember that there is a danger of things such as like calorie references being well-intentioned but counterproductive.

Carol Monaghan (SNP): We also need the removal of calories from menus; their inclusion was aimed at tackling obesity, but unfortunately the message is hitting the wrong people.

Sir George Howarth (Labour): The variation of eating disorders called T1DE—type 1 diabetes with disordered eating—is a growing problem that affects young men as well as young women. The right hon. Member for Maidenhead (Mrs May) and I have been co-chairing an inquiry into that variation of eating disorders. I will not pre-empt what our report will say, but one thing is clear: professional support, both psychological and physical, is vital to these young people, who could otherwise end up seriously ill if they do not take their insulin—in some cases, it is fatal.

Danny Kruger (Conservative): Crucially, we need more support for step-down services. It is not enough just to get somebody back to the appropriate weight. It can take months and months for people to be healthy again and to be free of treatment, so we cannot just say, “You get the acute treatment, then you’re back to health, and you’re free.” We need to support people for many months more, and we need more provision in the community for that step-down service.

Tim Farron (Liberal Democrat): It is worth mentioning that the use of BMI as a measure to decide whether someone can access services is dangerous and foolish. We would not say to a person who presented with cancer, “Come back when your tumours have spread.” If someone is presenting with an eating disorder, we need to believe them and allow them to access the right support immediately. That needs to be changed urgently.

Caroline Nokes (Conservative): We really have to move away from it (BMI). It gives a misleading impression of wellbeing. Can we please remember that it is designed for a Caucasian male’s body type? We know that the majority of sufferers of eating disorders are women.

Tim Farron (Liberal Democrat): More generally, this speaks of a lack of parity when it comes to care, treatment and taking seriously issues relating to mental health, particularly where young people and eating disorders are concerned. If one of our young people were to break their leg on a football pitch on a Saturday afternoon, they would be straight into hospital and the healing process would begin that day. If something invisible in them breaks, it could be weeks or months before they get support, or it could never come. It may come dangerously, or even fatally, too late, and that is wrong.

Maria Caulfield (Conservative):

Improving treatment for eating disorders is a key priority for the Government and a vital part of our work to improve mental health overall.

That is why, under the long-term plan for the NHS, we are investing £1 billion extra in community mental healthcare for adults with severe mental health illness, which includes treatment for eating disorders. The extra funding is being used to enhance capacity for new and improved community eating disorder teams, covering the whole of England.

Integrated care boards, which were set up in July, now commission services. We will hold them to account for their timelines, but hon. Members can also hold their local commissioners to account. The funding is given to them for mental health services. We do not dictate how it is spent, because that will be different for different communities, and the prevalence of eating disorders will be different in different parts of England. We expect commissioners to commission those services and to ensure capacity and timeliness for their local population, but if Members of Parliament feel that is not being done, we are happy to meet them to discuss how we can improve things locally.

Since 2016, investment in children and young people’s community eating disorder services has risen every year; there has been an extra £53 million per year from 2021. The pandemic continues to have an impact on the mental health and wellbeing of many people, and has caused a large increase in demand for eating disorder services. Services were almost closed, or certainly severely reduced, for nearly two years during covid, and covid itself had an impact, and there is now a tsunami of people coming forward. Data shows that the number of children and young people entering urgent treatment for an eating disorder in 2021 increased by 11% on the previous year, to over 2,600, and in the year before that it increased by 73%, from around 1,300 to close to 2,400, so there are more referrals than ever before.

I reassure colleagues that we are working with Ministers from the Department for Culture, Media and Sport on the online safety legislation, but also on other issues, because there is so much work that needs to be done to ensure that online influence is reduced where it is causing significant harm.

To return to the funding being made available, this is the first Government to really put mental health on the same footing as physical health. I am proud that we are creating parity of esteem, not just in planning services but in funding services. As part of the £500 million covid recovery plan funding for the mental health recovery action plan, we have invested an extra £79 million to expand young people’s mental health services, which has allowed 2,000 more children and young people to access eating disorder services. We have delivered this, with over 4,000 more young people entering treatment for an eating disorder than did in the previous year.

A number of Members talked about setting targets for children. We have indeed set targets for children’s eating disorders services. For adults, NHS England has consulted on setting a target for mental health services. I am particularly keen for that to be introduced as quickly as possible. I am meeting NHS England’s clinical lead for mental health services in the coming days and hope to be able to update Members on progress on that, because what gets measured gets done. While we may not be meeting the target for children yet, because of the sheer scale of demand, at least we have a target, and we know which parts of the country can and which cannot meet it, and I am keen that we do the same for adults.

The issue of BMI was raised, and I take the points made extremely seriously. Let me be clear: rejection for treatment on BMI grounds should not occur. If there are instances where that has happened, I am happy to address them; that practice is not in line with any guidance, including National Institute for Health and Care Excellence guidance, so it should not be happening. If there are examples of it happening, we are very keen to hear about them. If it is happening at a local level, I urge hon. Members to contact their local commissioners to find out why, because the guidance does not recommend that practice at all.

The Government have made huge amounts of funding available, for both mental health and eating disorders. More funding than ever before has gone into those services, but that funding needs to reach the frontline. That speaks to my point about local commissioners: where funding is given to a particular area, commissioners are supposed to use that money to commission services at a local level. If that is not happening in some parts of the country, then I am happy to meet with those commissioners and Members of Parliament to find out why.

We want to ensure that funding is going to the frontline to make the difference that we need it to. We are the first Government to prioritise mental health, and the first to set targets for eating disorder referrals. We are the first Government to set a standard of recruiting 27,000 additional mental health workers. We have started to roll out mental health teams in our schools, and when I spoke to the Royal College of Psychiatrists yesterday, for the first time it said that it had filled all its training posts in the last year.

We are making significant progress, but patients need to feel that. That is the next step. I am happy to work with (Wera Hobhouse) and the APPG on eating disorders to make sure that is happening on the ground, because, as someone said, it is great to talk about it, but we need to see the impact for patients.

I look forward to working with everyone across the House to make eating disorders a bigger priority for clinical work. Good progress has been made, but there is a lot more to do.