The report finds that training on eating disorders in medical schools is limited to ‘just a few hours’ and that, as the first port-of-call for many sufferers, medical staff and GPs in particular need significantly more training on the nature of anorexia nervosa and the behaviours that sufferers may display. The report also identifies a series of failings from the NHS to act on recommendations for improving care for patients with eating disorders to avoid unnecessary deaths.
PACAC’s inquiry into NHS care for patients with eating disorders followed the Parliamentary and Health Services Ombudsman’s (PHSO) 2017 report Ignoring the Alarms: How NHS eating disorder services are failing patients. Ignoring the Alarms reflected on the PHSO's investigations into the case of the death of Averil Hart (aged 19) and two others (Miss B and Miss E).
The PHSO concluded that eating disorder services are “an area of care that is at risk of failing its patients” and highlighted five areas of focus for improvement, including more training of doctors, improving coordination of services and investigating potential failings in previous serious incidents.
PACAC found that since these recommendations were made in December 2017, not enough action has been taken to implement them fully across the NHS risking avoidable deaths.
Commenting on the findings, the Chair of the Committee Sir Bernard Jenkin MP said:
“My Committee found serious failings in NHS care for people with eating disorders – doctors only receive a couple of hours of training, patients are left waiting for months for care and the NHS doesn’t even have accurate data on the number of people suffering from an eating disorder throughout the UK.
We cannot risk any more avoidable deaths from eating disorders. Eating disorders are complex mental and physical health illnesses and deserve dedicated training, specialist care and a commitment from the NHS to learn from its own mistakes. It’s been nearly two years since the PHSO reported on how NHS eating disorder services are failing patients. The Government needs to adopt a sense of urgency to stop this problem from spiralling, and my Committee is calling for swift action to address deficiencies in care.”
Key conclusions and recommendations
The prevalence of eating disorders
Some studies suggest up to 1.25 million people may be suffering from eating disorders throughout the UK, and the Committee was told that eating disorders have the highest mortality rate of all mental health illnesses. The Committee was shocked to find that, despite this, the NHS does not have precise information on the prevalence of eating disorders. The report therefore recommends, as a matter of urgency, that NHS England commission a national population-based study to properly assess how many people have an eating disorder.
Training for doctors
The report also outlines the serious lack of training for doctors on eating disorders. One study suggests training for doctors amounts to little more than a couple of hours in medical school, and the Committee heard that many doctors focus predominantly on using body mass index as the sole indicator of whether treatment should be offered. This is despite the fact that, the National Institute for Health and Care Excellence (NICE) guidelines recommend avoiding using single measures such as BMI to determine whether to offer treatment for an eating disorder.
The PHSO report, Ignoring the Alarms, recommended that the General Medical Council (GMC) conduct a review of training for all junior doctors on eating disorders. PACAC found that, though the GMC has taken some positive steps, it should use its influence to ensure that medical schools improve outcomes in relation to eating disorders. The Committee also recommends greater uptake of the MARISPAN guidelines (Management of Really Sick Patients with Anorexia Nervosa) to prevent further avoidable deaths.
Long waiting times and ‘cliff-edges’ in care
The report identifies a series of areas where care for patients with anorexia nervosa and other eating disorders falls short. In particular, people with lived experience of eating disorders described the difficulties of transitioning from child to adult care at the age of 18, or from in-patient to community-based services. Patients often experience unacceptably long-waiting times for adult mental health care at a difficult period in their life when they are moving from school to university. The quality of care received is also often subject a ‘postcode lottery’, as outlined by much of the evidence.
The Committee was extremely concerned to hear that some patients are discharged from eating disorder inpatient care when they reach a certain wait, without a guarantee that their mental health had recovered.
The Committee asks the Government to set out how much of the recently announced mental health funding for the NHS will be spent specifically on eating disorders, and welcomes the NHS’ commitment to piloting a four week maximum waiting time for adult mental health care.
The Committee also calls for more action on ensuring high standards of care as patients transition to adult care. Worryingly the Government claims in its written evidence that it has already achieved this, but the report finds little supporting evidence to suggest there is equality in the services available to children and adults.
Commenting on long waiting-times for adult services, Sir Bernard Jenkin said:
“For many people, the move from home to university can be challenging enough without the added complication of delayed care for an eating disorder. My Committee is calling for a quicker and smoother transition from child to adult eating disorder services.
We welcome the work of Beat in highlighting the lack of continuity in care at this important life stage.”
Addressing gaps in care
Ignoring the Alarms also found that there are few eating disorder specialists in the NHS, and therefore many patients do not have access to the specialist, dedicated care they need. The PHSO recommended a review of how training could address the gaps in care, including the potential to train existing staff.
PACAC found that more should be done to improve eating disorder awareness and understanding among wider healthcare staff, and recommends that all junior doctors undertake a four-month psychiatric placement to help them identify eating disorders.
Learning from serious incidents
Nic Hart, father of Averil Hart who died from anorexia at the age of 19, had been in constant correspondence with over six organisations before any formal investigation was launched into Averil’s death. The Committee notes that investigations into, and NHS learning from, serious incidents is essential to helping ensure that the circumstances leading to avoidable deaths do not reoccur.
The Committee calls on the NHS to move from a culture of short-term reputation management to one which facilitates open learning and longer-term improvements to service provision.
The Committee notes that CQC inspections are a useful way of monitoring this progress, and the importance of the work of Healthcare Safety Investigation Branch (HSIB) in investigating the causes of clinical incidents without attributing blame.