The Public Administration and Constitutional Affairs Committee (PACAC) has published a report on the care of people with eating disorders and found that there is a lack of understanding of eating disorders among doctors resulting in avoidable deaths.
It found that 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.
Ignoring the alarms report
The PACAC inquiry follows the 2017 report by the Parliamentary and Health Services Ombudsman (PHSO). In its report - Ignoring the Alarms: How NHS eating disorder services are failing patients - it reflected on the deaths of three patients.
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.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.
Key conclusions and recommendations
Around 1.25 million people may be suffering from eating disorders throughout the UK, and they 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.
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 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. It also 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.
GPs need more time with their patients
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "Training in mental health, including eating disorders, makes up a key part of the GP curriculum and family doctors are well-trained to identify, diagnose, treat and manage these conditions, including when it may be appropriate to refer a patient for specialist treatment.
"But for general practice, the real issue underlying this report is the immense pressure that GPs and their teams are currently facing and the urgent need for more time with our patients.
"This is an incredibly complex area and the standard 10-minute appointment is simply not long enough for us to unravel the many complex issues affecting a patient's overall health, especially if an eating disorder is not the main reason they visit us in the first place."
She added that while GPs can use the BMI scale to calculate whether a person is within a healthy weight range, it is simply not true that this is the only tool we rely on to help us determine whether someone has an eating disorder. Instead, GPs will assess the physical, psychological and social aspects potentially affecting the person sitting in front of them and draw conclusions from a holistic discussion with the patient before making a diagnosis.