I requested the debate because in the city of Norwich there are two eating disorders associations. There is first the Norfolk Eating Disorders Association, which spends a lot of time consulting and counselling people in its open surgeries. It is full not only of patients and people who are suffering but of carers, who have a major problem as well. Families and friends come independently and get advice and so on from the association, which is fanning out into Yarmouth and other parts of the county.
The other major eating disorders association is the national one, which represents those with problems across the country and has a phone line system, counselling and so on. It has recently changed its name from the Eating Disorders Association to “beat”. I remember the meeting in which we said, “Stop being negative about disorders. Let’s get after it and do something about it.” That is why I am here—to urge the Minister to consider the problem and what we can do about it.
Some harrowing pictures have been produced of individuals who have lost weight and had problems with eating. I do not want to discuss them too much, because the problem is not just about the physical body. There are also mental problems for individuals who use food as a comfort in trying to tackle their daily problems. It controls one aspect of their lives if they use food to try to cope with the emotional difficulties that they are going through. There may be several causes of eating disorders—we just do not know. One thing written in the National Institute for Health and Clinical Excellence guidelines, which I will discuss, is that more research needs to be done. I hope that the Government will respond to that.
Eating disorders primarily affect young women aged 18 to 25, but of course not always. They also affect older women, and an increasing number of men are afflicted by anorexia nervosa or bulimia nervosa. There are cross-governmental issues that we need to consider to get a whole-society approach to the problem. Low esteem among our young people is often a problem, and reports from various organisations and UNICEF studies have put Britain at the bottom of league tables. We can argue about the figures until the cows come home, but we know that they can be better. That is the message that we have all received. There are a lot of unhappy young people out there—as well as old people in here—and for many of them that sadly leads to the problems in question.
We must link the issue with balanced school meals and sport activities so that young people can get some esteem and pride in what they are doing. There is nothing like running around and getting a few endomorphines in the body to feel better and healthy instead of continually having to worry about weight.
The media have a lot to answer for. The problems came into the public radar in the ‘90s when Kate Moss and co. introduced to the wider media the phenomenon of “heroin chic”. Today we have Posh Spice and Nicole Richie, who my researchers tell me is Lionel Richie’s daughter—I cannot keep up with it myself. She evidently sells the “size zero” phenomenon, and the debate arises from such celebrities. Magazines are filled with pictures of skinny bodies, and they are on the bottom shelves. One does not have to go very far down the road from here, to Westminster station, to see magazines such as Zoo and Nuts, which hit esteem on two important levels. They treat women as objects, with no worth, and they feature page after page of unrealistic bodies, semi-naked—so I am told; I do not know myself, of course. We know the type of imagery that is used. There are also lads’ mags and papers with similar content. The media influence how people feel they should look.
There is increasing incidence of eating disorders among men. Men can and, I am told, should, look good, live up to the Adonis-style body image—I do not mean the Minister of that name—purchase beauty products and so on. We must ensure that the resources and treatments that we get for tackling eating disorders are relevant to both male and female patients. Family upheavals also play a part in developing low esteem and affecting a person’s state of mind.
Eating disorders are serious illnesses and need to be treated as such. To take patients and put them in psychiatric wards, as happens to some young people, is the worst thing that can happen. I had a meeting on Saturday in the Forest of Arden with cancer consultants and asked them, “What would you do? Would you know what to look at?” They said, “Well, not really, we are cancer experts, but we think that the worst thing in the world would be to stick young people with this problem into a psychiatric ward.” Sadly there are a lot of a cases in which that happens. The people affected need special psychological treatment, help and support, so we must stop the habit of dumping the problem somewhere else. The NICE guidelines reflect that and are highly praised by the charities to which I have spoken. They cover getting help early, getting good information about the illness to the patient and their family, giving access to counsellors and self-help groups, including for families, and recognising that patients may be ambivalent towards their treatment but that they persevere anyway and should be encouraged to do so.
Psychological interventions such as group therapy and cognitive behavioural therapy should be made available, as well as dietary counselling and an annual physical and mental health review. Pharmacological interventions are helpful only for morbid conditions, which are rare. The physical aspects of illness must be managed, including by reducing the laxatives that people tend to take and gradually increasing their calorie intake. There must be regular dental checks and dental hygiene advice—people who vomit, for example, need that care and attention. The problem is deep-seated and needs the involvement of a large number of people in repairing it.
We need to screen vulnerable groups by assessing their body mass index and asking them to consider their relationship with food. We must be honest about it. Such things need to happen in schools, too, and people need to know that they are happening. We do not need celebrities to tell us how our bodies should look, although Princess Diana did a good job by reflecting openly on her problems with bulimia, bringing it higher up the agenda.
The guidelines are not being implemented sure-footedly across the country, and not all GPs are aware of them. They do not all diagnose eating disorders when they should. We need to do something to inform GPs, and I shall make a suggestion about that. Health professionals might not know the symptoms or what to look for, and they may not have an understanding with the patient.
A particular case in my constituency has hit the media waves. A young woman, Catherine Scott, died. She weighed six stone and it was recorded on her death certificate that she died of a liver-related disease. The implication was that she was drinking and that that was the cause. She had been under the care of her local GP for several years. Her family complained about her treatment and, after advice, the death certificate was changed to show that she had died from bulimia. It is interesting that they had to fight to get that put on the death certificate.
The family, of course, were very hurt. They have been down here, and they met the Minister at a reception. They have carried on fighting, through the Healthcare Commission, and they have now gone to the ombudsman. They feel that the GP should have picked up the problem much earlier, but instead the young woman died. That cannot be right. The worst thing, which a newspaper picked up on, is that the GP has now fallen out with the family and taken them off the surgery’s list. That is severe. I understand that some patients, and some constituents, can be difficult, but trying to get rid of the problem in that way is an overreaction. Parents and carers need a lot of support and help. I hope the Minister will look into the case of my constituent, Catherine Scott.
Many people with eating disorders can be treated as out-patients, as long as the illness is recognised early. Although in-patient treatment is rare, it does happen, but a psychiatric ward is the worst place for treatment. The places where I have seen the best treatment are outside hospitals in private areas in nursing homes and so on, funded and supported by the NHS. Young people who receive the necessary care and attention in such places seem to recover.
Eating disorders are recognised, and the Government are beginning to move on that front. There is good work on that, but more remains to be done because many young people are slipping through the net and not receiving counselling or therapy. We need a crusade to ensure that that does not happen. The problem of eating disorders must be addressed because they can be treated and eliminated. No one should die because of misdiagnosis, but I am sure that there have been other cases of misdiagnosis.
The problem is not just about weight; it is about the emotions that young people go through. There may be problems at school or in the family that need intense understanding by the counselling service. The local health community must review its practice to ensure that every surgery has a doctor who knows something about the disorder. We could start with one or two specialists in every GP area, as happens with diabetes. One member of staff should have some expertise to enable the problem to be picked up early. When patients have finished treatment, they must be monitored and not just dropped back into society. Some young people go through an unhappy phase when they are under pressure, and they should be followed up to ensure that there is no relapse or recurrence.
We should get busy on this. We could score highly, because we know what to do. The NICE report said that we need more research and some money. We have good guidelines, and it would not cost much to put those into operation in every GP practice and prevent the sadness, illness, break-up of families and the continual remaining problems when someone, sadly, dies.
I congratulate my hon. Friend the Member for Norwich, North (Dr. Gibson) on securing this debate on an extremely important issue. This is a good opportunity to raise in Parliament the issue of eating disorders. We must raise awareness, not only among the public but, as he rightly said, among NHS staff.
I thank my hon. Friend for his work on behalf of “beat”, which is the working name of the Eating Disorders Association. The organisation wants to raise awareness and provide support for those with the condition and their families. He talked eloquently about the problems that can arise, and highlighted a case from his constituency. I am sure he will be aware that it is difficult for me to comment on individual cases, but I know from my constituency work the distress that can be caused. We often concentrate on younger people, but there can be issues with older people, particularly the elderly and frail, when recognising an eating disorder may be problematic. I was pleased to attend the “beat” campaign launch and to be able to congratulate it on pointing out that people can survive and recover from eating disorders. Getting out those positive messages is extremely important.
My hon. Friend referred to the media. It is absolutely right to recognise that some media images of excessive thinness must play a large part in encouraging young people to aim for an unrealistic body weight and to run the risk of becoming anorexic. The media have a role to play in addressing some of the issues. It would not be helpful to debate whether the media cause eating disorders, but I hope that they will, in conjunction with organisations such as “beat”, print positive stories covering the reality of eating disorders, the people who have recovered, how people must be able to talk about the problem and how to reduce the stigma of eating disorders, as well as providing good advice for those who need to look for the symptoms, whether families or teachers, to ensure that people are aware of the problem. The media have an important part to play.
It was interesting to see in the publication that “beat” produced on the day of the renaming launch that GPs and nurses are the most likely people to be confided in, and I was sad to learn that parents and teachers are not. A big question is how can we get over that and make sure that people feel able to confide in parents and teachers. We know that the sooner people come forward, the sooner treatment can start and the better the outcome.
As my hon. Friend said, there is a lot that we do not know about eating disorders and how they manifest themselves. I am happy to confirm that we are considering whether we can undertake further research, and I hope to make an announcement in the not-too-distant future.
I am pleased to hear that. I did not know about it. It is not often that an hon. Member leaves a debate feeling that something will happen. I thank the Minister on behalf of everyone concerned. If we can help in any way to make that happen quicker, I hope that we can work together. Many people will be happy that something is being done at last.
Thanks to the work of organisations, such as “beat”, and my hon. Friend awareness has been pushed up the agenda. The Government want to respond to public concern.
My hon. Friend was right to say that we must consider what GPs can do to identify signs of an eating disorder and to be able to offer the right treatment as early as possible. He made an interesting point about GPs in every practice having such training. We are always looking for ways of increasing awareness, but we must be aware of some of the practical difficulties—for example, in single-handed practices. We must ensure that good systems are available in primary care and that there is awareness of symptoms among health care professionals.
I thank my hon. Friend for pointing us in that direction.
The Government have assisted practitioners in choosing the most appropriate treatments. As my hon. Friend said, we asked NICE to produce guidance on the management of eating disorders, which was published in January 2004. In fact, “beat” was involved in drawing up those guidelines, and we are again very grateful to it for its assistance. The guidelines make clear recommendations about the available treatment and set out a structured pathway of care.
NICE has also published information for the public, explaining the guidelines and setting out what people with eating disorders can expect from the national health service. That is the other side of the story. As my hon. Friend said, such people may have low self-esteem and self-confidence, so they may find it difficult to share their circumstances. If they are unaware of the available services, they may wonder what is the point in going along to a meeting. We therefore wanted a two-track approach that involves being clear with health care professionals about the available treatments and the pathway to care, as well as ensuring that the public know about those treatments and that something can be done to help.
My hon. Friend talked about the different options that are available, including on psychiatric wards and so on. People with severe and intractable eating disorders might require referral to highly specialised services when local services cannot meet their needs, and specialised services have been developed in recent years. That indicates the various care settings that are now available.
When I visited a community mental health team recently, I was impressed because they had a eating disorders specialist. Previously, the practice had always been to refer people to in-patient care, but now consideration is being given to helping people at home and in the community through specialised services.
There are various ways of providing services, and there is some very good in-patient care. We must consider the individual to determine the most appropriate care. Sometimes in-patient care will be most appropriate, but it is important for commissioners to consider closely what can be offered in the community. As the role of PCTs changes and they clearly examine the needs of the local health population in the community and closely consider the services that they commission, it is important that they assess whether they have the right balance between in-patient care and the care that is available to people in their own homes—particularly at a highly specialised level—to help individuals with eating disorders.
The new role that PCTs will play in considering their own commissioning will help to identify and examine whether services are appropriate. They will often work with local organisations, such as “beat”, and those that my hon. Friend mentioned from his constituency, to determine whether there are occasions when they ought to commission services jointly, because voluntary organisations are sometimes more effective than statutory services at reaching out to people.
Although I agree with that point, does the Minister agree that young people with cancer do not like being on wards with adults? She will know about that from her work in the cancer field. Young people talk a different language, play loud music and have a different culture and style. It would also be dangerous to place them in a mental hospital where adults are on the same ward; that would distract them, and it might hold back their recovery.
My hon. Friend makes an important point. It is always vital, however, that we allow clinicians to exercise their judgment about what is most appropriate for individual patients, and it is important to examine closely the balance between in-patient care and the care that can be provided effectively in the community. For some people, it is better to provide services in the community; for others, in-patient care is the right approach. However, my hon. Friend is absolutely right that in-patient care must be appropriate to the needs of the individual.
The important point is that, in recent years, there have been massive increases funding for the NHS in general and in funding for mental health services. The issue is about examining how the funding is used to establish whether it is being used as effectively as possible to provide the personal services that we want—for example, the individualised and tailored services for people with eating disorders.
My hon. Friend also mentioned counselling. We made a manifesto commitment to increase the number of counselling services, because there are not enough of them. In 2001, we published guidelines on treatment choice in psychological therapies and counselling, which covered eating disorders, among a range of other conditions. In 2004, we published guidance called “Organising and Delivering Psychological Therapies” to help local services to understand best practice and how to organise local services to support access. Last year, we also started our demonstration sites in Doncaster and Newham to examine how we could provide psychological therapies for people with mild to moderate depression.
Some of those initiatives will tackle the very real points that my hon. Friend made about low self-esteem and lack of confidence. We want to increase support so that we can reach people as early as possible. We all agree that it is important to achieve early access and to ensure proper in-patient support, community support and general access to psychological therapies, because we can then provide treatment quickly.
The Government fund several voluntary sector organisations in the field, including Weight Concern and “beat”, and we are funding a three-year pathways to recovery project, which is about providing a buddy network of people who have had eating disorders. At the “beat” reception, I met some people who are very much involved in showing what has happened to them. It is so important to encourage people to share their experiences. We have done many things already, and we can do many more, to ensure that society takes on the challenge and that people work together to prevent more tragedies and blighted lives.
Sitting suspended until half-past Two o’clock.