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Severe Eating Disorders (North-East England)

Volume 583: debated on Monday 23 June 2014

Motion made, and Question proposed, That this House do now adjourn.—(Mr Evennett.)

Chi Onwurah (Newcastle upon Tyne Central) Severe eating disorders are a significant and growing issue for too many of our constituents. I pay tribute to the all-party parliamentary group on body image and the Backbench Business Committee for the excellent debate in February on severe eating disorders, which helped raise awareness about this terrible group of mental illnesses. I am also indebted to the many concerned people who have written to me, some with heartbreaking testimony; to the campaigning group, the North East Eating Disorder Action Group; and to the charity, NIWE eating distress service, for sharing their concerns.

This evening, I will focus my remarks on the treatment of severe eating disorders in the north-east, and in particular on the proposed closure of the Richardson unit in the Royal Victoria infirmary hospital in my constituency, the impact it is having on sufferers and their family and friends, and the sorry catalogue of mistakes and omissions by NHS England, which has brought us to the point where very ill and vulnerable patients from Tyneside are being forced to go for treatment to Norwich, Glasgow and London while suitable beds go empty in Newcastle.

The term “eating disorders” refers to a range of conditions, including, though not limited to, anorexia, bulimia and binge eating. They affect 1.6 million people in the UK, more than 90% of whom are women, although the incidence in men is on the rise. Severe eating disorders carry the highest mortality of any mental illness. We should think of that when we consider the situation of those suffering from these disorders, and the emotional turmoil that places on their carers. Do they really deserve to have the stress of travelling hundreds of miles added to that?

Unfortunately, eating disorders are on the increase. The number of hospital admissions is rising across the country, but in the north-east, at 6.5 per 100,000, they are 30% above the national average.

I congratulate my hon. Friend on securing this really important debate. The point she is making reflects the concerns of a few of my constituents who have contacted me. A couple wrote to me and said:

“No one associated with the unit can understand the decisions being taken at a time when the incidence of eating disorders is increasing. Our daughter relies on the excellent treatment and support provided by the dedicated team at the RVI’s unit. We have no doubt that her own health and those of others would suffer if this service was withdrawn.”

My hon. Friend makes an excellent point. Again, the testimony of those most intimately involved speaks to the excellence of the unit and the concern of people in Tyneside.

I congratulate the hon. Lady on securing this debate. Like her, I have had many letters of support from constituents who have been helped by the Richardson eating disorder service, and also from individual nurses and doctors, such as Dr Caroline Reynolds, the consultant psychiatrist at REDS, who have provided assistance to people with this terrible disease. Does the hon. Lady think it would be right for the mental health trust and NHS England, together and collectively, to review their decision and, going forward, address how they will recommission the service when the present contract ends?

The hon. Gentleman makes an excellent point, and I certainly believe that the decision should and must be reviewed. It is clear that a number of hon. Members have been contacted by concerned constituents. Indeed, the right hon. Member for Berwick-upon-Tweed (Sir Alan Beith), who cannot attend this debate, asked me to say that he also had constituents who are affected.

Given that admissions in the north-east are 30% above the national average, and that the Royal College of Psychiatrists recommends that six beds per million of the population are needed for average admission rates, the north-east’s 2.8 million people need 23 beds. I will return to that figure, but first a word about the threatened unit that hon. Members have already referred to.

The Richardson eating disorder service is operated by Northumberland, Tyne and Wear NHS Foundation Trust. It is in the centre of Newcastle, with excellent transport links. It is acknowledged to be an outstanding unit, rated excellent by the Royal College of Psychiatrists and the Care Quality Commission. It has just won Beat’s clinical team of the year award. A stable, vastly experienced staff has been treating adult in and out-patients since 1997, and it has saved many lives. One sufferer said:

“I have suffered from anorexia nervosa for over 12 years and unfortunately during that time I have required many admissions to medical and eating disorder units”.

She names a number of them before going on to say:

“The admission to the Richardson was by far the most successful. I made such huge strides towards recovery and was the healthiest I have been since this all began.”

In the light of what my hon. Friend says, and the fact that the unit’s model of partial hospitalisation of out-patient services has been so successful, does she not agree that NHS England should look at that model and perhaps reconsider its decision on the specification of specialised services?

My hon. Friend makes an excellent point. Indeed, if the criteria on which this decision was made were publicly available, we could perhaps tell which models NHS England considered and what it hoped to achieve. Unfortunately, there is no transparency, which is one of the key issues.

Problems started in 2010, when commissioned adult eating disorder in-patient beds were tendered and the contract was awarded to Tees, Esk and Wear Valleys NHS Foundation Trust, although it did not then operate an in-patient unit. It quickly established a 10-bed unit in Darlington, but on a site with poor transport links to the north. For clarity for those Members who may not be familiar with the north, Newcastle is to the north of Darlington.

The award was a shock to many people, not simply because of the result, but because of the lack of consultation. I should like to ask the Minister a specific question: against what criteria were proposed services considered to be better than award-winning ones already on offer in the Richardson? If he does not know, I hope that he will promise to find out. Was cost the driving factor? What was the evidence basis for the centralising of these critical mental health services?

The National Institute for Health and Care Excellence guidelines specifically state that for severe eating disorders patients should be treated near their homes, with the support of family and friends. These are often young, vulnerable people, who are not yet independent of their family, either financially or emotionally. As one told me,

“Seriously ill anorexics are often cognitively impaired as a result of severe starvation and separation from loving support, together with that the challenge to dangerous and entrenched behavioural traits is often too much to bear.”

Given the lack of consultation, the north-east specialised commissioning group was instructed to strengthen its relationships with stakeholders and report any other substantial changes or developments to the NHS scrutiny committee.

NEEDAG, formed by carers and patients concerned about the threat to the Richardson, hoped that at least five of the beds in the Richardson would continue to be used by those in the north of the region, given overall regional demand. However, in April 2012, the commissioner increased the number of beds at Darlington to 15—again, without any consultation, scrutiny or performance data by which to make judgments. When challenged, I am told that the commissioner said they were not obligated to consult anyone. I hope that the Minister will correct them on this point. It is possible that the top-down reorganisation of the NHS instituted by this Government may have led to them forgetting their obligations under the NHS constitution.

When Darlington was full, commissioners started sending very ill patients out of the area, instead of to the Richardson, saying that every commissioned bed in England, no matter where it was, had to be filled before a patient from Tyneside could be sent to Newcastle. That is how we have arrived at the ridiculous and tragic situation of our national health service sending vulnerable Tyneside patients to Glasgow, Norwich and London when there are empty beds in the Richardson unit in the centre of Newcastle.

The impact on vulnerable young people of being separated from their families undoubtedly makes it more difficult to recover—hence the NICE guidelines. The cost of visiting for families is enormous, both financially and emotionally. One parent wrote:

“This will then have an effect on our family’s mental health as we are all struggling to come to terms with the condition and to help M recover. I would refuse to let M be admitted so far away from home and would rather give up my full time job to look after her in the familiar and safe surroundings of home.”

Another parent who fought to win a place for their daughter at the Richardson said:

“We were very angry to have been put in the position of having to fight for a bed for our dangerously ill daughter at a time when all our energy was needed to comfort and support her through a very difficult time. The added pressure and anxiety it caused the whole family was dreadful.”

It has been announced that the unit will be closed down, because it was said—cynically and cruelly—that it was not being used locally. If it was not being used locally, it was because NHS England was sending local people hundreds of miles away. Freedom of information requests submitted by NEEDAG show that Darlington’s 15 beds are full; that there are eight in-patients from the north-east in London, Sheffield, Leeds, Glasgow and Norwich; and that five patients have managed to win beds in the Richardson.

We all understand the need for and importance of centralised specialist services, whether they be stroke services or those under discussion, but given the number of people per capita in the north-east who suffer from this terrible disease, is there not a genuine case to be made for the two services to co-exist?

The hon. Gentleman makes an excellent point. That is indeed the case. The number of in-patient admissions in the north-east as a result of severe eating disorders is 30% above the average, which suggests that about 23 beds are required. It would be possible to meet the NICE guidelines and retain the services in Darlington and in Newcastle, yet not meet the increasing demand for in-patient beds. There are a total of 28 in-patients from the north-east, but NHS England says that only 15 beds are needed; that clearly goes against the 23 calculated in accordance with guidelines.

NHS England argues that it is investing in the north-east, and that it is opening an intensive day unit in Newcastle that will reduce demand for in-patient care, but it has provided absolutely no evidence to support its claim. One parent said:

“For my daughter the thought of going back to the local community mental health teams fills her with dread.”

A day centre does not address the issues of isolation and support when in-patient care is needed.

Patients are so worried that two of them have decided to take both the trust and the commissioners to judicial review, based on the lack of consultation transparency. They are applying for legal aid, so we will be in the ridiculous situation of spending public money to both defend and attack a decision taken without the most basic public consultation.

Having written to the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), on the subject in the past, I know that he is sympathetic to the plight of sufferers of severe eating disorders and their families and friends. Both he and the Secretary of State have criticised sending patients hundreds of miles for treatment. I want the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), to answer the questions I have already asked and the following two in particular.

First, does the Minister support the concentration of mental health services? In the case of heart surgery for children, we are told that concentration saves lives, because surgeons must be operating on many patients to retain their skills, but the mind does not physically work in the same way as the heart. Does he believe that there is something to be gained from making mental health into a production line? Why is it not possible to maintain beds in Darlington and Newcastle? Why is NHS England not following NICE advice? If the aim is to save money, is this truly a cost saving, or merely moving costs from the NHS to the sufferers of this terrible condition and their family and friends? Is it not outrageous that NHS England should be moving costs on to the most vulnerable and risking lives by doing so?

Secondly, on transparency, how can the Minister possibly support a process whereby there is no consultation on decisions that are so important to the lives of patients and their carers? Is that not in itself a reason to reverse the decision, given that the commissioners did not consult the people to whom they are accountable and in whose interests they are paid—and often paid very well—to commission services?

I will leave the last words to someone more intimately concerned with this than I am, who wrote to me:

“My friend’s beautiful and talented daughter has battled this terrible condition for many years with the help of the Richardson and the support of friends and family every single day that she has been in there. I truly believe that if the unit near to home closes and she feels far from this lifeline of support, she will give up her fight and that could be the end not only of her dream to take up her place at University but possibly, it’s not too dramatic to say, her life.”

I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on securing the debate and not only raising important issues about the provision of services for people with eating disorders in her constituency, but doing so in the context of an important national debate, because many of us are aware that there has not always been a genuine parity of esteem between mental and physical health. If we are to have a holistic health service that focuses on better supporting people in their own communities, mental health will play an important part. In the north-east and elsewhere, it is vital that we try, in the first instance, to prevent people who have anorexia or other eating disorders from becoming so unwell that they need to be admitted as in-patients. That clear priority is not mutually exclusive to this debate, because it is clearly what good medicine and health care—whether for physical or mental health—is all about.

Eating disorders mainly affect young people, and I shall say a little about that as I address the specific concerns in the north-east that the hon. Lady outlined. Anorexia particularly affects women under the age of 25, from the early teens onwards. Research tells us that there might be more than 1 million people in the UK who are directly affected by an eating disorder.

Worse still, as the hon. Lady highlighted, anorexia kills more people than any other mental health condition, and the longer a patient is unwell with anorexia, the more likely the condition is to be fatal. Even before people begin to lose weight, they are failing to put on the bone mass that will sustain them as adults, and the disease is linked to osteoporosis and other conditions in later life associated with bone fracture. As the disease progresses, it becomes life threatening, particularly due to the muscle wasting that occurs to the internal organs, especially the heart. There can come a point, sometimes quite quickly, when as muscle mass deteriorates, it is lost preferentially from the heart. That increases the risk of heart attacks, which can often, tragically, be the cause of death in such cases.

We are also aware that eating disorders afflict young women at perhaps the most formative period of their lives. The peak age of onset of anorexia is 15. For bulimia it is two or three years later. On average, people with anorexia will recover, if they recover at all, after about six years of care. That highlights the importance of good out-patient services in delivering better care. If we can stop people getting to the stage where they become so unwell with anorexia, with better support through talking therapies and other interventions as part of good community-based care, that is a clear priority for mental health services and one that commissioners are taking very seriously in the hon. Lady’s part of the country, as she outlined.

Eating disorders span the transition between child and adolescent and adult services. This has sometimes led to unacceptable variations in care and fragmented services, as we heard. So how do we deal with this? Early diagnosis is key. We have to make sure that treatment is available to minimise the effect of these distressing conditions. But alongside this, and perhaps before this, we need to attack the causes as well. Eating disorders are often blamed on the social pressure to be thin, as young people in particular feel they should look a certain way. In reality, the causes are much more complex than that.

There are several risk factors—having a family history of eating disorders; depression or substance misuse; being criticised for eating habits, body shape or weight; being overly concerned with being slim, particularly if combined with pressure to be slim from society or for a job; and having an obsessive personality or an anxiety disorder. Other key causes of eating disorders are sexual or emotional abuse, the death of people who are close and other stressful situations. There are also issues specific to particular eating disorders, which I will not go into today. There are clear differences between anorexia, bulimia and binge eating disorder. Binge eating disorder has the added complication of the binge eating cycle, leading to increased blood sugar and potential links to diabetes.

It is important that such disorders are not looked at in the context of the mental health service in isolation. When we know that the cause of death may often be due to cardiac arrest in the case of anorexia, and when we know that there may be links between binge eating disorder and diabetes, it is important that an holistic approach is taken to the care of people who become very unwell. There is a link between the physical and the mental health services that are available to patients, and I know from conversations that local commissioners are looking at that in the way they deliver care.

Last year, the Home Office launched a report of its body image campaign, which highlighted the need to ensure that young people have healthier and happier futures where a wider spectrum of healthy male and female body shapes is represented. I am sure we would all support that.

I assure the hon. Lady that children and young people’s mental health, particularly in the north-east, is a priority for the Government. That is why we have invested £54 million in the four-year period from 2011 to 2015 in the children and young people’s improving access to psychological therapies programme, or children and young people’s IAPT services. This provides training in a number of evidence-based psychological therapies, not just the more common cognitive behavioural therapy or CBT, but systemic family therapy and interpersonal psychotherapy.

Given the complexity of the causes of eating disorders, that more holistic basis to the way that children and young people’s IAPT services work to get early intervention in place, and the £54 million supporting that deployment in the north-east and elsewhere, will, we hope, make a difference in the years ahead. We must recognise that we are coming from a baseline where there was no parity of esteem in terms of how the NHS prioritised eating disorders or how the NHS commissioned services for eating disorders. This investment in that early intervention will bring real improvements to the quality of care of people with eating disorders in the north-east and elsewhere. We know that early intervention is key. It is also important that we get a firmer understanding of the scientific basis and the research that underpins good treatment. The South London and Maudsley NHS Foundation Trust has conducted a £2 million programme of research specifically on the treatment of anorexia, which will improve treatment and care throughout the country.

In the north-east, child and adolescent mental health services have been transformed by the introduction of the children and young people’s IAPT services, which I outlined earlier, in the areas covered by three CCGs, namely Teesside, Newcastle, Hartlepool, Middlesbrough and Easington. Between them, they commission CAMH services for 61% of young people in the region already under other CCGs, and the other CCGs have agreed to follow them. Steps are being made in early intervention, in providing better support for people with eating disorders in the north-east.

I recognise the similarities between what is happening in the north-east and in the south-west. We have young people being discharged from services when they reach the 18-week threshold or because they have reached a body mass index of 18, yet the Minister has accepted that this is a complex condition which sometimes takes five or six years to recover from.

That is absolutely right, and it is important that there is a strong link between what happens in the community and what happens at the specialist centre. We know that there are advantages to commissioning specialist beds for eating disorders. We know that there is good evidence supporting the fact that that delivers better care for patients. But it is important that there is a strong link between that and what happens to the patient and the young person when they are discharged from that care, and that there is proper support in the community for those people afterwards. That is what will be supplied in this context by the newly commissioned services at Benfield House, which specifically focuses on providing high-quality day services and real support for young people and their families.

I considered the importance of continuity of care and the unique nature of in-patient care requirements, and the Richardson unit had both out-patients and in-patients, and that continuity of care was very important. Please will the Minister address the issue of the Richardson unit?

In the brief time available to me now, I will come on to the Richardson unit specifically. The hon. Lady outlined the decisions made in 2010 and why they were made. We must recognise that under the criteria brought in by this Government, there are now strengthened criteria for public engagement in future decisions about commissioning. In future, they will have to be clinically led by local clinicians and made on the basis of strong public engagement. I would hope that those decisions would not necessarily have been taken in the same way had they been made under the criteria introduced by this Government.

I invite the hon. Lady to have a further meeting with the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), when she will be able to raise more of those concerns with him directly, but it is important to recognise that there is now a change in the way in which consultations are carried out. That was not there at the time, and that is part of the reason why there was not the transparency that the hon. Lady wanted and desired; transparency that we would all find desirable, but unfortunately the criteria were laid down by the previous Government. People often felt done to, rather than done for and cared for. That is why we have changed and improved the criteria.

As well as offering that meeting with my hon. Friend, I want to say that it is completely unacceptable for patients to be travelling long distances for their treatment and care at specialist centres and units. That is not good health care. We know that part of the recovery for people with eating disorders is having a community-based package where there is a strong link with family support. On the basis of that, my hon. Friend and I will raise with NHS England the specific issues arising from this debate, and I would also like the hon. Lady to meet my hon. Friend to discuss this further. I hope she finds that reassuring, and that she also finds reassuring the important early intervention measures that have been put in place in her constituency.

Question put and agreed to.

House adjourned.