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Delay of 'At Least 2 Years' for NHS to Implement Child Eating Disorder Guidance

It will take at least 2 years for guidance aimed at saving the lives of children and young people with acute eating disorders to be consistently followed, a senior NHS official has admitted.

Campaigners have warned that people are dying because guidance on medical emergencies in eating disorders (Meed) introduced last year is not regularly being implemented by specialists.

Claire Murdoch, NHS England's national mental health lead, was challenged on why Meed is not always being adhered to when she gave evidence to MPs on the Public Accounts Committee on Thursday.

In response to a question from Labour committee member Olivia Blake, Ms Murdoch, who is also Chief Executive of Central and North West London NHS Foundation Trust, said the guidance in itself is "not enough" to eradicate poor and potentially fatal practices. She said it takes time to conduct the required training, identify poor performance, and share best practice, adding demand pressures on the NHS had hindered progress.

"A few years ago, we had virtually no specialist eating disorder services anywhere across the country for children and young people," said Ms Murdoch. "We have them everywhere now and the job of us is to make sure they are productive, that they are following clinical outcomes, working with acute colleagues and others.

"My experience as a chief executive of an NHS trust would be that it takes at least 2 years of very focused clinical network sharing best practice, training, and education, making sure you are inspecting against particular complaints or more generally as part of the (regulator's) inspection regime and involving staff and patients and their families. It is a very big job."

Trusts Not Following Guidance

Eating disorders campaigner Hope Virgo said young people and children across the country with a life-threatening body mass index (BMI) are regularly not admitted to hospital or provided a care plan in line with the Meed guidance.

"We have hit a complete crisis when it comes to eating disorder treatment, decades of underfunding, decades of stigma, and people being left with no care and dying," said Ms Virgo. "The guidance is there but none of it is being implemented in the right way, which means – daily – people are not able to get support.

"Patients are being diagnosed as terminal, turned away for not being sick enough, turned away for being too sick – it is a national scandal," she said. "We need a proper timeline of implementation to tackle this with adequate funding because no one should be dying of an eating disorder in 2023.

"The Government have hid behind the pandemic for far too long, and the inaction around eating disorder treatment is killing people."

Asked if she agrees that people with a life-threatening BMI should not be discharged from hospital without a care plan, Ms Murdoch said: "Absolutely". She added: "For patients who have urgent need, we would expect there to be a really clear plan.

"Also, we would expect there to be clear support for carers where patients are going home. That is unequivocal, but that would be true for any complex needs patient."

Waiting List for Urgent Treatment of Eating Disorders

NHS England statistics show of the 107 children and young people requiring urgent treatment at the end of December 2022, 55% had been waiting more than 12 weeks for treatment to start.

The standard for waiting times set by the National Institute for Health and Care Excellence (Nice) requires that treatment should start within 4 weeks of first contact with health services and one week for urgent cases.

Ms Murdoch said there was a "hope" that waiting times would meet this standard by the end of 2024.

Sir Chris Wormald, permanent secretary at the Department of Health and Social care, told the committee evidence shows "poor or badly trained interventions" in response to eating disorders are "particularly damaging".

He added: "There are no short cuts because it is one of those areas where the capacity to do harm is actually quite high if you don’t get the intervention correct.

"I would love it if we could achieve that 100% across the country tomorrow. We need the workforce, we need the training, we need to be able to respond to the new demand that COVID also seems to trigger."