Driving improvement in eating disorder services

Assistant Director of Insight and Public Affairs

This month we’ve seen how our work helps parliament hold NHS organisations to account for the quality of care people experience.

The Public Administration and Constitutional Affairs Select Committee (PACAC) has been holding an inquiry into the issues raised in our 2017 report into failings in NHS care for people with eating disorders, Ignoring the Alarms. Their inquiry looks at how Government and its agencies have responded to the findings and recommendations of our report.

The committee held oral evidence sessions as part of their inquiry, where they heard from six expert witnesses:

  • Andrew Radford, Chief Executive, Beat
  • Dr Dasha Nicholls, Chair, Faculty of Eating Disorders, Royal College of Psychiatrists
  • Professor Lisa Bayliss-Pratt, Chief Nurse, Health Education England (HEE)
  • Dr Colin Melville, Director of Education and Standards, General Medical Council (GMC)
  • Jackie Doyle-Price MP, Parliamentary Under Secretary of State for Mental Health, Inequalities and Suicide Prevention, Department for Health and Social Care (DHSC)
  • Professor Tim Kendall, National Clinical Director for Mental Health, NHS England (NHSE) and NHS Improvement (NHSI)

The impact of our report

In Ignoring the Alarms, we found that the death of a young woman, Averil Hart, could have been avoided if the NHS had cared for her appropriately. All four of the NHS organisations involved in Ms Hart’s care and treatment failed her in some way and all missed opportunities to prevent the deterioration which ultimately led to her death.

In our investigation, we found a general lack of awareness about eating disorders among the clinicians involved, a lack of specialist eating disorders clinicians, a poorly-managed transition from child and adolescent health services to adult services, and poor co-ordination between the different services involved.

As I watched the oral evidence hearings, it was clear to me that our report had focused attention on these problems and what needed to be done to address them. One of the witnesses, Dr Dasha Nicholls from the Royal College of Psychiatrists, said that our report had made clinicians more vigilant about the need to provide priority care to people severely affected by an eating disorder. Another, Andrew Radford, from the eating disorders charity Beat, described how our report had created momentum among policy-makers to make improvements, while Professor Tim Kendell and emphasised that NHSE and NHSI

“have absolutely said we want to do what the PHSO report says”.

This increased focus on improving the quality of care for people with an eating disorders is important, but it was clear from the oral evidence hearings that much more work needs to be done before this ambition becomes a reality.

More progress is necessary

The witnesses acknowledged that more progress needs to be made before people with an eating disorder and their families and carers see meaningful change in the quality of care they experience.

Dr Colin Melville from the General Medical Council and Professor Lisa Bayliss-Pratt from Health Education England explained the steps they were taking to improve the quality and quantity of clinical training in eating disorders, while the Minister, Jackie Doyle-Price MP, and Professor Kendall explained how DHSC, NHSE and NHSI were bringing different organisations together to collectively drive improvement in care quality.

They also explained that they are in the early stages of efforts to improve care quality. More time, effort and investment is required to achieve the change recommended in Ignoring the Alarms

We heard that medical royal colleges will need to collaborate to review postgraduate training for doctors and nurses. We heard that waiting time standards should be introduced so that adults with an eating disorder can access timely and appreciate care. And we heard that more investment is required to support improvements in the quality of care.

It is clear that the message of Ignoring the Alarms has been heard, and NHS organisations have ambitious plans for improving eating disorders care. But it is also clear that there is still some way to go before these ambitions will be realised. The scale of the improvement needed in eating disorders must be matched with clear funding and timescales for implementation.

Driving improvement in public series for everyone

PACAC, and parliament in general, has an essential role to play in holding Government to account for delivering on its promises. This inquiry illustrates one of the ways in which the PHSO enables parliament to do precisely that. Our Ignoring the Alarms investigation made findings and recommendations that PACAC used to hold Government and its agencies to account on behalf of everyone who uses public services.

But this inquiry also illustrates how much greater PHSO’s impact could be if the outdated laws that govern our purpose were updated. Right now, we can only investigate issues that affect a whole system of public services – such as eating disorders services – that are brought to us in a complaint about NHS or other public services. That means that we are unable to look at injustices suffered by people who may be in circumstances that leave them unable or unwilling to complain, such as people who fear personal consequences if they were to speak up about their concern

If PHSO were granted powers to investigate using our own initiative, without the need to focus only on the issues brought to us in a complaint, we could speak up on behalf of those who are in the most vulnerable circumstances. In doing so, we would not only achieve justice for individuals and their families, but also have an even greater impact in driving up the quality of public services for everyone.