Martin Daly demands answers on failing eating-disorder services
Martin Daly questioned the adequacy of eating-disorder services, citing high morbidity and mortality and reports from advocacy groups. He pressed for explanations on referrals, transitions from CAMHS to adult services, catchment restrictions and comorbidities.
Concerns over mortality and service adequacy
Martin Daly asked why services remain inadequate for an illness with such high morbidity and high mortality, suggesting deaths from anorexia nervosa and eating disorders may be underrecorded. He invoked submissions from CARE and Body Wise to underline the urgency of the problem.
Transition gaps between CAMHS and adult services
He highlighted a recurring problem in the transition from CAMHS to adult mental health services, saying the issue is one of planning, coordination and communication rather than funding. Daly said advocacy groups report gaps that leave families and young people apprehensive about moving to adult care.
Referral rejections and catchment-area restrictions
Daly questioned referral handling, noting he sees 80% of accepted referrals and asking whether GP referrals are being rejected as inadequate. He also criticised the restriction that only those within certain catchment areas can access the country's three adult beds, calling the practice archaic and system-serving rather than patient-serving.
Comorbidities and exclusion from programmes
He raised concerns that children with comorbid conditions, including possible neurodivergence, are being excluded from eating-disorder programmes, risking delays in care and poorer outcomes for those with complex needs.
Service improvements and recovery statistics cited by Dr Clifford
Responding, Dr Clifford said specialist eating-disorder teams have seen huge improvements and that mortality and morbidity are recognised and prioritised through training and service delivery. She reported that about 10% of CAMHS eating-disorder cases require transition to adult teams, gave a local example of 3 transfers from 70 cases, and stated that 95% of people recover with outpatient care while 5% require hospital admission.
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Why are the services so inadequate for an illness with such high morbidity and high mortality? I'm going to ask the questions and maybe allow you to come back then comprehensively. I just don't understand any other area of medicine that just wouldn't be driving advocacy in this area with such a huge morbidity and mortality. That's probably underestimated for chronic sufferers at 20%, but there are people who are dying probably from the complications of anorexia nervosa and eating disorders who aren't recorded as such. The other issue that has come through from CARE and from Body Wise is this transition from adolescence to adulthood, and this isn't just specific to eating disorders. This is a recurring theme between CAMHS and adult mental health services, which is inexplicable because it doesn't require funding. It requires planning and coordination and communication. The other issue then is I see 80% of all accepted referrals. I'd like to know if a GP refers someone with an eating disorder, are you saying that 20% of those referrals are inadequate? Because again, it's a recurring theme of rejected referrals. Probably the only service that there are rejections of referrals from any service in the health service. Then the catchment areas. I still don't understand that in a situation where we have only three adult beds in the country, and yet the only people that can access those three adult beds are people in that catchment area. And this is a recurring theme, especially in psychiatry and mental health services, that the system seems to serve the system and not the client or the patient. And I'd like a comment on that because it seems archaic to me. And then finally, comorbidities. Children suffering from other issues, perhaps neurodivergence and that, not being accepted into the referrals, not being accepted into the eating disorders programmes. Time is short, so they're the main issues I wanted to raise. I might go to Dr Clifford in terms of the morbidity, mortality, and in terms of the comorbidities as well, because I think that's a... Do you want to just start? Oh, thank you. Thank you. Thank you, Deputy. Just to say there have been huge improvements on the ground in the specialist eating disorder teams. In relation to the mortality, we absolutely recognise, which is why we have absolutely prioritised the delivery of the services, why we have prioritised the training of our staff, not only within the eating disorder teams, but we've also done training that has been offered out to community cams teams and adult mental health services as well. We recognise that there is the mortality and the morbidity, which is, again, why we have prioritised the services. In relation to the transition from cams to adult services, we recognise that approximately 10% of those attending cams eating disorder teams will require a transition to an adult eating disorder team. It is the minority. We are absolutely recovery-focused. For those, our teams work in cams eating disorder teams, we have policies whereby we can refer young people from the ages of 17 and a half to adult eating disorder services. We have transition pathways where we can nominate a key worker. We can do up a joint care plan. The majority of young people would not require a transition to an adult eating disorder team. Clinically on the ground, I work in a cam specialist eating disorder team. For the 70 open cases that I saw in the last year, just three young people required a transfer to the adult eating disorder team, and all of which were successful in transition to the eating disorder team. This is what we want to be able to replicate nationally and across the country, because we absolutely understand that it is such an apprehensive time for families and for parents. The lived experience from the advocate groups, Sarah, is not that experience. And are you saying that only three out of that group of people, you're saying that small majority, that the rest are completely cured, is not my... Yeah, so that is my experience on the ground, Deputy. Actually, that recovery is absolutely possible. The majority of young people, 95% will recover with outpatient care. That's for all people with eating disorders. Only 5% will require admission to hospital. It's one of the great myths, actually, around eating disorders, that recovery isn't possible, and that you absolutely need to be admitted into hospital for treatment. I'm not suggesting that. I'm actually suggesting about the gap from the groups who came here this morning, from Body Wise, who you worked closely with and cared, that they say that there is a gap in service between adolescents. And that's our experience in other areas of CAMHS as well. So it's a recurring issue. And Deputy, I acknowledge that that is the experience of people in different parts of the country. So it's geographical now as well. And it's absolutely what we're striving to change. And I think when we're delivering eating disorder services and teams, this is about a culture change across the whole system. We came from so little, not only in terms of the clinicians on the ground, but also in terms of our training and clinicians. And this is a core focus. And a core focus for us is also the early intervention, so we can prevent the morbidity and the mortality and the longer-term deficit. I have to move on to the next question.
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