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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.

Guy Opperman: 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?

Chi Onwurah: 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

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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.”

10.27 pm

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): 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.

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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,

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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.

Tessa Munt (Wells) (LD): 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.

Dr Poulter: 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

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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.

Chi Onwurah: 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?

Dr Poulter: 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.

10.39 pm

House adjourned.