Box 4: PHSO Recommendation Four
Health Education England should review how its current education and training can address the gaps in provision of eating disorder specialists we have identified. If necessary it should consider how the existing workforce can be further trained and used more innovatively to improve capacity. Health Education England should also look at how future workforce planning might support the increased provision of specialists in this field.
63.The PHSO identified a further barrier to good quality care transitions as being a scarcity of specialists who can provide the type of care required” saying there are often only “one or two professionals have responsibility for patients with eating disorders across a large geographical area, or that people are unable to access support where they live.”
64.The Government’s evidence pointed to a number of steps being taken by Health Education England (HEE), including:
65.In recognition of the fact that people with eating disorders can present in a variety of settings, not just in mental health services, HEE has broadened its education and training scoping exercise to include the learning needs of the wider workforce, this project is scheduled to report in June 2019. Beat has welcomed the steps taken by HEE, describing them as being in line with the PHSO’s recommendation.
66.Beat recommended that Health Education England should work with NHS England and others “to ensure that all junior doctors complete a four month psychiatry placement, and that these include clinical experience in eating disorders.” In oral evidence the Minister signalled her support for a four month psychiatry placement. Professor Bayliss-Pratt, Chief Nurse for Heath Education England, was somewhat more cautious, saying:
It is important that we have a flexible, responsive training circuit for junior doctors so that they can be in a variety of settings, get exposure to these issues and be trained and supported appropriately. The fear is that if we just put everybody into a four-month training pathway would we achieve what we really want to with this agenda? Again, we need to work with our partners to really test that a lot more to see if that is the optimum way forward.
But also explained that her mind was “open to it”. Professor Bayliss-Pratt made clear that work was being undertaken not just in relation to doctors, but also the wider workforce:
The other important thing to recognise is that it is not just about the medical profession, it is about the wider workforce. For example, we are just piloting an education mental health practitioner role that works between mental health services, primary care services and schools, because we think it is really important to get to children and young people and to spot people who are identifying these problems early. It is about that wider workforce at the moment and we are currently exploring how we create a more professional competency framework to ensure we get this education and training into everybody who comes into contact with people who require health and care services, including school nurses, health visitors and the whole public health agenda too.
67.People with lived experience strongly supported the need for teachers and university staff to be included in training. They explained that people with eating disorders can present in a variety of circumstances therefore providing effective training to a wide range of professionals would aid the early detection and provision of support for people with eating disorders. We also had our attention drawn specifically to the need to provide training to nurses. We were told that many people with eating disorders see nurses more often than GPs or specialists, so providing training to nurses and nurse practitioners could potentially improve the early detection of eating disorders. It was suggested to us that training delivered by people who have lived experience can be particularly effective.
68.All junior doctors should complete a four-month psychiatry placement and we welcome the Minister’s support for this proposal. Such placements should include exposure to eating disorders. We recommend Health Education England take this recommendation forward and assess whether it is possible to ensure each such placement includes exposure to patients with eating disorders.
69.We welcome the efforts of Health Education England to develop competency within the wider workforce in relation to eating disorders. People with eating disorders can present in a variety of circumstances and through a number of different pathways, therefore improving the wider workforce’s knowledge of eating disorders can significantly improve the early detection and provision of support for people with eating disorders. This work should specifically consider the provision of training to nurses and nurse practitioners. Health Education England should take steps to facilitate the delivery of such training by people who have lived experience of eating disorders. In circumstances where that is not viable, solutions such as online training should be pursued.
72 , Parliamentary and Health Service Ombudsman, December 2017, p 16
74 Department of Health and Social Care, Health Education England and the National Institute for Care Excellence,
Published: 18 June 2019