Last updated on July 20th, 2020
There's been a quiet revolution in the treatment of eating disorders in England.
Waiting times used to be appalling
Until recently, so much about eating disorder treatment in England seemed to be lacking. Sure, there were centres of excellence, but reports from BEAT and from parents kept highlighting horrendous issues. These were mainly:
- young people were waiting months to access treatment for an eating disorder
- when they did get treatment, it was often sub-standard
Regarding waiting times, we now have regular data on waiting times. I think they're extraordinary and I'm asking you to spread the word, wherever you live on the world, because every country can take inspiration from it.
So how long are youngsters waiting for treatment now?
At the start of 2019, 3.5 years after the standard was launched, roughly 80% of young people assessed as 'urgent' were starting treatment within ONE WEEK of contacting the health service. The rest, considered 'routine' cases, have to get treatment within FOUR weeks, and this was achieved for roughly 80% of them.
You can check the latest data any time on NHS England's site.
Treatment within one week of what? From "first contact with a designated
healthcare professional". The clock starts when the community eating disorders service has received a referral or a self-referral. GPs are required to make the referral "as soon as" an eating disorder is first identified, by phone or electronically.
One reason people are accessing treatment so fast is that they can now refer themselves directly to the eating-disorder specialists. They don't have to go through their GP, and they don't go through a generalist mental health service (CAMHS).
So the treatment delivered isn't the old-style incompetent mishmash that used to be the norm. Now England aims for evidence-based treatment, according to England's NICE guidelines, to be delivered by a specialist community eating disorder service.
Is it cynical to wonder if struggling health boards might massage their results by categorising some kids as "routine" cases when others would consider them "urgent"? Even so, having over 8 out of 10 kids getting treatment within 4 weeks is a huge improvement on what is happening in most of the world.
I also get a non-scientific sense of progress. In the past, when I talked to parents in England, their stories of delays and incompetence were awful. Now most often the parents who speak to me have got access to treatment within a few days by a specialised team.
What made these remarkable improvements happen?
One week is the maximum waiting time set in England's Access and Waiting Time Standard for children and young people with an eating disorder.
This amazing standard, which I summarise HERE, was launched in July 2015. It gives all services in England till 2020 to reach 95%.
Why you should tell everyone about this
The Access and Waiting Time Standard is a terrifically useful model for the rest of the world. I'm in Scotland and I want something at least as good – and I want it to include adults too. The Standard was written by an excellent team of experts, it's based on evidence, so the hard work has been done.
The standard launched a frenzy of training, recruitment and re-organisation among those treating child and adolescent eating disorders in England. It truly galvanised them into turning their services around. They have to show they are working towards the Standard, or they will get penalised financially. And for five years they are getting extra funds to manage the change.
It's not perfect everywhere but I am convinced this Standard is radically improving eating disorder treatment.
Is the Standard a big deal?
I don't have statistics for what was happening before the launch of the standard. The charity BEAT has for a long time been reporting how appalling the wait is but their surveys haven't particularly targeted children and adolescents. They say that the time between first symptoms and start of treatment is typically 3.5 years.
So we don't have before-and-after data to prove that the Standard has made a difference. However, speak to any clinician or parent in England, and you will hear how very slow and overstretched services used to be.
Waiting times are a life-and-death matter
The typical scenario all over the world is this: you worry that your child isn't eating or thriving, so you speak to their doctor, and the doctor may advise to 'wait and see', and when eventually you get referred to a service that treats eating disorders, you may wait weeks or months for your first appointment. At this stage you may get a diagnosis, but you may wait more weeks or months for the treatment to begin.
By this time your child is very ill, and very hard to treat. They may need to spend a long time in hospital. Many of the adults who are so hard to treat, and those who have died, were once adolescents who waited far too long for treatment that may or may not have been any good.
Whereas with specialist treatment within a week, we can reverse the course of the illness relatively smoothly. The evidence is strong, and that's why the government created the one-week standard.
Are some youngsters failing to receive treatment?
Yes. You can see this in the latest NHS England statistics.
Where to next?
- England needs to continue the progress. It has till 2020 to reach the one week or four week target.
- Some services in England are still poor, with kids' futures at risk. I still hear shameful stories from some parents — not so much of massive waits but of old-fashioned treatment that is not in accordance with the NICE guidelines. We need improvements across the board. The charity BEAT is monitoring the statistics and campaigning for improvements.
- Everywhere in the world, we need similar standards. Learn from England. Do even better.
- And everywhere in the world, we need similar standards for adult sufferers.
So spread the word, and get campaigning!
It shouldn't be that hard if you can get the political will. In England, Nick Clegg, depute prime minister, saw the Standard through from start to finish. The process of gathering a roomful of experts, putting pen to paper and finalising the Standard took a total of… five weeks!
Feel free to copy and send out the image below.