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London’s eating disorder services ‘struggling to cope’

Adult referrals for eating disorders in the capital increased 56% between 2016/17 and 2022/23, reports Noah Vickers, Local Democracy Reporter

Photo by Annie Spratt on Unsplash

Health services for Londoners with eating disorders are struggling to cope with demand and are allegedly going against clinical guidance to decide who receives treatment, a new report has warned.

According to data from London’s mental health trusts, adult referrals for eating disorders increased 56% between 2016/17 and 2022/23, while child and adolescent referrals increased 158%.

The findings are contained in a new report on the issue, published on Thursday (7th) by the London Assembly’s health committee and making twelve recommendations to mayor Sadiq Khan and City Hall officers.

The mayor’s office said that while Khan is not responsible for health services in London, he meets regularly with NHS officials and will “carefully consider” the report’s findings.

The report found that whilst NHS funding for eating disorder services is at its highest ever level, services in London have struggled to cope with the demand.

One consultant clinical psychologist told the committee that “almost all of the eating disorder services in London do not have the staffing levels available to safely provide the care required”.

The NHS has a target of ensuring that, from their first contact with a designated healthcare professional, 95% of children and those aged under 18 start treatment within four weeks. For urgent cases, the target is for 95% to start treatment within one week.

But among those urgent cases, the proportion who get treatment within one week in 2022/23 was only 80%. The report warns that “this data should be treated with caution due to a cyber-attack which impacted reporting for this year”.

The figure for the previous year was even worse however, at 64%. Both are down from the 83% of cases starting treatment within a week in 2016/17, which was Khan’s first year as mayor.

Among adults in need of treatment, waiting times appear to have improved since 2016/17. In that year, only 13% of cases started treatment in one week, and 42% within four weeks. Those figures had risen by 2022/23, so that 33% of adult cases were starting treatment within a week, and 61% within four weeks.

The report also warns: “Some services are left to prioritise only the most severely ill people and are reportedly going against clinical guidance by using body mass index (BMI) as a threshold for determining who should and shouldn’t have access to services.”


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Guidance from the National Institute for Health and Care Excellence (NICE) states that although BMI or body weight are important for doctors to assess, they must be considered alongside a range of other physical and mental health indicators.

The committee is said in the report to have “heard a range of evidence to suggest that significant capacity pressures” have meant BMI or body weight is sometimes being used to decide who receives “priority access to services”. The mayor is recommended to lobby NHS England to ensure this is not happening.

The committee’s Labour chair, Dr Onkar Sahota, said: “Many people suffer in silence with an eating disorder for too long. Some may not recognise their symptoms at first and others may feel reluctant to come forward and seek help due to the stigma associated with the condition.

“As a GP who may be the first point of call for someone who has taken the brave first step in seeking help for an eating disorder, I am troubled to hear that some Londoners have found their GP to be ill-informed and insensitive to their experiences.

“Given that it can take many years for people to reach out, it is crucial that when they do, they are met by informed practitioners who are able to provide the necessary advice and are supported by robust systems to deliver the specialist help required.

“We heard that improvements to waiting times for children and young adults have also stuttered in the past two years and that services in London are failing to meet national waiting time standards for children and young adults. In some exceptional cases people are waiting up to three years for treatment.

“We must ensure that the appropriate support is available to people on waiting lists who are at higher risk. I am particularly concerned to hear that some young people on waiting lists are engaging [primarily online] with ‘pro-eating disorder communities’ which may encourage and accentuate existing eating disorders.”

He added: “London is home to some of the most effective and innovative eating disorder services in the country, staffed by dedicated and expert professionals. I hope that the committee’s recommendations can harness these assets to deliver improvements to services across London.”

Responding, a spokesperson for Khan said: “The mayor is concerned about the increase in reports of cases of eating disorders and that Londoners have been struggling to access the care and treatment they need.

“As mayor, he is not responsible for health and care services in London as this rests with national government, but he meets regularly with NHS partners to champion and challenge them to provide the high-quality care Londoners deserve, including improved and equal provision of services. He will carefully consider the findings of this report.”


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