Baroness Parminter (LD)

My Lords, this is a very limited amendment. It aims to prompt ICBs to ensure that there are adequate placements for those with severe eating disorders—both those who are sectioned and those who are not sectioned. There is a need for this because general acute mental health hospitals are not appropriate if we are going to ensure the best outcomes for people with eating disorders, and there are far too few beds out there at the moment. Let us address that last point first. In the UK, at the moment, there are 450 adult beds—that is a combination of NHS and private beds—and less than half that number for children. However, last year there were 30,000 hospitalisations for people with eating disorders, which is a fourfold increase on 2010, when there were 7,000. This means that people are being placed in inappropriate settings, be that in general acute hospitals, the general hospital down the road, or in out-of-area placements. All of those will deliver non-optimal recovery rates and result in more costs in the long term to the country, as well as greater suffering for individuals and their families and carers. It is pretty obvious to most people that eating disorders require specialist staff—it is not rocket science. People with very severe eating disorders, sectioned or otherwise, will often need nasogastric tube feeding, which is a specialist skill, and there will be issues around avoiding refeeding syndrome, along with the cardiac risk. It is very clear why there is a need for specialist staff. The APPG on Eating Disorders did a recent report on this, The Right to Health, which looked at why specialist eating disorder nurses are required. Those provisions are not in general mental health hospitals, or indeed in the general physical health hospital down the road. It is pretty clear to most people that you need specialist staff. What is probably not so clear, if you are not familiar with eating disorders, is that the physical constraints of a general mental health facility are not appropriate or optimal for people with eating disorders. If you have a severe eating disorder, you need feeding six times a day. People who are very anxious about eating will need to be supervised, one to one, in a calm environment. That is not what you get in a general mental health facility. Those people will then need to be supervised, one to one, for a period after meals, to help them to keep that food, again in a calm and spacious environment where they can be managed one to one. Those individuals will all have diets, weekly prepared especially for them, which will require a specialist canteen. Not only will you need staff to facilitate the provisions of those meals but you will need an area where people with eating disorders can be helped over a period of weeks to refamiliarise themselves with preparing food and to not be anxious about touching or preparing food—so you will need a second kitchen. The provisions in a general mental health facility are not optimal for people with specialist eating disorders. The legislation as it stands asks ICBs to focus only on general mental health facilities. I am not making the case that eating disorder sufferers are somehow special—please do not think that. I am just making the case that they are different. For too long, they have not had a focus on their needs, which is why we have so few eating disorder beds in this country at the moment. This is probably a very poor attempt, but it is my attempt to ensure that ICBs are given a gentle nudge by the Government to do what I think the Government want to do—which is to treat the majority of people with eating disorders in the community but, for those who require beds, ICBs must at the appropriate time ensure that there are such beds. We must not rely on general mental health facilities, which will not produce the outcomes that we need. I beg to move.