Eating disorder services need to change, nursing experts warn

Nurse leaders have vowed to tackle failing eating disorder services in England, in the wake of the damning report from the health service ombudsman, which warns of widespread problems in eating disorder services.

Nurse leaders have vowed to tackle problems with eating disorder services in England, in the wake of the damning report from the health service ombudsman.


The Parliamentary and Health Service Ombudsman has criticised a lack of funding, training and eating disorder specialists, as well as inadequate care planning, assessment and coordination for people with eating disorders.

The ombudsman wrote: ‘We have seen in our casework, and in our discussions with system leaders and experts, the same problems of poor transitions, coordination and a lack of awareness replicated.

‘All of which contribute to an area of care that is at risk of failing its patients.

‘In the words of one eating disorder specialist we spoke to – “it is a miracle we don’t have more tragedies”.’

The ombudsman investigated the death of teenager Averil Hart – who had anorexia and was 19 when she died in 2012 – highlighting a series of failures involving every NHS organisation that should have cared for her.

The report concludes that Averil’s death could have been prevented if the NHS had provided appropriate care and treatment.

The investigation found missed opportunities and inadequate coordination and planning of Averil’s care during a vulnerable time in her life, when she was leaving home to go to university.

1.25 million

people in the UK are affected by eating disorders

(Source: research from charity Beat)

There were also failures in her care and treatment at two acute trusts when she became seriously ill.

Public apology

All the NHS organisations involved have apologised publicly and offered condolences to Averil’s family.

In several instances, the report highlights situations where patients with severe eating disorders were erroneously – and with tragic consequences – assessed by doctors as having capacity to make decisions about medical care and treatment.

It also flags up a lack of knowledge and experience among staff supporting people with eating disorders on admission to hospital.

Bill Kirkup, who led the ombudsman’s investigation into Averil’s death, says: ‘I hope this report will act as a wake-up call to the NHS and health leaders to make urgent improvements to services for eating disorders so we can avoid similar tragedies in the future.’

Action promised

England’s national mental health director, mental health nurse Claire Murdoch, has now pledged action to improve NHS eating disorder services.

In a letter from Ms Murdoch to the ombudsman, which Mental Health Practice has seen, she acknowledges the report ‘contains important lessons for the NHS’.

‘We are committed to taking action to address your specific recommendations and more generally to improving eating disorder services across England,’ Ms Murdoch writes.

‘I will write again shortly with further details and would be happy to meet to discuss the actions we are taking.’

3 1/2 years

The average length of time that passes between the symptoms of an eating disorder emerging and treatment starting

A spokesperson for Health Education England (HEE) confirmed the organisation is ‘working with the ombudsman and NHS partners to understand the workforce issues’ raised by Averil’s death.

The spokesperson said HEE ‘will seek to ensure action is taken by the appropriate body to address any agreed shortcomings that contributed to these service failings.

‘HEE is already working closely with NHS England and partners through its mental health workforce plan to ensure the service improvements, including to eating disorder services, outlined in the five year forward view for mental health are delivered.'

What does the nursing profession say?

RCN professional lead for mental health Catherine Gamble highlights the lack of nurses working in the eating disorder specialism, as well as a lack of training in eating disorders at pre-registration level.

Ms Gamble says: ‘Nurses play a vital role in eating disorder recovery, in primary care and as specialists in secondary care – but there are critical shortages of nurses in this highly specialised field.

‘Nurses in this area are already working with minimal resources and training.

‘For junior registered nurses, this specialism is often learned on the job rather than formally, as their pre-registration curriculum does not adequately cover this complex area.’

Ms Gamble says that shortages will continue until there is an emphasis on eating disorders skills in training and funding is given to develop an advanced practitioner role.


has the highest mortality rate of any psychiatric disorder, from medical complications associated with the illness as well as suicide

Action plan is needed

Dorset Healthcare University NHS Foundation Trust consultant nurse in eating disorders Ciarán Newell says all local areas should now develop an action plan of how they are going to address the issues raised in the ombudsman report.

Dr Newell says that, around the country, support for those with eating disorders is ‘patchy if not absent’.

‘It is crystal clear that eating disorders are serious illnesses,’ he emphasises. ‘They are mental health issues with marked, serious consequences – anorexia has the highest mortality rate of any psychiatric illness.

‘If this report brings about change in some of the resources available, and supports education and training of all professionals in the care of those with eating disorders, that would be a very good thing.’

The ombudsman’s report highlights five areas for improvement

  1. Training on eating disorders for all junior doctors to improve understanding of these complex mental health conditions.
  2. Health Education England should review how its current education and training can address the gaps in provision of eating disorder specialists.
  3. Adult eating disorder services achieving parity of provision with child and adolescent services.
  4. Better coordination of care between NHS organisations treating people with eating disorders.
  5. National support for local NHS organisations to conduct and learn from serious incident investigations, particularly in circumstances involving several organisations.


Crucially, Dr Newell believes more could be done to reduce or better manage transitions between services, given the increased risk for patients when moving into adult or to different services geographically.

‘Around 85% of eating disorders occur in the 10-30 age group, so these transitions are a major issue. There are statutory reasons for these boundaries, but no real strong clinical reason, and every carer you speak to talks with dread of the experience of going through them.’

Dr Newell runs a successful integrated eating disorder service which treats people of all ages and sees 95% of patients start treatment within four weeks of referral, or one day in emergency cases.

His team supports hospital staff when a patient with eating disorders is admitted to a ward, and runs a weekly clinic in the practice attached to nearby Bournemouth University.

With the right resources, training and focus afforded by the ombudsman’s report, other areas of the country could be able to follow suit and make the lasting changes needed to improve care for patients with eating disorders.

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