Agenda item

The Chairman invited the following Officers to the table:

·                     Chris Munday – Commissioning Director for Children and Young People and Statutory Director for Children’s Services

·                      Eamann Devlin – Children and Adolescent Mental Health Services Joint Commissioning Manager (interim), Barnet CCG

·                     Dr Mark Berelowitz, Lead Clinician for the Eating Disorder Service at the Royal Free London NHS Foundation Trust

·                     Dr Andrew Howe, Director of Public Health (Harrow and Barnet Councils)

·                     Ruth Ouzia, Senior Consultation Manager

The Chairman noted that the report had arisen as a result of a Member’s Item in the name of Councillor Amy Trevethan.  The Chairman commented that as Councillor Trevethan was particularly interested in this matter, she had been in touch with her following her resignation as a Councillor in order to put forward any questions on her behalf. 

Referring to the report, the Chairman noted that an allocation of £198,000 was made available to Barnet and that the decision was made to place £100,000 against development of the existing service, with the remainder being invested in Out of Hours and Crisis Care related works.  The Chairman questioned if the £100,000 was just going to crisis care, or if it would include self harm care as well.  Dr. Berelowitz informed the Committee that the £100,000 was being invested in order was to reduce waiting times. The remaining £98,000 would be used for out of hours and crisis care including suicide and self-harm.  Ms. Ruth Ouzia commented that extra recruitment was underway to appoint more specialist staff members to the existing team.

The Chairman noted that the report stated that: “As part of the Transformation Plan Barnet will roll out training for all eating disorder staff as part of the “Improving access to Psychological Therapies for children” (CYP-IAPT), provide outreach education training for eating disorders and provide telephone support for General Practitioners.”  The Chairman questioned who was included in the outreach education and whether GPs could access the telephone support line during as well as after a consultation.  Mr. Devlin informed the Committee that feedback had been obtained from many Headteachers to the effect that teachers often found it hard to have conversations with pupils or even identify the signs and symptoms of eating disorders.  The Committee noted that a training session had recently been held  so that staff would know what to do if they were worried about a child.  The Committee also noted that GPs could access the telephone line either during a consultation of afterwards. 

Mr. Devlin informed the Committee that there is less stigma than there used to be about eating disorders although stigma is a much bigger issue for boys than girls. 

The Committee noted that The Royal Free London CAMHS eating disorder service covered the five North Central London Boroughs plus the London Borough of Brent.  The Committee noted that Brent did not commission the Royal Free Hospital’s “intensive service” but they buy-in when they need to. 

The Committee commented that the Psychiatry reviews that were being undertaken by service being very positive. 

Referring to the report, the Chairman noted that a study by King’s College London and the UCL Institute of Child Health in 2011 had showna 60 per cent increase in females with the types of eating disorders known as Eating Disorders Not Otherwise Specified (EDNOS), and a 24 per cent increase in males.  The Chairman questioned if EDNOS would be taken as seriously from a treatment point of view and if it could be a stepping stone to anorexia, bulimia or binge eating.  The Chairman further questioned if patients would only get treatment when fully diagnosed with one of the three disorders mentioned above.  Dr. Berelowitz informed the Committee that the term EDNOS would be applied to someone who doesn’t meet all the criteria of other eating disorders.  The Committee noted that EDNOS could be a misleading term and it didn’t mean that the condition was less severe.  Dr. Berelowitz informed the Committee that a patient would not be denied treatment because they did not have all of the symptoms of anorexia, bulimia and binge eating. 

The Chairman noted that most patients wait over a year from first symptoms before seeking treatment and questioned how best to reach these people.  Dr. Berelowitz informed the Committee of the importance of ensuring that schools, GPs, youth groups and other such organisations are as aware of the issue as they can be.  Dr. Berelowitz commented on the importance of ensuring that primary care providers in particular are aware of the risks.  Dr. Berelowitz also informed the Committee that eating disorders were often perceived as a more predominately female illness.  The Committee noted that because boys do not menstruate, it could be harder to tell the difference between Orthorexia and Anorexia in males. 

Referring to the report, a Member commented on the higher rate of referrals to the eating disorders service in Barnet compared with Camden.  Dr. Berelowitz informed the Committee that there were more than twice as many young people in Barnet as in Camden, which would account for the higher figure.  Dr. Berelowitz also noted that the higher rate of referrals in Barnet could also reflect better education and detection. 

A Member questioned if it would be possible to do further work to see if the high number of Barnet patients being referred to the eating disorder service was not only due to Barnet’s greater population, but also good diagnosis and early detection.  Dr. Berelowitz informed the Committee that a study could be done, but that it would not be worth doing unless it was to a very high standard and that such a study would be very expensive.  The Committee noted that the Eating Disorders Service would not be able to fund it from their own treatment resources. 

The Chairman noted that the report stated that a depressed mood is often a common feature of an eating disorder and questioned if a GP would consider this diagnosis if a young person presented with depression.  Dr. Berelowitz commented that diagnosis in such circumstances was difficult because there would be so much else to rule out.  He also commented on the need to ensure good education concerning dietary issues at primary care level. 

A Member questioned if people are being sent out of the Borough for treatment if there is not a bed available locally.  Dr. Berelowitz said that it was hard to say what the exact capacity for treatment was in Barnet, because NHS England requires that every bed for eating disorders is open to every person in the country, so a Barnet calculation cannot be done.  He believed that there were 400 adolescent beds in England.  Dr. Berelowitz commented that the number of patients being sent out of Borough per year had been no more than five patients from all the five NCL Boroughs combined.  He stressed that it was most important to keep them in school as much as possible. 

A Member commented that the fact that Barnet has a higher rate of referrals than other Boroughs could indicate that other Boroughs should have higher referral rates.  The Member questioned if the service was content that Barnet schools have the right policies in place to spot the warning signs of an eating disorder and to make a referral. Mr. Munday referred to the CAMHS transformation plan and noted that work with schools was planned to help schools understand how good their policies are.  Mr. Munday noted that many school are academies and so will have their own policies.  Mr. Munday further commented that he would be very happy to work with Dr. Berelowitz and colleagues in Education and Skills in order to progress the issue. 

Responding to a question from a Member, Dr. Berelowitz informed the Committee that some schools are better at calling the service when they have an issue of concern and stressed the importance of the service making a link with every school in the Borough. 

The Chairman sought the Committee’s support to receive a future report on the issue of eating disorders.  The Committee supported this.

RESOLVED that:

1.    The Committee notes the report

2.    The Committee requests to be provided with an additional report on eating disorders at a future meeting.