A.N.T.S.
Adequate Nationwide Treatment for Sufferers
of Eating Disorders
Provision of Treatment For Eating Disorders Proposal
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What is Required?
Factors Affecting Solutions
Options
Proposal
Requirements
Rationale
Funding
Conclusion
Please click here for a map (110Kb) showing the local NHS Trusts. Reproduced without permission.
The provision of treatment for eating disorders is the responsibility of the Avon & Wiltshire Mental Health Partnership NHS Trust (AWMHPT). The area the Trust serves has a population of some 1,630,000 of which there would, typically, be some 16,300 eating disorder sufferers. North Somerset has a population of about 75,000, of which some 750 would suffer from an eating disorder.
The STEPS Eating Disorders Service, based at Southmead Hospital in Bristol, provides current specialist facilities. STEPS have facilities for 4 in-patients and about 10 day-patients. Of the four Community Psychiatric Nurses (CPN’s) at STEPS, one has responsibility for the co-ordination of the unit; the other three have a designated area of responsibility for care in the community. The areas are South Gloucester, Bath & North East Somerset and North Somerset. The Bristol area does not have a designated CPN, so is managed by the three CPN’s in addition to their duties at STEPS.
The Community Health Team, enhanced by the designated CPN, administers care in the Community.
The current system of treatment is inadequate, ineffective and financially wasteful. Having been fortunate enough, or so severely ill enough, to secure in-patient treatment, the required level of support can sometimes be available. Once the 'required' level is attained, in-patients then become day patients or are discharged to care in the community. It is at this point that the major breakdown occurs and effects anorexics in particular but not exclusively. The level of support is not available to maintain progress or enable the patient to continue to recovery. This is not the fault of the staff 'on the ground' who are committed, resourceful and professional. They are under-funded, under-staffed and overworked.
The recent report from the Eating Disorders Association, 'The Hidden Costs of Eating Disorders', gives the cost of a basic twelve weeks NHS treatment as £25,000, rising to as much as £53,000 if private treatment facilities are used. Unless adequate support is provided the public funds expended are totally wasted. In addition, the patient, carers and others have been given false hope. The consequential damage, both physical and psychological, is enormous and will increase the future costs of the inevitable treatment needed at a later date. It is not surprising that, at 20% or one in every five, this condition has the highest mortality rate of all psychological disorders.
The AWMHPT have publicly admitted that the service is inadequate and blames the severe lack of funding for the situation. This being the case, a number of initiatives are required to address the problem and it is essential that there is the minimal delay in their implementation. The normal timescale of arranging meetings, consultations and prolonged decision-making is unacceptable. These problems have been known about for a considerable number of years without being addressed and it is inevitable that there will be those who have died because of that. It is time to fast track the solutions.
In the absence of any significant funding, the cost effective solution for North Somerset will need to have a substantial self-help, voluntary input.
Currently there is no voluntary group supporting eating disorders in North Somerset. The choice is to either form such a group or seek the support of an existing group that is close by. The latter is the obvious choice as this would be the most cost effective solution and would offer an almost immediate impact on the current situation.
There is a group, Somerset Eating Disorders Association (SEDA), which was formed in 1992 and covers the whole of the area now known as Somerset. There are historical links, pre political boundary changes, which make SEDA the prime choice. For more information about SEDA, its history, constitution, development and current services please refer to their website at http://web.ukonline.co.uk/seda/aboutseda.htm.
They have also formed what I believe to be an almost unique working relationship and funding partnership with the Somerset Partnership NHS & Social Care Trust. SEDA is already soundly managed and in a position to meet the challenges that expansion into North Somerset would bring.
North Somerset’s eating disorder sufferers would benefit from SEDA’s many years of accumulated experience, the range of essential services they offer which currently are not provided and the ability to access them in the minimum possible timeframe. These are services that would otherwise take many years to provide and without which the human suffering and economic wastage of the past would continue.
Those partners who funded such an initiative would receive an exceedingly cost effective solution to a problem that has existed for many, many years without resolve. The solution would provide the maximum benefit to both sufferers and funding providers, who would also benefit from the need for minimal effort or disruption to present services. I am certain that there would also be economies to be reaped from a lower demand on current service provision, thus enabling overstretched resources to be more strategically targeted.
Having opened preliminary enquiries with SEDA, I can confirm that SEDA would be more than willing to extend their services to include North Somerset if the issue of sustainable funding and logistical support, e.g. accommodation, can be agreed. The funding would need to be a minimum of three years with a view to continuation thereafter. To provide services for a year and then close because of lack of funding would raise the expectations of all service users, only to emulate the current situation. This is contrary to the ethos and principles of SEDA, with which I whole-heartedly agree.
That it be agreed that SEDA should be approached officially with the intention of securing their expansion into North Somerset to provide support services to eating disorder sufferers in accordance with SEDA’s published Constitution.
That it be further agreed that these negotiations be given priority status to enable them to be completed within three months; that is, by the end of May 2003 at the latest.
Guaranteed funding, at a level of £75,000 per annum, for three years on a rolling basis. The funding would enable the employment of a number of suitably qualified staff to manage the project, recruit and train additional volunteers to enhance the established volunteer base and deliver the services.
The funding would also secure accommodation, volunteers’ expenses, initial and ongoing training costs and miscellaneous running costs.
The costs are below the recommendations made by The Royal College of Psychiatrists, who, in their report “CR87. Eating Disorders in the UK: Policies for Service Development & Training” say, “Expenditure on staffing should be approximately £1 per head of population”. Website http://www.rcpsych.ac.uk/publications/cr/cr87.htm refers.
With a population of about 75,000, the funding represents £1 per annum or 1.932 pence per week, per head of population. With some 750 eating disorder sufferers in North Somerset, the funding is £100 per annum or £1.923 per week, per sufferer. If one compares this sum with the £25,000 for NHS or up to £53,000 for private care, for twelve weeks basic treatment for one patient, that will have to be repeated at regular intervals, the cost effectiveness and value for money is obvious.
The obvious funding partners would be AWMHPT and North Somerset Council, Social Services Department. There may be other statutory bodies that would fund such an initiative. North Somerset Council may have information on such sources.
It may be possible to secure some funding from other sources such as SRB or ESF etc. Charitable organisations may fund some of the initial set-up costs and the South West Learning and Skills Council may be a source for training costs.
As the most cost effective proposal, able to provide the solution to a major crisis that is a barrier that prevents people living a full, satisfying and contributing life in the community, this incentive should be implemented without delay. Those with the responsibility and the authority to adopt the proposal should use all means at their disposal to ensure it meets the May 2003 target date.
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put simply, save the life of someone they love."
Brian Cotter MP, Liberal Democrat Member of Parliament for Weston-super-Mare 1997-2005.
