NHS England sending anorexic patients to Scotland for treatment

The NHS in England is sending patients who are seriously ill with eating disorders to Scotland for treatment because chronic bed shortages mean they cannot be cared for in England.

Vulnerable patients, mainly teenagers and young adults, are being taken hundreds of miles from their homes in order to receive residential care in Glasgow and near Edinburgh.

Mental health experts voiced deep concern about the trend and said it could damage patients’ chances of recovery, increase their sense of isolation through the separation from their families and even increase their risk of dying.

Doctors, eating disorders charities and patients have told the Guardian that the quality of care received by patients, some of whom are at risk of dying, is being compromised by the NHS in England having far too few beds to cope with the growing number of cases of anorexia, bulimia and other forms of psychiatric illness linked to eating habits.

“I’ve seen a rise in calls from people saying their children have been sent far away, miles away, to be looked after because there are either no services nearby or they are full”, said Jane Smith, chief executive of Anorexia and Bulimia Care. “This is a life-threatening situation for young people. People are in inpatient care because they are at risk of dying. They are in a very fragile, risky state.”

Rebecca Doidge, 20, from St Albans in Hertfordshire, spent six months in the Priory private hospital in Glasgow earlier this year because she was desperate for treatment and could not find anywhere else. The distance had negative side-effects, she said.

Despite being well looked after there, “being sent so far away does compromise care”, she said. “The outcomes are going to be better if you can stay near home. It’s really hard to integrate back home or go to another environment when discharged if you are in a different country. It makes communication between those treating you in hospital and those at home difficult.”

During her stay in the Priory, which has 25-30 beds, “about seven of the people there were from Hertfordshire,” she said. “The number of English people there massively outnumbered Scots.”

Anup Vyas’s stepdaughter has been receiving treatment for a rare eating disorder in Huntercombe private hospital in Livingston, near Edinburgh, since February. After previous stints in units in Watford, London and Colchester in Essex, the 17-year-old’s condition is so serious that “now she is basically being kept alive in Scotland”, said Vyas.

“NHS England acknowledge that her being so far away is not ideal. Her brothers haven’t visited her since June and no friends have gone up. Most people in the unit are from England, especially the north of England – places like York and Manchester.” The family’s home is in Hemel Hempstead, 350 miles from Livingston.

The health secretary, Jeremy Hunt, criticised the practice as “completely unacceptable”. He recently said NHS children and adolescent mental health services were the NHS’s worst area of care.

“It is clearly unacceptable for people to be sent hundreds of miles away for care at a time when they need the support of friends and family the most”, he said. “That’s why in April we committed to a national ambition to eliminate inappropriate out-of-area placements by 2020-21.” Ministers had also earmarked £150m for enhanced services in community settings to help ensure that mental health problems in young people were tackled before their health worsens, he said.

NHS England, despite its professed commitment to openness, refused to say how many patients from England were receiving treatment for eating disorders in Scotland. Expanding the supply of specialist beds to treat people with those conditions would take time, it said.

“It’s extremely distressing for parents to have a child who is so unwell that they require inpatient care, and it’s even worse when they can’t easily visit their child because of long travel distances”, said Sarah Brennan, chief executive of Young Minds. “For many young people the distance from family and friends is one of their biggest fears when they are hospitalised. Being separated from loved ones doesn’t help with recovery and makes the stress of hospitalisation worse.”

Dr Jon Goldin, a consultant psychiatrist in London specialising in children and adolescents, said he had heard of patients being moved long distances. “But it shouldn’t be happening,” he said. “It’s a concern. Patients should be treated nearby and should be in contact with family. They need support and it’s much harder to get that when families have to travel long distances.

“Part of their recovery may involve therapy with their family, especially for children aged 14 and under.”, said Goldin, who is also a spokesman for the Royal College of Psychiatrists.

More young people were developing eating disorders, he said. Genetic factors, personality factors and socio-cultural factors, such as images in the media of models “which glamorise thinness” are among the many reasons for the trend, Goldin said.

A spokeswoman for the Priory hospital in Glasgow said it took patients from all over the UK. “The Priory hospital in Glasgow has a reputation for providing some of the highest standards of mental healthcare in the country, and has been given a ‘very good’ rating by our regulator, Healthcare Improvement Scotland, for staffing, management, information to patients, and the environment it offers those we care for. As such, we support patients from across the UK and overseas.”

A spokeswoman for NHS England said: “The NHS recently laid out very clear plans to expand staff and services for specialist eating disorders and other mental health problems, in order to tackle and eliminate distant out-of-area placements. Transformation won’t happen overnight but work is under way to improve services for everyone and to make sure care is available at home or as close to home as possible when a patient needs more intensive therapy.

“To help achieve this, the government has allocated a cumulative £1.4bn to children and young people’s mental health services over the next five years, and the new waiting time for eating disorder patients will ensure patients get better care more quickly.”

NHS England sending anorexic patients to Scotland for treatment

Sending fat smokers to the back of the queue is a betrayal of NHS values| Polly Toynbee

The Vale of York has been granted permission this week by NHS England to put fat people and smokers to the back of the queue for operations. Starting in January, their treatments will be delayed a year; the obese must lose 10% of their body weight, and smokers give up for at least two months.

The Royal College of Surgeons says it is “very disappointed that NHS England and No 10 seem to be backing this arbitrary policy”.

It’s always good advice to live healthily, but this crosses a new red line. The clinical commissioning group (CCG), which buys services for people in York and Selby, is the first to be given official permission, agreed by Downing Street, to discriminate against particular patients – something forbidden in the (non-justiciable) NHS constitution. But the CCG is in trouble, in July judged “inadequate” and put into special measures and prescribed a “financial turnaround” for its debts.

Rationing will always be a part of the NHS social contract. Every system in the world rations: just look at the strict limits in US health insurance policies. There never was, or can ever be, an instant, ever-open door – however much politicians pretend, with their impossible seven-day pledges on no extra money, that there can be. But the UK system is judged one of the most efficient in the world, getting the biggest bang for its modest bucks, spending less than similar countries.

The key is its unique gatekeeping GPs who dispense the great bulk of treatment, while the National Institute for Health and Care Excellence (Nice), devised by the last Labour government, judges which drugs and treatments are good enough value for money for the NHS. The rule of thumb is to spend up to £30,000 for an extra year of good quality life.

Right from 1948, when the NHS was first set up, waiting lists were the traditional rationing mechanism. When governments tightened spending, waiting times grew, which was good for surgeons’ private practice.

For the first time in history, the last Labour government all but abolished waiting lists, something seasoned NHS experts never thought possible. With a spending increase of 7% a year, new targets saw waiting times drop from sometimes two years to just 18 weeks maximum, and two weeks for suspected cancers. Surgeons’ incomes plummeted, as did payments for private healthcare.

But in the present crisis, rationing is tightening everywhere. You get only one cataract fixed where CCGs think one eye is enough. The list of treatments being struck off is lengthening, and the postcode lottery of what your CCG pays for produces injustices.

I reported recently on a podiatry clinic treating severe diabetics that can give some patients a cast that cures ulcers in eight weeks. Those in other CCG areas get a cheaper bandage, which means healing takes 52 weeks. In the past, old people were often denied many life-enhancing treatments. All such rationing may be unfair, but at least it was never personal.

The abiding principle was that the NHS treated people in order of medical need, according to resources available. Minor complaints went to the back of the queue. Urgent cases were treated first, followed by those people likely to be rendered wheelchair-bound and needing social care if they did not get surgery on hips or knees – as will many of these obese patients.

The system was blind to everything but medical priority, a founding NHS principle that treated viscount and vagrant according to urgency, priest and sinner in next-door beds regardless of rank or virtue.

But once a patient’s personal failings can be taken into account, where does that lead? More people on low incomes are obese and smoke, and therefore already suffer worse health. This is for a host of psychosocial reasons, including the sheer stress and hardship of being at the bottom. (See Michael Marmot’s work, or the irrefutable evidence from Richard Wilkinson and Kate Pickett, authors of The Spirit Level, on the link between low status and poor physical and mental health.)

The poor often get worse NHS treatment, having less sharp elbows, and living in areas where the best doctors are harder to recruit. Undoubtedly most will have tried to lose weight and quit smoking, but public health budgets for obesity and smoking programmes have been cut, and are set to shrink again. This blaming of the individual conveniently shuts out social context. Don’t they have free will, these people? Politically, they will be easy to cast to the back of the queue, shamed into silence for their fatness and addiction. They will make much less fuss than local campaigners against any closures to hospital units.

This opens up new horizons: how much easier rationing becomes when we can blame the patients. Hey presto, waiting lists can be pared right down, targets hit, leaving only the virtuous on the lists.

But who are they? Let’s weed out anyone in any way responsible for the burden they put on the NHS. Away with the boy racers smashing themselves up with their first motorbikes and cars. Out with the extreme sports addicts – the climbers, potholers, boxers, base jumpers paragliders, skiers and F1 drivers, who get their adrenaline kicks at the NHS’s expense. Forget all sports injures.

Away with my own age group, too: drinking too much wine of an evening, slowly corroding our livers: a host of cancers are caused by drink and diet. And what about people bitten by their own horrible, fierce dogs? Or idiots tripping over while texting on smartphones?

As Hamlet said, use every man after his desert (or perhaps desserts) and who shall ‘scape whipping? Until now, in the NHS, the service may have creaked under the strains of the worst funding crisis in its history, but the quality of mercy was not strained. That has been the NHS’s great moral strength, as with the Red Cross or Médecins Sans Frontières, or indeed the Hippocratic oath itself. In treating the sick, let there be no discrimination over their moral worth.

Sending fat smokers to the back of the queue is a betrayal of NHS values| Polly Toynbee