Eating disorders such as anorexia nervosa and bulimia nervosa are serious mental health problems. They can have severe psychological, physical and social consequences. Children and young people with an eating disorder often have other mental health problems (for example, anxiety or depression) which also need to be treated in order to get the best outcomes.
It is vital that children and young people with eating disorders, and their families and carers, can access evidence-based, high quality care as quickly as possible. This can improve recovery rates, lead to fewer relapses and reduce the need for hospital admissions.
The Access and Waiting Time Standard for Children and Young People with an Eating Disorder was published in 2015, and applies to children and young people up to the age of 19. The standard states that by 2020, 95% of those referred for assessment or treatment for an eating disorder should receive NICE-approved treatment within one week in urgent cases, and four weeks in routine/non-urgent cases. The ability of services to meet this standard has been monitored since 2016.
The percentage of patients starting urgent treatment within one week of referral increased from 65% in Q1 2016/17 to 85% in Q2 2020/21. Between Q1 2016/17 and Q2 2020/21, the percentage of routine cases starting treatment within four weeks of referral increased from 65% to 90%. Despite this improvement, waiting times for children and young people with an eating disorder need to improve further if the 95% target is to be met.
In Q2 2020/21 (July to September 2020), 625 urgent cases and 2,001 routine cases started treatment for an eating disorder. Children and young people are designated as being an urgent or routine/non-urgent case based on a clinical decision that is received and recorded on local IT systems.
533 children and young people with an urgent referral started treatment within one week in Q2 2020/21, and 1,792 patients with a routine referral started treatment within four weeks. However, some patients who started treatment had been waiting longer than 12 weeks since referral.
Between Q1 2016/17 and Q1 2020/21, the number of children and young people starting treatment each quarter following an urgent referral fluctuated at around 300. In Q2 2020/21 (July to September 2020), the number of urgent referrals starting treatment increased to 625, almost double the number starting treatment in Q2 2019/20.
The number of routine referrals starting treatment increased from 915 in Q1 2016/17 to 1,850 in Q4 2019/20. This may reflect an increase in the prevalence of eating disorders among children and young people, or improved awareness of eating disorders meaning that more routine referrals are made. In Q1 2020/21 (April to June 2020), after the Covid-19 pandemic began, the number of routine referrals starting treatment fell slightly to 1,347. It then increased to 2,001 in Q2 2020/21 (July to September 2020), 38% higher than in Q2 2019/20.
The increase in urgent and routine referrals starting treatment in Q2 2020/21 may indicate a worsening of children and young people’s mental health during the Covid-19 pandemic. Alternatively, lockdown measures may have caused more eating disorders to be recognised, leading to increased numbers of children and young people seeking help.
About this data
This indicator uses referral-to-treatment waiting time data for children and young people with an eating disorder. Their wait ends during the quarter that NICE-approved treatment was started. The referral is classified as urgent or routine by the community eating disorder service, based on the level of risk that the child or young person is thought to be exposed to. This may include physical risk, psychiatric risk, safeguarding or other areas of risk. The data covers children and young people aged up to 19 years old. Due to small numbers being referred in some areas, suppression rules have been applied to the published data to mitigate risks of case disclosure.
For more information, please see the Access and Waiting Time Standard for Children and Young People with an Eating Disorder and NHS England's Guidance and Risk of Disclosure documents.