Background
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.
Hence, it is vital for children and young people with eating disorders, their families and carers, to 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.
During the coronavirus (Covid-19) pandemic, concerns were raised about an increase in the prevalence of eating disorders. In November 2020, NHS England announced plans to scale up an early intervention service for young people with an eating disorder to reduce waiting times and improve outcomes. To learn more, you can see our data story on the impact of Covid-19 on healthcare for children and young people.
In November 2020, NHS England announced it would expand an ‘early intervention service’ for eating disorder cases as part of an increase in investment, set out in the NHS Long Term Plan. In March 2023, Be Body Positive, a new online resource supporting children and young people experiencing disordered eating, was launched after a period of testing. This resource aims to provide digital access to early interventions not only for children and young people but also to the people around them. For more information, please visit Be Body Positive - Support for Young People, Parents, Carers & Professionals.
Children and young people’s access to treatment for eating disorders
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.
Between Q1 2016/17 and Q1 2020/21, the percentage of children and young people starting urgent treatment within one week of referral increased from 65% to 88%. The percentage of routine cases starting treatment within four weeks of referral also increased over this period, from 65% in Q1 2016/17 to a high of 90% in Q2 2020/21.
Since Q2 2020/21 the percentage of children and young people getting timely treatment for eating disorders has worsened; this comes alongside an increase in demand and service provision. From Q2 2021/22 onwards, there was an improvement in the percentage of those getting timely treatment, although it was still much lower than pre-pandemic levels. In Q4 2022/23 (January to March 2023), only 79% of urgent cases started treatment within one week. For routine cases, 83% started treatment within four weeks, a very small improvement on the previous quarter. Starting with Q1 2023/24, the performance of services for children and young people with eating disorders began to be assessed by the Mental Health Services Data Set (MHSDS). This change followed the discontinuation of the Strategic Data Collection Service (SDCS) collection at the end of March 2023. As a result, the data from the first quarter of 2023/24 and onwards cannot be directly compared with previous years. Q3 2023/24 saw 64% of urgent cases starting treatment within one week and 79% of routine cases starting treatment within four weeks.
Despite NHS England’s advice that the sooner someone with an eating disorder starts treatment, the better the outcome, the target that 95% of those referred should start treatment within one week in urgent cases and four weeks in routine cases by 2020 has not been met.
Before the pandemic, the number of children and young people starting treatment for eating disorders had been increasing steadily. Between Q1 2016/17 and Q4 2019/20, routine cases starting treatment doubled, from 915 to 1,850, and urgent cases rose by over a third.
Since the start of the Covid-19 pandemic, there has been a prominent increase in the number of children and young people with an eating disorder starting treatment. Between Q1 2020/21 and Q1 2021/22, the number of patients starting urgent treatment rose tremendously, from 328 to 852. This was accompanied by a rise in patients starting routine treatment, which went from 1,347 to 2,600. Between Q1 2021/22 and Q3 2022/23, the number of patients starting routine treatment remained at the same level, but patients starting urgent treatment decreased by 35%. In the same period, waiting lists more than trebled for routine treatment and more than doubled for urgent treatment. In Q4 2022/23, 2,497 patients started routine treatment and 553 started urgent treatment. From Q1 2023/24 to Q3 2023/24, although volumes of children and young people in treatment have increased, they have been far surpassed by children and young people who were waiting to start treatment, especially for routine cases. In Q3 2023/24, 2,345 routine cases had started treatment (5,278 were waiting) and 420 urgent cases had started treatment (1,001 were waiting). In response to the increase of children and young people seeking care, integrated care boards (ICBs) have planned to spend £96 million on eating disorder services, £13 million more than the previous year.
The increase in referrals during the Covid-19 pandemic may indicate a worsening of children and young people’s mental health. Additionally, many risk factors for eating disorders have been exacerbated during the pandemic, such as social isolation, loss of routine, and difficulties accessing face-to-face clinical appointments.
A&E attendances for an eating disorder diagnosis by age group
Between April 2019 and February 2020, the number of A&E attendances for an eating disorder wavered around 100 for individuals aged 0-18 years and at 70 for individuals aged 19 and above. The onset of the Covid-19 pandemic caused attendances for both age groups to dip slightly, before increasing sharply up until June 2021.
A&E attendances for an eating disorder more than doubled for individuals older than 19 years, from 62 in April 2019 to 133 in June 2021, and almost tripled for individuals aged 0-18 years from 105 to 282 for the same period. The worsening of mental health in children and young people and increased demand for treatment for eating disorders following the onset of the Covid-19 pandemic could explain the burgeoning number of A&E attendances for this condition.
Between June 2021 and December 2023, A&E attendances for an eating disorder decreased overall for both age groups. In December 2023, there were 162 attendances in individuals aged 0-18 years and 92 attendances for individuals aged 19 and above.
Between Q3 2019/20 and Q3 2021/22, the number of children and young people waiting to start treatment for an eating disorder following an urgent referral increased from 22 to 203 – a nine-fold increase.
In November 2020, NHS England announced it would expand an ‘early intervention service’ for eating disorder cases as part of an increase in investment, set out in the NHS Long Term Plan. Despite this ambition, more children and young people are waiting longer than before to receive urgent treatment. The number of patients waiting longer than 12 weeks to start urgent treatment increased to 73 in Q3 2021/22 – 36% of all patients still waiting to start treatment.
About this data
This indicator uses referral-to-treatment waiting time data for children and young people (aged up to 19 years old) 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. Due to small numbers being referred in some areas, suppression rules have been applied to the published data to mitigate risks of case disclosure.
The Children and Young People with Eating Disorders Collection was monitored by the Strategic Data Collection Service from March 2016 to March 2023. Starting in April 2023, the access and waiting time standard for Children and Young People with Eating Disorders has been reported using data from the Mental Health Services Monthly Statistics (NHS Digital) as the Strategic Data Collection Service (SDCS) collection and Young People with Eating Disorders (CYP ED) was retired at the end of the 2022/23 reporting period. MHSDS has a particular data quality issue around “stopping the clock” for patients who are transitioning between CYP and adult services. Therefore, it is thought that some of these referrals are still categorised as waiting for treatment. As a result, the data from the first quarter of 2023/24 and onwards cannot be directly compared with previous years.
Data from the two recent quarters, (Q2 2022/23 and Q3 2022/23), were imputted due to a cyber security incident. For more information, please see NHS England’s Children and Young People with an Eating Disorder Waiting Times.
The Emergency Care Data Set collects information about why people attend emergency departments and the treatment they receive. We receive this data at patient level, without patient identifiers, from NHS Digital under a data sharing agreement, and use it to construct a metric on the number of A&E attendances for an eating disorder. An A&E department attendance for an eating disorder in children and young people was defined as patients aged 0 to 18 who attended a Type 1, 2 or 3 A&E department and received a primary diagnosis for eating disorder and had a valid arrival and departure date and time. Adults were classified as those aged 19 and over.
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.