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.
During the coronavirus (Covid-19) pandemic, significant 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.
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 patients 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 time, from 65% in Q1 2016/17 to a high of 90% in Q2 2020/21.
However, for the past two quarters waiting times have worsened, alongside a large increase in the number of children and young people starting treatment and number still waiting to start treatment. In Q4 2020/21 (January to March 2021), only 71% of urgent cases started treatment within one week and 73% of routine cases started treatment within four weeks. The target that 95% of those referred should start treatment within one week in urgent cases and four weeks in routine cases by 2020 was not met.
In Q4 2020/21 (January to March 2021), 719 urgent cases and 2,421 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.
507 children and young people with an urgent referral started treatment within one week in Q4 2020/21, and 1,759 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 around 300. The number of routine referrals starting treatment has increased over time, 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 cases are identified.
Since the onset of the Covid-19 pandemic, the number of urgent and routine referrals starting treatment has increased sharply. In Q4 2020/21, 719 urgent referrals started treatment, more than double the number in Q4 2019/20. 2,421 routine referrals started treatment in Q4 2020/21, 31% higher than in Q4 2019/20.
Alongside this, the number of children and young people waiting to start treatment has increased. In Q4 2020/21, 130 urgent referrals were waiting to start treatment, seven times higher than in Q4 2019/20, and 1,404 routine referrals were waiting to start treatment, more than double the number in Q4 2019/20.
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.
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.
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.