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. You can read more about this in our annual statement Growing problems: What has been the impact of Covid-19 on health care for children and young people in England?
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. Between Q1 2020/21 and Q3 2021/22, there was a 98% increase in patients starting urgent treatment, from 328 to 629, and a 45% increase in patients starting routine treatment, from 1,347 to 2,460 (data not shown). In Q3 2021/22 (October to December 2021), only 59% of urgent cases started treatment within one week. For routine cases, 65% started treatment within four weeks, a very small improvement on the previous quarter.
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 increased 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 noticeable increase in the number of children and young people with an eating disorder starting treatment. Between Q1 2020/21 and Q1 2021/22 routine cases starting treatment increased by 93%, from 1,347 to 2,600, and has remained higher than pre pandemic levels. In Q3 2021/22 alone, one third more patients started routine treatment than in Q1 and Q2 2016/17 combined. Similarly, urgent cases starting treatment more than doubled between Q1 2020/21 and Q1 2021/22, from 328 to 700.
What is striking is the continual increase in children and young people waiting for treatment since the start of the Covid-19 pandemic. From Q1 2020/22 to Q3 2021/22, waiting lists more than trebled for routine treatment and were more than two times higher for urgent treatment.
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.
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.
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.