4. What steps will the Welsh Government take to ensure that all eating disorder services are equipped to provide early intervention? OQ57288

We continue to prioritise support for eating disorder services in Wales and we've been increasing our investment each year since 2017. This funding aims to support the transformation of services towards early intervention, in line with the recommendations in the 2018 independent review.

Thank you, Deputy Minister. As you rightly point out, you did set out an ambitious vision for a world-class service in every part of Wales in the 2018 review and strategy. This called for a shift towards prevention and assertive early intervention and for access to evidence-based treatment and support being available equitably. Staff in eating disorder services are now under even greater pressure than before, due to the level of demand for treatment. Will the Welsh Government publish a new service model or framework, including timescales, to guide health boards in their response to the eating disorder service review? And will it ensure that there is an appropriate central resource in place to support this work?

Can I thank Heledd Fychan for that question? As I believe she's aware, health boards now receive, since 2017, an extra £3.8 million to support improvements in ED services and waiting times, and since 2019 funding has been provided to health boards specifically to reconfigure services towards early intervention to work towards achieving the National Institute for Health and Care Excellence standards on eating disorders within two years, and to develop plans to achieve a four-week waiting time across adult and children's services, as recommended in the review. We've also provided an additional £100,000 to the eating disorder charity Beat as a direct result of the pressures seen during the pandemic, which she has highlighted herself in her supplementary question.

Aside from the funding that we provided specifically for ED services, we're also improving primary care understanding through the dissemination of clinical resources for GPs, improving awareness within the paediatric community of the need for their skills and experience within eating disorder services, improving specialist knowledge on eating disorders amongst non-clinical staff, and including body image and relationship with food and body issues in the new well-being curriculum and the whole-school approach. We'll continue to use our whole-system approach across Government to build in early intervention support for young people, including at their schools and colleges.

Evidence shows that the impact of COVID on those living with eating disorders was very significant, and throughout the pandemic Welsh Government has released funding with flexibility to manage the increased demand within the eating disorder service. We know, of course, there will be more work to do, and she will be aware that there is an implementation lead in place who has been driving that change across Wales. 

Deputy Minister, social media's impacting young people massively, and apps such as Instagram are affecting the way that people view their bodies. For some young people they take inspiration from what they see online, but for many others the reality is that, due to a huge number of factors, including genetics, work-life balance and affordability, they will just not look like people do on social media and the way society expects them to. Subsequently, we've seen a rise in the number of people treated for anorexia and bulimia, and it's almost doubled in the last five years. Here in Wales, we don't have waiting time targets for those suffering with eating disorders or specialist centres to help people, and that cannot continue. So, what is the Welsh Government doing to ensure that young people are educated about the effects of social media? And what plans does the Government have to improve access for people suffering with eating disorders?

Thank you for that question, James. I think I've already set out the very significant investment we are putting into eating disorder services to transform those across Wales, with a very strong focus on early intervention. We are investing £3.8 million extra every year, and that has continued since 2017. It has been a really challenging time, because we did see during the pandemic an increase not just in the numbers of people suffering from eating disorders, but also an increase in the acuity of people at the time that they presented for support. That has been really challenging, and that's why our focus is on ensuring that, across the board, we've got that range of services from primary care up, including the eating disorder service provided by the charity Beat, which offers a range of really excellent online and telephone support for people with eating disorders and their families to try and make sure that there is support there across the board.

The issue that you've raised in relation to social media is really challenging, and I think one that we all recognise. I think it's vital, really, that through our whole-school approach we work with young people to make sure that they do understand that what they see on social media is not necessarily something that is going to be achievable for most of us. It's also really important that we, through the work in schools and the other work we're doing through the Nest framework, make sure that there is early help, and also encourage people to seek help. But the challenges with social media are real, they're large and, of course, they go well beyond Wales and include—. You know, I hope that you'll make some of those arguments to the UK Government on the work that they are doing to try and tackle some of the harms because of social media.

People on social media do not look like the people on social media in terms of their photograph. Many have been Photoshopped and many have used filters to make themselves look an awful lot better. Can I just say that eating disorders, like all other mental health services, are under increasing pressures? It has been reported that eating disorder services across Wales are experiencing unprecedented demand in referrals. So, the question that I've got is: when will we see the full implementation of the Welsh eating disorder service review recommendations, including the allocation of sufficient staff training and an implementation plan?

Thank you for that supplementary, Mike. We were clear when the Tan review was published that the changes wouldn't happen overnight, given the range and the breadth of the recommendations, and that's why we've continued to invest such a significant amount of funding in implementing the Tan recommendations year on year. As you've highlighted, the pressure that eating disorder services have seen as a result of the pandemic has created challenges with implementation. I'm very pleased that the increased demand in the latter part of 2020 now appears to have stabilised. However, we are continuing to monitor the situation closely, undertaking census days to quantify the volume and complexity of patients occupying a bed with eating disorders. 

In terms of the workforce issues that you've highlighted, recruiting to posts in eating disorder services is, unfortunately, a challenge felt across the UK. The eating disorder implementation lead confirms that all posts from 2020-21 funding were filled by the end of the financial year, but they were often slow to recruit to. As implementation lead, Dr Menna Jones has championed more creative solutions e.g. upskilling current staff to move the vacancy; lowering the structure, which may be easier to fill by less-skilled staff; and recruiting on a regional basis to ensure that an individual has a full-time contract, but across areas. This is, of course, not an issue that is confined to Wales; there are challenges recruiting for mental health across the UK, including in eating disorders. But, I'd just like to reassure the Member that the implementation of the Tan review remains a priority for me as Deputy Minister.