Nothing that anyone can say or do will bring Averil Hart back
Nothing that anyone can say or do will bring Averil Hart back. All her parents wanted was answers, but it has taken them years of tireless campaigning to get to the bottom of what really happened to her and who is to blame for her tragic death.
As reported yesterday, the 19-year-old student, who suffered from anorexia, was found unconscious on the floor of her university flat after she became so weak she couldn’t stand.
Only four months previously she had been discharged from hospital, but her case was not followed up properly and her weight plummeted. A catalogue of failings from every NHS organisation involved in her care led to her death in 2012. The Parliamentary and Health Service Ombudsman has now said that these failings were symptomatic of wider NHS failings in the treatment of people with eating disorders and needed ‘urgent national attention’.
As a specialist in eating disorders, I completely agree. The way that those with eating disorders are treated in the NHS is nothing short of a scandal.
The problem is eating disorders are one of the last areas in mental health where people still feel at liberty to dismiss it as ‘all in the mind’.
These days, no one would dare say to someone with depression that they should ‘pull their socks up’, but I’ve heard doctors and nurses say to someone with anorexia that they should ‘just eat’, or to stop being so vain. It’s considered something that silly young girls do to get attention, driven by vanity and narcissism.
As reported yesterday, the 19-year-old student, who suffered from anorexia, was found unconscious on the floor of her university flat after she became so weak she couldn’t stand
This couldn’t be further from the truth. Anorexia is not about vanity: quite the opposite. Many of the patients feel profoundly disgusted by their bodies and feel they don’t deserve to eat.
For many, it’s not even about how they look; it’s about the sense of control and mastery they get from restricting their food intake.
The nature of an eating disorder means that many patients don’t want treatment or will avoid contact with services. We have to be very proactive — and this requires a lot of energy.
The condition also means many don’t see themselves as sick or don’t feel they’re deserving of treatment. Many have very low levels of self-esteem and entitlement, and it’s all too easy for this group of patients to be ignored and pushed to the margins. I’ve had patients told by GPs and doctors in A&E that they ‘didn’t look very anorexic’.
GPs will often not bother to do the blood tests I request to assess how damaged their organs are and to check that patients are not physically deteriorating.
The nature of an eating disorder means that many patients don’t want treatment or will avoid contact with services. We have to be very proactive — and this requires a lot of energy
Despite the high risk of heart attacks in this patient group, heart tracings are not done and scans are not ordered. GPs also dismiss the patients when they go to see them about physical health concerns — chest or abdominal pains, for example — attributing everything to the eating disorder.
Other mental health services, such as those dealing with depression, anxiety or personality disorder, are reluctant to get involved if the person has an eating disorder, even though we know that eating disorders often go hand in hand with these other mental health problems.
There is no doubt that the eating disorder service failed Averil. These services are in dire straits and I know Averil’s story is far from unique. This area of medicine is highly specialist, requiring a depth and breadth of knowledge — both psychiatric and medical — that few have.
The vast majority of doctors go through their entire training with no experience of eating disorder services — and this is true, too, even for many working in mental health. There are extraordinary levels of ignorance about the condition among medical professionals and, because of this, few people choose to specialise in it.
At the unit where I work, we have been searching for appropriately-qualified staff not just for months, but for years. They simply aren’t there.
There is no doubt that the eating disorder service failed Averil. These services are in dire straits and I know Averil’s story is far from unique. She is pictured with her father Nic
As a result, many services downgrade what they offer. There are no doctors, so instead they are run by psychologists and nurses, who are often very good and highly skilled, but lack the medical background needed to ensure that patients are physically safe. One in five people with an eating disorder dies from an eating disorder. It’s a shocking statistic that preys on my mind — and when I go to work a part of me dreads looking at my emails for fear that a patient has died.
The mortality rates are similar to brain tumours. Now imagine a service for patients with brain tumours being run without doctors. It would never happen.
And to compound the tragedy, we only know about Averil’s case because her parents fought tirelessly for answers, while some of the NHS organisations involved tried to hinder the investigation into their conduct.
Let’s not beat around the bush: Averil was allowed to starve to death. This is a total dereliction of duty for those whose job it was to save her.
It is a tragedy that it took her death for the shortcomings of services for eating disorder patients to be discussed, but also a tragedy that today there are patients out there who still won’t get the care they need.
Is the doner a gonna? Have kebabs had their chips? It seems the EU is proposing to ban phosphates — used to keep seasoned kebab meat moist — because they might raise the risk of heart disease. For goodness’ sake! What kind of life is it when we can’t have a few ‘bad’ indulgences every so often? The public health nannies treat us like children. Their only solution to any element of risk is to ban it. But there is much in life that is risky — and it’s up to us to decide what risks we’re happy to accept, not the EU.
I can’t stand heath hypocrites
When it comes to handing out lifestyle advice, I think health professionals must practise what they preach. But now a study has found that one in four nurses is obese, with nearly two-thirds of them overweight.
Why are so many so overweight? They’ve seen the heart attacks, the strokes, the diabetes and the leg amputations associated with obesity, so should know better.
It’s a clear example of denial — a psychological defence mechanism to resolve conflicts. You simply pretend it’s not happening.
When it comes to handing out lifestyle advice, I think health professionals must practise what they preach
I’m worried about the appalling example those overweight health- care professionals set others.
Yes, of course nurses and doctors are human and can’t be expected to have blemish-free lives. But when you’re a professional seeing patients, you have a duty to uphold basic principles of a healthy lifestyle. And if you can’t stick to the principles that you’re promoting, you have no business being on the front line. No patient is going to take you seriously.
You wouldn’t take advice about your drinking from an alcoholic, so why listen to an overweight professional telling you to shed a few pounds? Yet a once-obese nurse who has lost weight could be a real motivation for patients.
As a former smoker, I like to think that knowing I used to smoke helps my patients. It means I’ve done daft things, but I’ve changed — and so can they.
How to cure the crisis in the NHS
There have been warnings that the NHS is facing its worst winter ever, thanks to a combination of a particularly virulent flu virus, a sudden drop in temperature, chronic staff shortages and under-investment.
Some predict this could even be the tipping point for the NHS finally to keel over — and part of me wishes it would, because as someone who works on the front line, I know that it really can’t keep on like this.
In a desperate attempt to make resources stretch, we keep cutting services further and further, with the result that now, if I’m honest, the care we provide is all too often not adequate.
There have been warnings that the NHS is facing its worst winter ever, thanks to a combination of a particularly virulent flu virus, a sudden drop in temperature, chronic staff shortages and under-investment
It pains me to say this because I am a great advocate of the NHS. All the evidence shows it’s the fairest, most efficient and cost-effective way of delivering healthcare. Of course it could be better, but overall it’s pretty good.
Yet years of political meddling and under-investment have weakened it, and rather than see it limping and stumbling along, mortally wounded, I wish the inevitable end would come.
Then we would have no choice but to have a serious, sensible, national discussion about what we want our health service to look like, how we want it run and how much we’re willing to pay for it.
Until it collapses, no politician is going to tackle the subject because no one wants to court controversy. They’ll just keep on talking about improvement and efficiency, occasionally throwing some money in the vague direction of front-line services.
They’ll continue dodging the vital questions we should be debating now to enable us to plan things, rather than adopting crisis management when the crunch comes. The politicians know this is only a matter of time: they’re just hoping it doesn’t die on their watch.
We need an independent review of the NHS which hears from all those involved — politicians, staff and members of the public
The fact is that health and social care is expensive.
Earlier this year, the Office for Budget Responsibility warned that the NHS annual budget would need to increase by £88 billion to about £228 billion by 2066-67, in order to keep pace with the rising demand for healthcare.
So what do we do?
We need an independent review of the NHS which hears from all those involved — politicians, staff and members of the public.
The ideal forum would be a Royal Commission, as this is both independent of government and powerful. Such a review will require a considerable amount of debate and soul-searching. But without it, the NHS will flatline.