RCPsych raises concerns over planned spending cuts to children’s eating disorder services as referrals rise

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The Royal College of Psychiatrists (RCPsych) has identified plans that would result in funding cuts for children and young people’s eating disorder services in more than half of areas across England. 

RCPsych’s analysis found that 24 out of 42 Integrated Care Boards (ICBs)¹, which are responsible for planning and commissioning health services in local areas, have planned changes that, if enacted, would result in real terms spending cuts totalling more than £835,000 for these services in the current financial year (April 2024 to March 2025).² The reductions in funding range from £3,000 to £112,000 across individual ICBs.  

The planned spending cuts come amid a backdrop of children and young people’s eating disorder services seeing: 

• A 13% increase in referrals (from 7,008 to 7,933) in the last 12 months;³  
• High thresholds to access services results in more young people being in crisis;  
• 787 urgent and 5,310 routine referrals still waiting for treatment at the end of December 2024;⁴  
• 81% of urgent referrals being seen within a week, and 82% of routine referrals within four weeks, far from the 95% NHS England target which has never been met across England as a whole;⁵ 
• A 30% true vacancy rate for all eating disorder consultant psychiatrist positions across England as of March 2023.⁶  

Eating disorders have among the highest rates of mortality of any mental disorder yet are treatable. Eating disorder services are having to prioritise the most unwell children and young people due to rising demand, staff shortages and a lack of resources. There are young people who meet the threshold for specialist eating disorder services yet are having to wait too long for care. As a result, they can become more ill while their treatment is delayed and are increasingly in crisis before they access care.  

Every child with an eating disorder can be treated effectively if seen early enough.  

The RCPsych is calling for the creation of a national strategy for eating disorders in England. This must ensure that services are sufficiently funded to improve the care that children and young people, as well as adults, receive and address the significant challenges facing eating disorder consultant psychiatrists and the wider eating disorders workforce.  

Dr Ashish Kumar, Chair of the Royal College of Psychiatrists’  Faculty of Eating Disorders Psychiatry, said: 

“Eating disorders, in particular anorexia nervosa, have high rates of mortality, yet are treatable conditions and with the right care and support in a timely manner most patients can make a full recovery. However, if these planned cuts come to fruition, it would result in the NHS cutting funding for these vital services in many areas across England.  

“There is a significant gap between the children and young people in need of care and those who can access treatment, with many awaiting suitable treatment, and this will only get worse unless we take urgent action to address this crisis.  

“We need a national eating disorders strategy that prioritises the recruitment and retention of the mental health workforce. This must be backed by adequate funding so that services have the resources they need to deliver the care our children and young people deserve.  

“We also need more research into eating disorders to improve care. The dedicated funding for children’s eating disorder services as planned by NHSE must reach frontline services so that vulnerable young people receive the best and timely care.”  

Footnotes

1. Integrated Care Boards (ICBs) are partnership organisations that bring together NHS organisations, local authorities, and voluntary, community and social enterprise organisations in a given region to collectively plan, fund, and deliver healthcare services and produce joined up health and care strategies for their region. Their aim is to localise care: as the NHS devolves power downwards to these regional partnerships, ICBs gain further commissioning responsibilities. They were officially formed in 2022 with the passing of the Health and Care Act. There are 42 ICBs in England. 
2. The 2024/25 planned spend for children and young people’s eating disorder services in England is £101.0 million, a real terms increase of 2.9% (or £2.9 million) on the 2023/24 spend (£98.1 million). After adjusting all CYP ED spending to current prices (2024/25), over half (24/42) of the ICBs have reported planned spending cuts for the current financial year compared to their actual spend reported for 2023/24, with a cumulative cut of more than £835,000. Source: RCPsych analysis of NHS England. NHS mental health dashboard Q1 2024/25.  
   14 November 2024. The figures have been adjusted to account for the impact of inflation using HM Treasury. GDP deflators at market prices, and money GDP December 2024 (Quarterly National Accounts). 8 January 2025.
3. There were 7,933 new referrals for children and young people (aged 0 to 18 years) with eating disorder issues in the quarter ending December 2024, an increase of 13.2% from 7,008 for the quarter ending December 2023 (End of Year data). Source: RCPsych analysis of NHS Digital. Mental Health Services Monthly Statistics. 2023-2024.
4. Source: RCPsych analysis of NHS Digital. Mental Health Services Monthly Statistics. 2024. 
5. In the most recent data for October-December 2024, 81% of children and young people needing urgent care for eating disorders received treatment within one week of referral, up from 74% in the respective quarter for 2023 (End of Year data), however, 14 percentage points lower than the national target. 82% of CYP with routine cases commenced treatment within four weeks, 13 percentage points lower than the target. Source: RCPsych analysis of NHS Digital Mental Health Services Monthly Statistics 2023-2024.
   To explore these trends further, we have produced an interactive dashboard for our Mental Health Watch website, looking at the proportion of children and young people requiring urgent care for an eating disorder starting treatment within 1 week of referral.
6. Among the psychiatric specialties, eating disorders psychiatry had the greatest proportion of vacant consultant posts across England in March 2023 with 21.8%, an increase of 5.7 percentage points from 16.1% in 2021. The ‘true vacancy rate’ for eating disorder psychiatry, including both locum and vacant consultant posts, was 30.0%. Source: RCPsych workforce census 2023.
7. A full breakdown of the planned ICB spending cuts is available upon request.