Congratulations on getting the No 1 question. Research shows that the best long-term outcomes for people with an eating disorder are achieved when they are cared for in the community, close to family and other social support networks.
Eating disorder services are, therefore, provided through a stepped care approach, which ranges from early detection and intervention to community-based treatment to specialist in-patient provision. The aim is to provide treatment in the community and prevent hospital admissions. There are separate eating disorder services for adults, children and adolescents, provided by specialist community-based teams in four health and social care trusts. The Belfast trust provides those services for the South Eastern Health and Social Care Trust, and those teams include consultant psychiatrists, eating therapists and dieticians.
Adult in-patient treatment is facilitated in existing hospitals, with in-reach support provided by specialist community-based eating disorder teams. That ensures a continuum of care when patients are discharged. In-patient care for children and adolescents with eating disorders is provided at Beechcroft, the regional child and adolescent mental health in-patient unit, which has a consultant who specialises in the treatment of eating disorders.
The cost is significant when families have to go to other jurisdictions, not just the cost of the facility and the charge that is laid on the Northern Ireland health service but also the cost of flying other family members over and keeping them close to the location for visits and so forth.
Since 2005, £2 million has been invested in the development of community-based eating disorder services — £1 million in 2005-06, £500,000 in 2007 and £500,000 in 2008. Since 2010, in-patient eating disorder capacity has been provided in each trust area, each of which has one to two beds. Those are managed by specially trained medical psychiatric staff, supported on an in-reach basis by staff from the community-based eating disorder teams. That provides a seamless service, which is key to achieving the best long-term outcomes for patients. Aside from that, there has been interest from the private sector in developing facilities in Northern Ireland, and discussions have been ongoing with the HSC in that regard.
Families, friends and carers are essential in the process, so when young people in particular are referred to clinics not in Northern Ireland, we will support families by providing travel costs and, indeed, accommodation and so forth when they are providing support for the family.
Often, that will be once every two weeks. However, it depends on the advice from the specialist as to how often they will allow the individual to see their family because at times when there are particular problems the medical advice is that perhaps fewer visits are appropriate; whereas at other times they are looking for more visits. We work very closely with the experts on that issue.
Given the size of the population in Northern Ireland, it would be difficult to sustain a specialist unit here, as such a facility would have a relatively small inpatient client base. In the current economic climate, we will not tie up money directly with the development of such a unit, but, as I indicated, the private sector has expressed an interest and has been in discussions with the HSC about the number of clients that would be provided for.
It is for clinicians to decide whether individual patients might benefit from care in a specialist eating disorder unit outside Northern Ireland, but the indications are that, over the past number of years, there has been a reduction in extra-contractual referrals to other jurisdictions. That trend is expected to continue as we develop local expertise in the management of complex conditions. That is something that we wish to continue with.
The HSC has been having that discussion with the private sector to establish how many beds we in the HSC would be buying from it if such a unit were established.
We are doing that already, as we are sending young people who suffer from anorexia and so on to other parts of the UK, and we are buying these services off the private sector there. So, I would welcome the opportunity to engage in doing that in Northern Ireland.