As the NHS approaches its 70th birthday in July 2018, the prospect of a long-term funding settlement has become stronger. While debate rages about what that should and will be, the stated aim is to give the NHS more certainty and stability about its future funding. As with all previous funding settlements, it will most likely be accompanied by conditions about the way extra funding is spent.

One area that has been mentioned widely as one of the key targets for extra resourcing has been mental health care: specifically, efforts to fill gaps in current provision for children and adults alike. And there are many good reasons to do this. Mental health care accounts for about 13% of NHS spending despite comprising an estimated 23% of the ‘burden of disease’ in society. Children’s mental health support features particularly stark gaps in provision, where only a minority of children and young people with mental health problems receive any help and services often have high thresholds and long waiting times. And among adults, an estimated 10% of all NHS spending (at least) is accounted for in extra physical health care provision for people with long-term conditions exacerbated by largely untreated poor mental health. Overall, the NHS spends as much again on the consequences of not dealing with our mental health as it does on mental health care.

Mental health care accounts for about 13% of NHS spending despite comprising an estimated 23% of the ‘burden of disease’ in society

The current Five Year Forward View for Mental Health is accompanied by a much-needed extra £1 billion recurrent funding for mental health care, and there is a further (time-limited) investment of £1.4 billion in children and young people’s mental health services. These investments are linked to specific service improvements: for example to expand psychological therapy provision to people with long-term conditions, to improve crisis care and to expand supported employment services.

As a long-term settlement becomes a very real prospect, it is therefore important to ensure that the opportunity is taken to reinvest at scale within the NHS to put right the historic bias against mental health, to meet needs that for too long have been ignored, and to continue the work that has begun under the Five Year Forward View and Future in Mind.

Overall, the NHS spends as much again on the consequences of not dealing with our mental health as it does on mental health care.

But there is a much bigger prize to be had in investing in mental health more broadly. The NHS is not the only source of support for our mental health. Local government has a particularly important, often undervalued, role in promoting good mental health and supporting people with mental health difficulties: in public health, early years, social care, youth services, housing, addiction services and more besides. Any long-term settlement for health would have to ensure a fair distribution of resources to support the vital services local authorities are responsible for: many of which have experienced significant cuts in recent years. It would also recognise the importance of schools in promoting and supporting children’s mental health. It would understand the value of welfare benefits to the daily lives of people with long-term health problems and disabilities. And it would ensure that communities were involved as equal partners in producing better health and reducing inequalities.

It is important to ensure that the opportunity is taken to reinvest at scale within the NHS to put right the historic bias against mental health, to meet needs that for too long have been ignored, and to continue the work that has begun 

A long-term settlement for health would focus not just on the NHS but on the full range of public services that enable people to live healthy lives and that tackle the injustices too many people face every day. As the NHS reaches 70, its promised long-term settlement must be used to bring about a real shift both within the NHS and in society as a whole to achieve better health for us all.


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