The NHS Funding Bill and mental health in England

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4 February 2020

By Andy Bell

Today, MPs will debate the Government’s NHS Funding Bill, a new piece of legislation that enshrines in law the spending increases that were pledged in 2018 for the next five years and that form the basis for the NHS Long Term Plan, published in 2019.

An amendment to the NHS Funding Bill proposed by the Royal College of Psychiatrists and put forward in the House of Commons by Preet Kaur Gill MP puts forward a further proposal to safeguard mental health spending.

The amendment would require the Secretary of State to report annually to Parliament about how far the parity gap between mental and physical health services has been bridged. The aim of this amendment is to require specific accountability for achieving the goal of providing a fairer share of NHS funding for mental health services. This is an important safeguard to ensure that mental health services receive a fair share of overall NHS spending and that there is clear accountability to Parliament for achieving this.

The amendment would require the Secretary of State to report annually to Parliament about how far the parity gap between mental and physical health services has been bridged.

While the NHS Long Term Plan sets a clear expectation that the £2.3 billion earmarked for mental health will be additional to existing resources – and much of it will be controlled by NHS England directly, at least initially – there is still a risk that local decision-making bodies will not prioritise mental health services in practice or that new or expanded services will be funded by reductions in others.

But there are wider concerns relating to this piece of legislation. Significant elements of mental health support for people of all ages come from outside the NHS, predominantly through local government. The largest part of this derives from adult social care (accounting for £1.3bn in 2015/16) but there are also important contributions from public health (eg in drug and alcohol services, suicide prevention, stop smoking services) and housing budgets. Two-thirds of schools also fund their own mental health support (eg counselling services) in addition to what the NHS or local authorities commission for school-age children.

Significant elements of mental health support for people of all ages come from outside the NHS, predominantly through local government... These essential services have just as great a need for a long-term funding settlement

While NHS spending is projected to rise steadily over the next five years, social care currently has only one year’s funding agreed to date and public health services are yet to receive confirmation of next year’s Public Health Grant (starting in April, in just two months). These essential services have just as great a need for a long-term funding settlement; and in the case of social care an agreed basis for future financing.

Legislating for increases in NHS spending risks exacerbating the financial imbalance even further. Ultimately, if funding for the NHS is diverted from public health, youth services, housing and social security, we will simply create yet more demand for more health care services over time without addressing the preventable causes. And this in turn risks increasing inequalities in mental health that all too often relate to people’s economic and social circumstances.

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