Measures that matter: integrated care systems, national targets and mental health services

10 January 2023
Andy Bell

By Andy Bell

A government-commissioned review led by former health secretary Patricia Hewitt is currently investigating how recently established integrated care systems (ICSs) in England are working and asking how they should be held to account for improving health and care services.

It is early days for integrated care systems. And so far they are giving mixed signals about to what extent this latest incarnation of the ever-moving structure of the NHS and its relationship with local government will be beneficial for the public’s mental health and our mental health services.

Every integrated care board has to include at least one member with mental health expertise as one means of making ‘parity’ more achievable. They are also required in the legislation that created them, the 2022 Health and Care Act, to take steps towards parity between mental and physical health, tackle health inequalities, improve population health, and join up health and care services to meet people’s needs more effectively and efficiently. So far, so good.

But with the NHS under so much pressure, there are clear and worrying signs that mental health is being sidelined both nationally and in many local areas because of rising costs, elective care backlogs and stresses on emergency departments. Historically, when the NHS as a whole is under intolerable pressure, mental health services get neglected.

For that to happen again would be disastrous for mental health. The prevalence of mental ill health has grown incrementally over the last two decades, exacerbated more recently by the Covid-19 pandemic and the cost of living crisis, and compounded by the years of austerity that have stripped away protective factors for individuals, families and communities. While the long-term solutions to this growing level of distress lie predominantly outside the NHS, it’s health and care services that have to respond now to the rise in demand for mental health support.

This is where another aspect of the Hewitt Review, the role and value of national targets for the NHS, comes into view. Access and waiting standards have been an essential tool for many years now for holding health services to account and making sure people are treated within reasonable timescales. From 18-week waits for surgery to 4-hour waits in emergency departments, they have a talismanic role in assessing the state of the NHS and they protect people from excessive delays in all but the most testing times for health services.

Until recent years, there were no specific targets for mental health services. In 2015, this changed with the introduction of access and waiting time standards for adult psychological therapy, first episode of psychosis and children’s eating disorder services. These have helped to ensure that more people get timely access to treatment when they need it, reducing geographical variations and directing investment to these services to avoid long waits. But they are limited to these specific areas, with little such imperative for other areas of mental health care.

In 2021, a national review led by NHS England medical director Dr Steve Powis recommended a set of four further access and waiting time standards for mental health care, both urgent and routine. These are yet to be implemented but would have an important part to play in extending access to timely treatment nationwide. Without these standards, mental health care will continue to be regarded as less important than other health services when it comes to access and waiting times.

In a world where what gets measured is what matters, the paucity of what gets measured in mental health services makes them too easily disregarded and sidelined at every level of the system. While national performance measures should never be the only ones that matter, they are an important signal of priorities and investment, and it is high time, in 2023, we had parity for mental health care in the NHS.

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