9 September 2021
The parliamentary committee examining proposed new health arrangements have heard from the Centre for Mental Health about how mental health needs to be prioritised.
Deputy chief executive of the Centre, Andy Bell, was invited to take questions from MPs on the Health and Care Bill committee which aims to improve the proposed reforms to the NHS in England.
The bill would put regional structures for organising NHS services, called integrated care systems, onto a statutory status to better join up health care, social care, public health and other services.
Andy told MPs that the bill’s implications for people’s mental health and for mental health services in England are profound and important. Integrated care has the potential to benefit up to five million people who live with both mental and physical health needs, among many others.
But the proposed new system has risks as well as possible benefits. At present, there is nothing in the bill that ensures mental health will be given equal precedence with physical health in integrated care systems – and without such assurances, history suggests it is at risk of being marginalised, Andy told MPs.
By moving decision-making from more local clinical commissioning groups to much larger integrated care systems, local communities will be further away from the centres of power in the health care system. This could undermine well established working relationships with local government and with voluntary and community organisations.
While the bill makes clear that integrated care boards are required to tackle health inequalities, there is little suggestion of how they will be held to account for how well they do this. The Centre believes that the regulators, the Care Quality Commission, should have an expanded remit to provide assurance on this vital aspect of the proposed new system.
Further, the bill provides little reassurance that local government services such as public health (including drug and alcohol treatment) and social care will have equal standing with health services in the new arrangements. While integrated care boards will include local government representation, they are not required to align with local government boundaries. And with local government funding falling further and further behind NHS spending, the inequality between the two grows year by year. Yet improving the public’s mental health and delivering modern mental health care depend on a well-functioning and equal partnership between the NHS, local councils, communities and a range of other agencies.
Andy asked MPs to consider the following amendments:
- The bill needs to specify that NHS England and integrated care boards and partnerships are expected to pursue ‘parity’ between mental and physical health in all their functions
- NHS England and integrated care systems should have a strengthened requirement to identify and address health inequalities and to monitor progress towards reducing them
- The Care Quality Commission’s remit should be extended to include holding systems to account for planning and commissioning decisions
- Integrated care boards should include representation from at least one mental health organisation in their area
- Integrated care system areas should be coterminous with upper tier local authorities. If they are not, decision-making should happen at this level wherever possible
- Integrated care systems should be mandated to work in partnership with voluntary and community organisations in their areas.
The Centre is also urging amendments to ensure the new system tackles inequalities and the causes of ill health by paying Living Wage Trust wages, as well as employing and training local people, including those who with mental health diagnosis, and buying local goods and services.
If the bill passes the rest of the stages in parliament the new system should begin in April 2022.