On behalf of the Mental Health Policy Group, comprising Centre for Mental Health, the Mental Health Foundation, Mind, the NHS Confederation Mental Health Network, Rethink Mental Illness and the Royal College of Psychiatrists.
The NHS Mandate sets out the Government’s ‘instructions’ to the NHS in England and was recently updated for 2016/17 by the Department of Health following November’s spending review. A few days after it was published, NHS England produced its Planning Guidance for clinical commissioning groups in the year ahead.
The Mandate includes some important objectives relating to mental health care and treatment. As part of one of seven overall objectives in the Mandate, it states that: “We expect NHS England to strive to the reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and support them to live full, healthy and independent lives” (p9). Within that objective, the Mandate points to the importance of “prevention, early intervention and…integrated services” with a particular focus on perinatal mental health care and on “vulnerable children, homeless people, veterans and people in places of detention”.
Going into more detail on this objective, the Mandate notes that the forthcoming Mental Health Taskforce report will set out the ambitions for ‘closing the health gap’ alongside existing commitments to implement access and waiting time standards (for talking therapies for adults and Early Intervention in Psychosis services for young people), to improve crisis care and to transform children’s mental health services (pp16-17).
Looking beyond the specific objectives relating to mental health, however, there is a great deal more in the Mandate where mental health should be regarded as essential to achieving its wider aims and ambitions. In the very first objective, the mandate says that “NHS England must secure measurable reductions in inequalities in access to health services” (p7). Given that only a quarter of adults and children with common mental health conditions get any support at all, and that people with schizophrenia have a life expectancy 15-20 years below average, we cannot ignore mental health in this central pillar of the new Mandate.
The Mandate goes on to require NHS England “to ensure that the NHS lives within its means and achieves…year on year improvements in efficiency and productivity” (p8). With £10 billion spent annually on the extra costs of caring for people with long-term conditions who also have mental health problems – much of which could be saved through better psychological support – mental health can no longer be sidelined as a bit-part in the NHS. It is as relevant to cancer care, diabetes and heart disease as the physical treatment of those conditions and fundamental to helping people recover good health.
"Mental health currently receives less than 6% of all funding despite accounting for 23% of ill health"
The Mandate also includes specific objectives in relation to employment, reducing the ‘gap’ between disabled people and the rest of the population. Currently less than 10% of people using mental health services are in work even though many more want the chance; and through Individual Placement and Support we know we can do better. And there is a major objective to boost health research, where mental health currently receives less than 6% of all funding despite accounting for 23% of ill health.
Many of the themes in the Mandate are reflected in the Planning Guidance. Achieving the new waiting time standards is one of the NHS’s ‘must-dos’ for 2016/17. The document also carries forward the requirement of CCGs this year to “increase investment in mental health services each year at a level which at least matches their [CCGs’] overall expenditure increase” (p7). As yet we do not know how many CCGs followed the guidance for this year, but it will be vital that all do in the coming years if we are ever to achieve equal treatment for mental health.
"With £10 billion spent annually on the extra costs of caring for people with long-term conditions who also have mental health problems, mental health can no longer be sidelined as a bit-part in the NHS. It is as relevant to cancer care, diabetes and heart disease as the physical treatment of those conditions."
The Planning Guidance also requires all local areas to produce Sustainability and Transformation Plans within the next six months. It is vital that these all include action to support greater equality for mental health and better integration with other health and care services.
We know that the context for the next five years is extremely challenging for the NHS. The recent analysis of the spending review by The King’s Fund, Nuffield Trust and Health Foundation presents a sobering picture. They show that while NHS spending will keep rising in real terms, overall health spending will be under greater pressure, with public health spending set to fall by £600 million in real terms by 2020/21 and social care facing a ‘funding gap’ of at least £2 billion.
Even the extra funding for the NHS, the report notes, “will be absorbed by dealing with deficits among NHS providers and by additional pension costs”. The charities also point out that while 2016/17 will see a big rise in NHS spending, the years 2018-20 will see much smaller increases, as a result of which “the NHS will struggle to maintain services, let alone invest in new models of care” (p1). Such pressures have been evident in mental health care for most of the last five years and the NHS as a whole needs to work together to ensure targeted investment on mental health to achieve change.
After the publication of the Mandate, it is now up to NHS England to do as much as possible to deliver on its important objectives. Putting mental health is at the heart of this process will help the NHS to achieve more of its potential to reduce inequalities, to be much more efficient and to improve people’s lives.
Last updated: 4th September, 2018