Last week, the Government and NHS England published the Medium-Term Planning Framework for the NHS in England for the next three years. Its bland title understates its importance as a set of instructions for the NHS that will be used across the country to guide decision-making, prioritisation and resource allocation. It replaces the previous annual planning guidance, meaning that integrated care boards now know what they are being asked to do for the next three years rather than just one at a time.
What the Planning Framework makes a priority, the NHS makes a priority nationwide. Perhaps more importantly, what is not mentioned in this document is at risk of being seen as a low priority.
For mental health services, the Planning Framework presents at best a mixed picture. There are some pieces of good news. It commits to expanding mental health support teams to all schools and colleges in England by 2029, in line with the Government’s manifesto pledge. This should help to close a big gap, with implementation of the programme so far about half way through. It will be vital, of course, that these teams are additional to, not a replacement for, existing school-based mental health services, and that learning from the evaluation to date is incorporated to make these more comprehensive and equitable.
For other mental health services for children, the Planning Framework offers less. Improvements in access, it says, are to be achieved by productivity savings – a big assumption in a system that is already struggling to meet rising demand. And the vital Young Futures hubs, also a manifesto commitment, are not included here at all.
For adults, the Planning Framework sets ambitions to expand further the coverage of NHS Talking Therapies services, and increase the number of people benefiting from Individual Placement and Support (IPS) employment services. The latter is especially welcome, because we know that IPS is highly effective and access is still a postcode lottery.
The Planning Framework also mentions planned investment in ‘mental health emergency departments’ despite the lack of evidence for this idea. It requires systems to ‘reduce’ rather than, as previously stated, to ‘eliminate’ inappropriate out-of-area hospital placements, and to do the same for the use of ‘locked rehabilitation’ wards.
That leaves a lot missing. Long-promised access and waiting time standards for mental health care are still not part of the picture. So waits for mental health care will continue to be regarded as less important than those for physical health treatment.
Requirements in previous planning guidance documents to offer annual physical health checks to people with a severe mental illness are also omitted. Not a word is said about mental health in later life, or supporting people with long term conditions with their mental health. And despite a clear and welcome pledge in the Planning Framework to fight racism and discrimination, it makes no mention of the Patient and Carer Race Equality Framework despite its importance in bringing about systemic change to mental health services.
It’s unlikely that the Planning Framework will be the last word in what NHS organisations are asked to do over the next three years. But it will be used by integrated care boards across the country next year to make decisions on how to use scarce resources. And it offers very little hope of the kind of transformational change and investment that we need. So we will keep making the case, nationally and locally, for evidence-based and promising approaches to mental health support, with the level of ambition that is needed.
