Establishing parity of esteem within national policy

Over the last decade, the mental health sector has benefited from national focus and additional investment delivered via fully costed programmes for mental health care delivery in the shape of the Five Year Forward View for Mental Health and the NHS Long Term Plan.  

While there was much from both national plans to welcome, the focus and investment they afforded to the sector has not been long term or broad enough to turn the tide on the scale of historical and structural disadvantage the sector has faced compared to physical health provision. The healthcare system is still operating in the context of a ‘care deficit’ where it is accepted that a larger proportion of those that need mental health care and treatment, particularly those with the most acute and complex needs, will not be able to access timely support. The provision of mental health services, particularly for those with severe and enduring mental health conditions, is not prioritised across the whole of the NHS. Indeed, a broader set of mental health waiting time and access standards comparable to those we have had for decades for physical health services have not been introduced despite having been consulted on and agreed to years ago. 

Many of the challenges facing the mental health sector are rooted in a historical, structural disadvantage. During our most recent conversations, mental health trust leaders have highlighted disparities in the payment and costing mechanisms used for acute and mental health services as a particular example that needs to be addressed as part of the current ongoing review. The current approach to payments and costings guarantees that mental health and community services receive a smaller share of funding, even with the mental health investment standard in place. The majority of the delivery metrics in the draft NHS Performance Assessment Framework are a recent, further instance of how mental health is overlooked in national considerations. Given what gets measured gets prioritised, this needs to be addressed.  

We have also heard that current key mental health performance metrics do not fully reflect the areas trusts and ICBs would prioritise given the areas of greatest pressure and need they see locally. They highlighted in particular: access to care for those experiencing mental health crisis; demand for and lengths of stay in children’s mental health services; and annual physical health check for people with serious mental illness. These areas offer significant opportunities to deliver better outcomes and save money if prioritised and reflected in trust and system accountability metrics.  

National plans often focus exclusively on physical health services, for example, those relating to urgent and emergency or elective care, delivering digital transformation or the government’s latest ambitions for 24/7 neighbourhood health centres. This is a missed opportunity. Services need to be built around people and meet their needs holistically. While the skills to support individuals’ physical and mental health can be distinct, they are also complementary.