NHS England has published the new NHS Long Term Plan, setting out a vision for the future of the NHS in England – including healthcare provision and outcomes to be achieved.
As advertised, the plan includes, for the first time, new commitments to prevention and mental health and is also the first plan that goes well beyond the current political terms, indicating a shift towards more strategic, visionary and investment-based thinking.
Understanding the future of mental health care as defined by the Plan requires understanding how the changes in the healthcare system will more generally affect mental health.
And there are three important reasons to be optimistic:
1. Spending on mental health
The NHS has committed to growing mental health spending as a proportion of the overall spending on the service, creating a new ringfenced local investment fund worth at least £2.3 billion a year by 2023/24.
We welcome not just the much-needed increase in funding but also the ringfencing. This acknowledges the historical underinvestment in mental health – which the Foundation has pushed to change on several occasions. It also takes a step in the right direction to make mental health the strategic priority it should be, especially in the areas facing the deepest inequalities.
2. Addressing health inequalities
The plan commits the NHS to continue targeting a higher share of funding towards areas with high health inequalities than would have been allocated using the previous system of the ‘core needs formula’.
From April 2019, NHS England will introduce a more accurate assessment of the need for community health and mental health services. It will ensure that allocations formulae are more responsive to the greatest health inequalities and unmet needs.
To ensure local programmes are focused on reducing health inequalities, the NHS will set out specific, measurable goals for narrowing inequalities, including those relating to poverty, perhaps the strongest determinant of poor mental health.
In 2019, all local health systems will be expected to set out what specific action they will take to reduce health inequalities by 2023/24 and 2028/29.
In collaboration with Public Health England and voluntary and community sector partners, NHS England intends to develop and publish a menu of evidence-based interventions for use at a local level to contribute towards the goal of reducing health inequalities, including for groups that the Foundation has worked with in co-production, such as people with learning disabilities, older people, and carers of people experiencing health problems.
To get funding, local areas will be crucial to show they are appropriately focusing on those with the greatest need.
It is pleasing to see that access to funding is attached to ensuring that health inequalities are addressed as mental health problems are not evenly distributed across society. Generally, people living with mental health problems encounter poorer health outcomes more widely. On several occasions, the Foundation has strongly advocated for appropriate local action based on evidence.
3. A new focus on prevention
The plan brings a renewed focus on prevention – the strongest advocacy point we have pursued in the Foundation. There is a welcome emphasis on:
- children’s health (including, crucially, a new model which will deliver an integrated approach across health, social care, education and the voluntary sector)
- perinatal mental health (including expanding access to care for women with perinatal mental health problems, as well as to support services for couples and partners)
These points can certainly do much to ensure our next generation will have better mental health outcomes. Diversifying the support available to people of all ages and enabling digital care can add to this optimism.
Digital health and social prescribing
The Long Term Plan brings some further positive priorities to transform the NHS's digital elements, including online access to records and using tools and interventions to support better care. It’s great that the changes will empower clinicians and people who use services while ensuring personal data protection.
However, it’s not only the online aspect of the services but also the non-clinical elements that can bring much desired additional support. We often call this “social prescribing", which provides more personalised therapeutic options outside clinical settings, such as exercise or art interventions.
Encouragingly, the NHS will roll out the NHS Personalised Care model across the country, reaching 2.5 million people by 2023/24 and then aiming to double that again within a decade. As part of this work, link workers within primary care networks will work with people to develop tailored plans and connect them to local groups and support services.
It is important to welcome the plans to improve health and mental health through action across different sectors. Integrated approaches within clinical and community settings are vital.
We are pleased to have contributed to helping in making the plan more ambitious in going beyond the needs of the traditional clinical services and into public health approaches. We will have to see – and provide consultation to – the forthcoming Social Care green paper to understand how some of the elements of holistic care will be followed and also continue lobbying for increased local public health funding, which is critical in achieving the mission of prevention.
Of course, our work does not end here. The Plan will now move into the arduous process of implementation, which has historically been hindered in England by complexity at a local level, systems that have lacked integration and persistent inequalities impacted by social structures and austerity.
It is promising that several of the pledges cover an integrated care system for the country and are going beyond the current political cycle and over the next decade, but tracking progress and assessing impact won’t be straightforward. The investment has increased, but the resources are finite, and the focus on healthcare personnel (such as doctors and nurses) will have to remain on top of the agenda, especially in the context of Brexit.
We will need to think innovatively about how we widen the workforce, including capitalising on the lived experience of peer workers and attracting talent into the mental health sector: both will require continued efforts to tackle stigma and articulate the very real rewarding aspects of working in mental health. The Health and Care Workforce Strategy for England will need to address these issues deeper.
It seems that for the first time in its 70-year history, the NHS has gone a considerable way to provide the promise of action to prevent mental health problems. To achieve this promise of prevention – as we have been consistently presenting at the Foundation – we will need to address the wider determinants of health, which most often lie in non-health domains (social, education, housing, criminal justice, family, labour).
We now need to work together across the sectors to ensure mental health remains a priority within and throughout the implementation process. To achieve that, we are calling for a cross-government body to protect the ringfenced funds and the commitment to growth and to help focus on the specifics for the next Five Year Forward View on Mental Health. This should truly go beyond just the traditional clinical NHS services for people of all ages.
At the Foundation, we will continue to support to build on this start and ensure we address those factors that continue to place our mental health at risk so that we can protect the mental health of the next generations as the most valuable asset we will hold.