On 7 January 2019, the Prime Minister Theresa May MP and NHS England Chief Executive Simon Stevens outlined the NHS Long Term Plan (The Plan), setting out a ten-year vision for health services in England. The Plan represents the start of a conversation about how to sustain the NHS and determines how the additional funds earmarked for the NHS will be organised over the next decade.
The Plan also has major implications for the nation’s mental health services. A substantial part of the plan focuses on how current mental health services will be improved – from improving waiting times and providing a universal 24-hour helpline to investing in services to support children and young people.
For those with mental health difficulties and those that provide mental health services, the Plan – if delivered upon – could bring about a number of significant benefits.
The Big Picture
The Plan aims to deliver a “new service model for the 21st century”, aligned to the over-arching principles of more joined up and coordinated care, a preventative outlook on population health management and an increased offering of personalised support in community settings.
Many of these principles have of course been outlined before, with The Plan indicating the potential benefits of legislation to reform key aspects of the 2012 Health and Social Care Act and suggests that the current divide between the NHS and public health in local government may need to be re-examined.
At least half of people with mental health difficulties also have at least one long-term physical illness, and many have multiple and complex needs that the current system struggles to meet. A move towards a health and care system that seeks to meet people’s needs more holistically, and aims to prevent health problems from developing, whilst offering personalised support, would improve the care that many people with mental health difficulties currently encounter.
The first step towards embedding the principles outlined in The Plan involves the commitment for all local health economies to become Integrated Care Systems (ICSs) by 2021. ICSs are described in The Plan as a practical way of delivering the “triple integration” of primary, physical and mental health services, and health with social care”.
The Plan also outlines that “real terms funding for primary and community health services are guaranteed to grow faster” than the total NHS budget. The funding uplift will be aligned with an expansion in community multidisciplinary teams and new primary care networks, first introduced through the New Models of Care “Vanguards” programme and expanded through the creation of Sustainability and Transformation Partnerships (STPs) in 2016.
For The Plan to bring about significant changes to mental health services, it is essential that mental health providers grasp the opportunity to embed mental health support within primary and community health services and ensure these services meet the needs of people with both mental and physical health problems. Providers will then be able to implement a collaborative care approach and meet the needs of people who currently do not get adequate help from primary and secondary mental health services.
The Long Term Plan also includes a clear commitment to increase the funding for mental health services. The NHS has committed to growing spending as a proportion of the service, creating a new ring-fenced local investment fund of £2.3bn a year by 2023/24. However, it remains the case that in total, community health services, mental health and primary care costs the NHS around £27bn a year, so the allocation for mental health services remains less than 10% of total NHS spending.
It also commits the NHS to continue targeting a higher share of funding towards areas with health inequalities. From April 2019, NHS England will introduce a more accurate assessment of need for community and mental health services to ensure that allocations are more responsive to those with the greatest health inequalities and unmet need.
To ensure programmes are focused on reducing inequalities, the NHS will set out specific, measurable goals for narrowing inequalities, including those related to poverty – a strong determinant of poor mental health. All local health systems will then be expected to set out what specific actions they will take to reduce health inequalities by 2023/24 and 2028/29.
By the standards of previous NHS strategies, the Long Term Plan places a significant emphasis on mental health services. Many of the pledges in The Plan will naturally take time to be put into practice, providing significant scope for mental health providers to shape the implementation of the plan.
Health is GK Strategy’s largest policy area and we are experienced at working in highly regulated areas and with local government as well as national government, helping to navigate complex markets and building relationships with key decision makers.
To engage with the Plan effectively, organisations will need to understand the wider direction of health and care, of which the much-delayed Social Care Green Paper and the promised paper on prevention will be key. GK Strategy can help you establish your services as best practice and can campaign for the right policy levers to be deployed to incentivise uptake for adoption to deliver on the priorities on The Plan.
With the Long Term Plan signalling a number of changes to mental health policy, there are plenty of opportunities for mental health providers to benefit.
by Jack Sansum