Parity of esteem must be an enduring priority
The ambition of “parity of esteem” between physical and mental health was one of the significant contributions of the Liberal Democrats to health policy in the last Parliament. It has been a frustrating concept, at times, because of the gap between the aspiration which the phrase contains and the reality of services and budgets on the ground at a time of austerity. It did however, for me, capture a laudable and crucial aim to put mental health centre stage in our health and social care system and to address the appalling long term and structural inequalities faced people who experience mental health problems in accessing help. While champions such as Norman Lamb and Paul Burstow are no longer part of Government it is crucial that new Ministers and other senior leaders pick up this mantle, first, because people with mental health problems deserve it but secondly because it is a fundamental part of sustainable health and social care system in this country.
The NHS has always treated mental illness as a second class problem and an area of expenditure which is easier to cut than A&E or cancer when savings have to be made. Despite the political commitment there has been on the issue, there has been clear evidence of disinvestment from the sector, the most recent estimate from Community Care suggesting that this has been as much as £600m or 8% of total budget over the length of the last Parliament. NHS Providers’ recent report “Funding for Mental Health Services: Moving towards Parity of Esteem” indicates that this year has failed to reverse the tide despite the strongest injunction I have ever seen in national guidance to increase mental health spending in line with the overall increase in allocations received by CCG.
There are many reasons why it’s hard to do. Many CCGs, or their acute providers, are already facing significant deficits and pressure on key performance standards such as the 18 week wait or the 4 hour wait in A&E inevitably focus attention away from less visible gaps in services in areas such as mental health. From 2016 mental health will, for the first time, have its own waiting time targets for access for treatment for anxiety and depression and to early intervention services for people with a first episode psychosis. These are welcome developments and it must be a continued priority in the next 5 years to see an extension of the kind of guarantees of access to services for people with mental health problems as we take for granted for physical health problems. Progress will not be without cost and it is crucial that additional resources, such as those promised for children and young peoples’ mental health promised by the last Government, reach the front line. Simon Stevens leadership on the issue has been helpful and I very much hope that the Taskforce he has established, chaired by Paul Farmer, will add to the case.
But a priority around mental health goes much further than just traditional mental health services, important though they are. The proper consideration of mental health as a central component of the model of integrated care is also crucial if the kinds of benefits envisaged in the Five Year Forward Year are to be properly realised. Some progress has been made in work on both the Better Care Fund and New Models of Care to bring mental health to the table but that is a long way further to go.
There are three dimensions to this issue which between them have a massive impact on how our wider health and social care system operates. First there is the issue of co-morbidity where mental health issues such as depression, anxiety or dementia set alongside physical health problems, restricting recovering, reducing wellbeing and contributing to frailty and risk. Many such patients currently receive no help for their mental health problems despite an excess cost to the NHS of failing to treat these symptoms estimated by the Kings Fund and Centre for Mental Health of as much as £13 billion per year.
Secondly there is the issue of medically unexplained symptoms where psychological distress or other mental health problems can underlie the presentation of physical symptoms. Such issues might account for 1 in 3 patients seen by a GP and 1 in 4 patients in a hospital clinic. As services such as our primary care psychotherapy service working alongside GPs in Hackney show there are really benefits from providing psychological support for such patients, improving their outcomes and saving money in other parts of the system.
Finally there should be an important recognition of how psychological considerations impact more widely on individuals affected by illness and on care givers, both professionals and informal carers. Nowhere would this be truer than in end of life care, as anyone in the hospice movement would readily tell you. Better regard to such issues might well lead to better decisions about the utilisation of healthcare and more effective interventions when they are applied.
As I have argued in this blog there has never been a more important time to put mental health centre stage. It may have been the Liberal Democrats who coined the term “parity of esteem” but it is the duty of the new Government, NHS England and other senior leaders in the system to make sure, however difficult it is to find the funding, that there are concrete steps taken in the next 5 years to make it more of a reality.