The Taskforce report is a great start but this time we have got to be serious about change
The recent Mental Health Taskforce report presents a clear and compelling picture of what we still need to do to deliver the right support for the one in four people in this country who, in their lifetime, will be affected by mental health problems. While there wasn’t much in the analysis which was particularly new, it powerfully made the case for change backed up by the voice of 20,000 people with lived experience of mental health problems who contributed to its work. Paul Farmer and colleagues on the Taskforce deserve a big of vote of thanks for what they have achieved, in particular in helping to secure a commitment of an additional £1 billion of funding over the next 5 years.
But where do we go next and how confident can we be that this will be genuinely be the start of a new dawn for mental health care in this country. Those are slightly harder questions to answer. As I have often said over the last couple of years these are is both the best and worst of times for mental health. There is a genuine sea change taking place in public attitudes, encouraged in part by programmes such as Time for Change. Senior politicians have been falling over themselves to stake some ownership of an issue which matters to so many people. At the same, as the Taskforce rightly highlight, demand for services is increasing and resources in many key services are being cut back. So far, in the round, we have scarcely scratched the surface in addressing the historic underfunding of mental health care and delivering a genuine parity of esteem between mental and physical health.
There are a number of things which have got to happen if, this time, we are to be really serious about change. The first is the money. Let’s be clear to start with, £1 billion, however welcome as a start, is not the sum total of what is required to put mental and physical health on an equal footing. In what is still the most authoritative statement on the issue, the LSE’s 2012 report on “How Mental Health Loses out in the NHS” made the case that, while representing 23% of the demand, mental health services received only 13% of the funding. To close that gap we are talking about £10 billion additional funding. However long it takes it must be the explicit objective to reach a genuine parity of funding.
Behind the financial numbers lie literally millions of individuals for who, we as the NHS, are currently unable to provide any help. The same LSE report highlighted 6 million people with depression and anxiety and 700,000 young people who are unable to access to treatment. No similar treatment gap exists for any major physical condition.
This said, the £1 billion additional funding is welcome, and it is particularly welcome when the overall pressures on NHS and other public resources are so great. However it is to be the catalyst for change there has got to be clear transparency about how the additional funding reaches the front line. There has been a difficult recent history of the mismatch between national funding promises and decisions by local funding bodies. One of the most shocking statistics highlighted by the Taskforce is the variation in local funding and it is crucial that the Taskforce’s recommendation on establishing clear reporting of mental health investment is followed through.
Clearly the backdrop to the debate about mental health investment will be the current crisis in the finances of the acute sector which has attracted some much attention in the last couple of weeks. There is already evidence of the needs of stabilising hospital finances being prioritised ahead of much needed investment in mental health, primary and community services. There is a real tragedy here. We all want good quality and financially stable hospitals but the route to managing the pressures on hospitals fundamentally lies in strengthening out of hospital services. While we fail to invest in those services any efforts to stabilise the acute sector will inevitably have the nature of a sticking plaster. There is a particular point about mental health with estimates of at least £8 billion and may be as high as £13 billion additional annual costs linked to untreated co-morbid mental health conditions. This was an area which secured a helpful focus in the Taskforce report and it highlights that fair funding for mental health is not just a matter for mental health services. It is fundamental to the future sustainability of the whole NHS.
The last point I want to comment on is leadership. If the vision set out by the Taskforce is to become a reality it will need determined leadership at all levels of the system. NHS England and other Arm Length Bodies will need to give more priority to this issue in how they allocate their own resources and effort. It will need priority to be given by Commissioners, however many other pressures they face. It will need leadership, creativity and determination from providers. The success of this endeavour must not be up for negotiation or just a nice to have if we’ve sorted all the other issues. The stakes in terms of broken lives, lost opportunities and the very future of the NHS are too high.
It is been good to see engagement from the very highest levels on this issue and, for the first time, seeing the Prime Minister making a speech on mental health. He has rightly commented on the need to end the stigma relating to mental health. However it also must be the time where we stop stigmatising people with mental health problems, not just with our words, but also with our actions and the decisions we make about spending the nation’s resources.