The government’s new Health and Care Bill is threatening to push mental health to the peripheries of NHS priorities — with patients ‘left to pay the price’, according to the Royal College of Psychiatrists.
With an eye to bring together local NHS and local government, the Bill sets out to ensure all parts of England fall to the control of integrated care systems (ICSs), which will hand over the reins to clinicians, carers and public health experts to work collaboratively in delivering care in their area.
Despite mental illness constituting a quarter of ill-health in the UK, the ‘Triple Aims’ of ICSs laid out by the government fail to address the need to provide committed and adequate mental health care — sparking immense concern among mental health experts.
So let’s get this right, under the Health and Care Bill private companies like Virgin, can sit on new Integrated Care Boards, but there’s no slot for a representative from a mental health organisation. This is disgraceful #ScrapNHSBill— EveryDoctor (@EveryDoctorUK) July 14, 2021
“Now is the time to make sure that your voice is heard”
With the introduction of ICSs set to become enshrined in law, RCPsych has launched a campaign to safeguard the government’s duty to promote equally the value of mental and physical health among NHS reforms.
“For too long mental health has struggled to be heard at the top table of NHS decision making, leaving many patients with a mental illness unable to access the care they need,” the campaign outline reads.
“Shockingly, the new law sets out a ‘Triple Aim’ for what every Integrated care system (ICS) has to achieve but makes no reference to mental health.
“The Royal College of Psychiatrists is asking MPs to amend the ‘Triple Aim’ to include a clear reference to both mental and physical health and for ICSs to report every year on the steps they have taken to further parity of esteem for mental health.
“As MPs are preparing to debate the Bill, now is the time to make sure that your voice is heard, or it could be another decade before a chance comes again.”
Parity of esteem
The Health and Social Care Act 2012 enshrined in law the obligation on the government to promote ‘parity of esteem’ — a holistic approach to care which values equally a patient’s physical and mental health needs.
Parity of esteem was established on the pretext that poor mental health puts patients at a significantly higher risk of physical health problems.
It broke a long time ago. Gov’t never wanted it. Only a bare knuckle fight in the Lords got it into the 2012 Act. https://t.co/QOeFmCKw0H— Terence Lewis (@PARITYFORMH) July 14, 2021
With demand for mental health support to rise by about 10 million people over the next few years, according to government estimates, RCPsych has warned that the careless disregard for parity of esteem in establishing the legal blueprint for ICSs will divert resources away from mental health care provision.
Without mandated representatives, the implementation of the new NHS reforms as they stand puts patients and staff at risk of being without official representation in seeking care and funding.
In an opinion piece for the Health Service Journal, Dr Adrian James, president of the RCPsych, wrote that a simple change in the wording of the Bill would have a “transformative effect” in meeting the swelling demand for mental health care.
“Oversimplified box-ticking exercises won’t deliver parity of esteem, but a clear legal requirement would focus minds and hold the system to account in a meaningful way,” he wrote.
“Alarmingly, the current wording of the Bill and NHS guidance also means that it will be possible for some areas to have no mental health representation on their Integrated Care Board.
“It is impossible to deliver a population health-based approach without mental health services being part of decision making and accountability.”
Levelling-up mental health
Earlier this year, the government laid out plans to invest £500 million into mental health care services as part of its Mental Health Recovery Action Plan.
The plan was borne out of the sharp increase in people requiring mental health support as a consequence of the pandemic, with particular focus on those who have been most affected – including frontline health care workers.
Among the beneficiaries are the most deprived local authority areas in England, set to receive £15 million in mental health funding, and £2.5 million in trialling new approaches to support children who have experienced complex trauma.
I see the Tories are announcing another ‘levelling up’ strategy, despite being in Government for 11 years. This time with a specific mention on mental health.— Dr Rosena Allin-Khan ? (@DrRosena) July 15, 2021
You can’t level up mental health when you’ve cut a quarter of mental health beds since 2010. https://t.co/oxKaG0D4oH
‘Escape the Junk Food Cycle and protect the NHS’
Much of the current emphasis with regards to preserving the NHS concerns a new report into plans to fight the obesity crisis in the UK.
The proposals outlined in England’s National Food Strategy include introducing a tax on sugar and salt, while fruit and vegetables will prescribed by GPs.
We’ve published the National Food Strategy today. A Manifesto for a better food system alongside a Strategic Plan to achieve it. https://t.co/uc9sFIfWZi— Henry Dimbleby (@HenryDimbleby) July 15, 2021
The response has been mixed, with some politicians and high-profile chefs – including MP Caroline Lucas and Tom Kerridge – calling on the government to implement the recommendations made.
Others have criticised the report, condemning it as a missed opportunity to tackle food poverty in Britain.
In the most deprived areas in England, the prevalence of excess weight (overweight or obese) is 9 percentage points higher than the least deprived areas, according to government statistics.
10 million people currently living below the breadline would have benefited from #TheRightToFood recommendations being implemented in the National Food Strategy. Sadly the report has failed to do what’s necessary. The fight goes on! We need the right to food enshrined in law! pic.twitter.com/ZZytKFzKnq— Ian Lavery MP (@IanLaveryMP) July 15, 2021
Chair of national activist network Fans Supporting Foodbanks, Dave Kelly, said: “I am disappointed in the National Food Strategy report and think it is weak on inequality – this section of the report did not even mention foodbanks. We wanted and needed a legally binding Right to Food for all, but we got Andrew Marr extolling the virtues of the free market!”
“These recommendations duck both the need for universal free school meals and a duty on Government to state how much of minimum wages or benefits it has apportioned for food. These were just two of our key asks in our submission to the National Food Strategy,” said Shami Chakrabarti, a key supporter of the Right To Food who helped to write the campaign submission to the National Food Strategy.
“There are perfectly credible ideas in the Report but nothing resembling a Right to Food. This is a wasted opportunity.”