Today the NHS received its first mandate from the government. The mandate, significantly ‘slimmed down’ from the draft produced for consultation earlier this year, offers a clear message from the start. Throughout, the ‘parity of esteem’ between mental and physical health is no mere rhetorical device.
From the outset, the mandate sets the NHS Commissioning Board and clinical commissioning groups the task of tackling the longstanding, and long outdated, disparity between mental and physical health support on the NHS.
This clear message is vital for the success not just of the government’s mental health strategy but also to make the NHS as a whole fit for the future.
Closing the gap
Joining up mental and physical healthcare, and giving each equal precedence, will increase the efficiency of the NHS by enabling it to respond to people as people instead of separating out their different diagnoses without reference to one another.
‘The task of delivering on the mandate now falls on the commissioning board’
To underline this point, a report published last week by the Centre for Mental Health and the NHS Confederation concluded that ensuring every hospital had an effective liaison psychiatry service could save the NHS some £1.2 billion a year.
The mandate makes a number of commitments that should help to make ‘parity’ more of a reality than it is today.
It makes integration a priority for all NHS organisations at all levels. There have been numerous debates about how to achieve different kinds of integration (such as between primary and secondary; mental and physical; health and social care) in a complex system. But for patients and service users, the daily reality is of services that are not integrated in numerous ways.
Genuine integration has to encompass all these elements, all working for the person, not just some joining forces in isolation from all the others.
The mandate calls on the board to make measurable progress to closing the health gap for people with severe mental illness, whose life expectancy now stands 15-20 years lower than average. It requires action to continue the national rollout of the Improving Access to Psychological Therapies programme to 15% of those who are eligible for it. And it sets the objective of improving the diagnosis of post-natal depression.
‘Making parity a reality is fundamental to the success of the whole NHS’
The mandate also sets longer-term ambitions for the NHS. These include the development of better means of addressing waiting times for mental health treatment and to consider how to create stronger entitlements and choices in this area.
Coinciding as the mandate does with the proposed changes to the NHS constitution, the need to enhance people’s entitlements regarding mental health treatment compared with those for physical health is starkly evident.
The task of delivering on the mandate now falls on the commissioning board. It has a historic opportunity to tackle some of the most dramatic inequalities in health and healthcare. The government, however, retains the crucial role of holding the board to account robustly for achieving on all of its objectives.
Making parity a reality is fundamental to the success of the whole NHS. We must now all work together to achieve it in every part of the country.