Mental Health Matters: Mackey on mental health

For the last few years, the mental health sector’s star has been on the rise.

It started in 2016, with the publication of the landmark Five Year Forward View, promising over £1bn invested each year in mental health by 2020-21. At a similar time, the mental heath investment standard was brought in, championed by Sir Simon Stevens, and designed to address parity of esteem in mental healthcare.

Just a short time later, the then chancellor Philip Hammond committed to increasing mental health investment by “at least £2bn a year in real terms by 2023-24”, with improving crisis care a priority, and in 2019 the mental health implementation plan promised yet more money and set out how local services should achieve the ambitions for mental health as described in the Long-Term Plan.

Of course, none of the above was a quick fix – waiting lists for certain specialties continued to grow and much of the estate continued to crumble, ignored by the ‘new hospitals’ programme, and concerns about pay award funding fairness persisted – but the commitment was set at the highest level to set right the imbalance of funding.

Things started to go awry in 2023. A promised 10-year cross-government plan for mental health and wellbeing was scrapped and rolled into a “Major Conditions Strategy” (also now binned), and development of a new five-year plan was stopped in its tracks after Labour won office last year (the party’s election manifesto had scant mention of mental health). 

The removal of the vast majority of mental health-related targets in the 2025-26 planning guidance was soon followed by revelations that the government is to cut mental health’s share of spending for the first time in several years.

The sector’s time in the sun appears to be over.

Mind chief executive Sarah Hughes described the fall in funding as “unacceptable”,  with Andy Bell from the Centre for Mental Health calling it “unjust”. Leaders are equally worried the sector is slipping down the priority list and heading for “invisibility” again. 

Sir Jim on mental health

It was in this context that Sir Jim Mackey last week gave his first keynote on mental health since becoming NHS England CEO last month, at NHS Confed’s annual MH network conference.

He acknowledged MH “does get crowded out” on decisions and resources. He was not pressed, unfortunately, for his views on the drop in MH’s share of funding, nor the downgrading in the planning guidance.

Interestingly, Sir Jim said he was concerned MH was too often over-simplified by others in the health service – that it was seen as a “single phrase”, and this “wasn’t doing anyone any justice”.

He was also concerned about the need to “power up” mental health data, in the context of wanting more transparency and less variation across systems.

He vowed: “l will commit to you [that] I’ll work with you, through Claire [Murdoch] and her colleagues, and whoever needs to be there… and make sure you get a seat at the table.”

Sir Jim kept cards close to his chest when it came to specific ambitions for the sector, and what’s in store for the 10-Year Health Plan.

Early concerns I’ve heard about his appointment higlight his acute sector background – and that of his early hires to his top team. 

However, his former trust Northumbria has reached out beyond physical hospital care. As Sir Jim told Confed chair Lord Victor Adebowale, he is particularly proud of a service change which co-located children’s mental health services with physical health. He criticised the NHS for often “putting people into packages” when they were more complex.

The CEO’s mind is – however – clearly on capacity problems in emergency departments. He gave an example of a porter in his trust attacked by a patient, and expressing concern “no one was owning” patients attending A&E with complex physical and mental health problems. And as reported by HSJ last month, it’s an area likely to be included in the 10-Year Plan.

Sir Jim may have reassured sector leaders that “mental health was in the mix” for future development – recent bad news has suggested otherwise –  but the halcyon days of a dedicated plan with funding promises are over.