Health Service Focus

04.05.16

Why are we still waiting for progress on waiting times in mental health?

Liz Felton, CEO of Together for Mental Wellbeing, a national charity working alongside people with mental health issues, discusses the lack of progress on reducing mental health waiting times. 

The National Audit Office has reported that the government is unlikely to meet its pledge to bring waiting times for mental health in line with those for physical health. In fact, government officials “do not yet have a grip on how much the policy will cost”, five years after the original promise was made.  

This commitment and others, designed to bring mental health care in line with physical health care, have been enthusiastically lauded when announced. Described as ‘bold and impressive steps’ the assurances on waiting times rightly won the attention of individuals, organisations and campaigners when they were made in October 2014. The mental health sector applauded it as a significant step to eliminate an inequality that has kept mental health care behind the curve for decades. It finally felt like a sea change was imminent. 

But when it was revealed last week that little or no progress has been made towards the target, that officials don’t even know how much the policy will cost, the warning went largely unreported. It certainly wasn’t accompanied by an outcry to match the praise that preceded it. 

Of course it’s not the first time we have learnt of promises not being fulfilled, and perhaps this is why the news failed to get the attention it deserves. After all, we have seen it before. In the current economic climate, we half expect it. And as a sector, we have exhausted a portion of our outrage on service cuts and removal of benefits. 

The current situation amounts to yet another waiting game for people in need of mental health support. Politicians shouldn’t leverage public support by making popular commitments that they cannot resource or see through to completion. As a charity, we would be severely criticised for promising to achieve something that wasn’t founded on a solid plan with measurable delivery milestones. The NAO praised the government’s clear objectives and strong leadership as two areas where they are doing well. We know from experience this isn’t enough to make things happen. 

But we cannot let this go under the radar, and as a sector, we still have plenty of energy to see this ambition realised. We have to believe the government’s commitment to parity of esteem is genuine and achievable, and we have been busy fulfilling our part of the bargain. Mental health charities have been chipping away at the stigma that acts as a barrier to accessing care and support. We have taken steps to put services in more accessible community locations. We have done what we can to make it is as easy as possible for people to seek and receive help, by giving them the information they need and by delivering services that eliminate barriers. The NAO rightly pointed out that “improving care for people with mental health problems depends on action by many local organisations working together”. The third sector has displayed considerable leadership and maturity by combining its efforts and designing services that weave together the skills and resources of numerous agencies. 

CCG disparity is a cause for concern 

But the onus for achieving equality on waiting times cannot rest on third sector providers. And much as we want to see those seeking help being in charge of their own support and recovery, it cannot rest with them either. The NAO’s report identified the fragmented nature of mental health services as a factor in the government’s failure to meet its promise: not only does provision vary significantly between CCGs, their modes of data collection differ, meaning there is scant evidence on how the government is performing on its target. But perhaps most important is the NAO’s reminder that the additional £120m given to CCGs in the past two years for this policy is not ring-fenced. 

The disparity among CCGs is itself a cause for concern. Besides the burning question of why the funds haven’t been ring-fenced and whether they have been spent as intended, there are a number of other pertinent questions that rely for answers on a connected, united group of commissioners. For example, could CCGs commission services differently to bring waiting times down? What could change in the modelling of services to facilitate this? What are the responsibilities of statutory providers to ensure their services are outward-facing and emphasise early intervention? Third sector providers like ours frequently seek opportunities for conversations with commissioners about service design and the commissioning process for precisely this purpose, but it is not easy to do so when commissioners represent such a heterogeneous group. Not to speak of engaging those who use services in these conversations. 

And this unity needs to go even further still. By seeing physical and mental health provision as separate, competing parties – one dominant and the other lagging behind – we set up an opposition that only hampers progress. We know that physical health and mental health are interdependent and inseparable. We know that the climate is challenging and that targets are missed in physical health too. Only last month, the King’s Fund claimed that treating physical and mental health separately costs £11bn a year. By seeing the two instead as integral parts of one health system, we could take a jump towards efficiency and create an environment of being ‘in this together’ towards a common goal.

No one is in any doubt that the government needs to take ownership of this target and get to grips with the figures. As third sector providers, we will continue to see ourselves as having a role, and will remain committed to doing everything we can to creating an environment where people know what they are entitled to and are empowered to seek help. An open dialogue about commissioning led by a united and cohesive commissioning sector could be the catalyst for real progress, and would almost certainly have benefits reaching far beyond the realm of waiting times in mental health. 

Biog: Liz originally trained as a psychiatric nurse at Hollymoor Hospital, Birmingham and has worked in in-patient settings, including acute admissions and rehabilitation services. Before joining Together in 2006, she was Deputy Chief Executive of Rethink. 

At Together, her major aim is to shift thinking about mental health services away from something ‘done’ to people with mental health issues and towards a system ’built’ by individuals and their supporters, promoting quality of life, ambition and hope. 

Liz is currently Chair of Trustees at the Helplines Partnership, a board member of the Voluntary Sector Mental Health Providers Forum and sits on the NHS Confederation’s Mental Health Network as a representative of the voluntary sector.

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