Last Thursday, NHS England published its long-awaited 2024/25 Priorities and Operational Planning Guidance. This document is produced annually as NHS England’s ‘instructions’ to integrated care boards about what they should prioritise in the coming year. What is, and what isn’t, included in this document has a big effect on how decisions are made across the country about how limited resources are used.
This year’s guidance comes out at an especially difficult time for the NHS: with long waiting lists, huge pressures on all services, declining public satisfaction, and ongoing industrial action. Against this backdrop, the guidance is perhaps necessarily cautious about expectations. With a funding settlement that means NHS spending this year is ‘flat’ compared to last, it says ‘we now need to consolidate’. And with political uncertainty in an election year, it speaks of the need to recover services that are struggling and ‘lay the ground’ for the future rather than making big strides ahead now.
Mental health services are one of six priorities in the guidance for the year ahead. This in itself is an important message for the 42 integrated care boards across England to hear. After five years of centrally directed expansion in mental health care through the NHS Long Term Plan, it is vital that the progress made is sustained and continued. With demand for support rising faster than many services can grow to meet it, it can feel like we’re standing still when services are actually running to catch up. Stopping now would have terrible consequences for people, families and communities nationwide.
The planning guidance sets out five specific objectives for mental health services, including: increasing the numbers of people getting access to NHS Talking Therapies and to ‘transformed’ community mental health services for both adults and children; working towards eliminating out-of-area hospital admissions; and ensuring at least 60% of people with a ‘severe mental illness’ get their annual health check this year. There are further specific actions for mental health services, including improving the quality of inpatient services, reducing lengths of stay in hospital, and implementing the Patient and Carer Race Equality Framework.
The guidance also asks systems to arrange ‘appropriate services for mental health patients requiring urgent care’ as part of its priorities for urgent and emergency care, and it stipulates that NHS England ‘expect[s] ICBs to continue to meet the Mental Health Investment Standard’ (MHIS) this year. The latter ensures that local funding allocations treat mental health services fairly by either maintaining or increasing the share of NHS funding they receive each year. As a result, mental health services received 9% of ICBs’ ‘baseline spend’ last year and are projected to get 9.01% this year.
Nine per cent of NHS funding for about 23% of ill health is hardly ‘parity of esteem’, but the MHIS continues to provide a safeguard against cuts to mental health care (or the parts of it funded through the NHS at least) in systems that are under enormous pressure from every angle.
The annual planning guidance is not the place NHS England sets out new visions or policies; by its nature it’s about making progress towards longer-term goals, or dealing with immediate and pressing risks. It’s the least we can expect for our mental health services this year, which doesn’t stop ICBs from aiming higher and doing more.
A year ago, the Centre and the NHS Confederation published No Wrong Door, setting out a longer-term vision for mental health, autism and leaning disability services. Achieving this vision in a decade will need more than incremental improvements; it will require sustained commitment to invest in and change mental health services. We know this is possible because the NHS has managed to expand mental health care in the most difficult circumstances over the last five years. Now is not the time to sit back; there’s still a lot to do to reach a point where mental health support in England is accessible, equitable and effective to all who need it.
