As health and care services evolve, primarily as they move to Integrated Care Systems (ICSs), the College is working to ensure the voices of mental health services and their patients are clearly heard.Working with local leaders we have brought together the opportunities and challenges faced by mental health services and compiled recommendations for local and national leaders to support prioritisation of mental health as ICSs develop.
To encourage changes in how care is delivered locally the NHS Long Term Plan calls on all areas to become “Integrated Care Systems” (ICS) by April 2021. The aim is to achieve a new way of working with even greater collaboration between organisations.
All 44 Sustainability and Transformation Partnerships (STPs) across England will therefore need to evolve further. This will include changes to contracting and funding flows to run local health services in a more pragmatic and coordinated way to deliver primary and specialist care, physical and mental health services, and health with social care.
In an ICS, NHS organisations, local councils and others take collective responsibility for:
- delivering NHS standards
- managing resources and
- improving the health of the population.
ICSs draw on the experience of the 50 ‘vanguard’ sites in England, which aimed to join up GP, hospital, community and mental health services through new models of care.
As all areas work towards becoming ICSs this is likely to significantly change the delivery of care in all local areas in England. And so there’s a huge opportunity for mental health services to be integrated more comprehensively into the wider health system and to give better, more joined up care to people with mental illness.
People living with mental illnesses, and alcohol and substance use disorders, could benefit most from this due to the close links between mental and physical outcomes. Mental illness remains one of the largest single causes of disability in England but two-thirds of people don’t have access to evidence-based treatment and mental health has rarely been prioritised sufficiently in local healthcare planning.
As ICSs develop, health services will be systematically reviewed and re-configured. This throws up challenges around the viability of mental health trusts, many of which might be too small to have their voice heard and could face re-organisation.
In 2017, we published a report with the King’s Fund which looked at mental health plans in the vanguard sites with three case study examples.
In November 2019 we published Improving mental health services in systems of integrated and accountable care: emerging lessons and priorities (PDF).
From our research, policy analysis, site visits and interviews, we have drawn from the opportunities and challenges for mental health to compile recommendations for local and national health and care leaders. These seek to support prioritisation of mental health as ICSs develop over the next 12-18 months and focus on the following areas:
Establishing and maintain a clear purpose and role of ICSs
- All local 5 year plans should reflect mental health commitments in the NHS Long Term Plan.
- Capture learning and share best practice on mental health services within developing ICSs, including through peer support
- Secure mental health services in a shifting health and social care landscape through legislative obligations to reduce inequality and assess gap between people with mental health problems and the rest of the population.
Engage and collaborate during the planning process
- Work with patients, public, staff, local authorities and voluntary sector to develop a shared understanding of patient needs and to design services to meet these needs.
- All STPs/ICSs should be reviewed on their mental health plans and their local people plans, with clear support in place for NHS England and Improvement regional reams
- Greater clarity to be provided on the roles and functions of national organisations in workforce planning
Make use of population health management, data and outcomes
- Develop a population health management workstream which includes mental health expertise.
- Develop a system-wide mental health and wellbeing outcomes framework co-designed with users, which defines partners’ collective ambition for improving outcomes.
- Local systems should be supported with guidance and good practice of how population health management approaches can help address mental health issues as well as wider public health issues.
Using new contractual models to delivery high quality care
- If an ICP (integrated care provider) contract is awarded where mental health services are in scope, their priorities should align with Long Term Plan mental health priorities.
- Sub-contracting a mental health trust should be required to happen in a mutually beneficial way with agreement from both parties.
- Primary mental health care should be a core requirement of any primary medical services integration agreement, even if the local mental health trust(s) are not part of the ICP.
- NHS England & NHS Improvement should review all organisational mergers which include mental health services for risks and benefits in the short-medium-term and in the long-term require a comprehensive risk/benefit analysis.
- NHS trusts should be enabled to act as lead providers of provider collaboratives to act as statutory NHS bodies to commission specialised services for mental health, where clinically appropriate.
Funding, whole population budgets and incentives
- Agree an ICS mental health investment strategy taking account of the NHS Long Term Plan.
- Fairly apportion capital funding to mental health trusts based on ICS estates and capital plans.
Ensuring mental health can play a leading role - leadership and governance
- Mental health leaders’ experiences of working across complex systems is invaluable in supporting others to adapt. Mental health leaders should be at the heart of all relevant local decision-making structures.
- Mental health leadership should always include service users, who are supported to be able to effectively participate throughout planning and delivery.
- To secure current and future leadership capability in mental health the NHS Leadership Academy should establish a Future Mental Health Leaders programme.
- We support NHS England’s view that trusts and CCGs should be able to form joint committees in every ICS to exercise functions, and make decisions, jointly. Statutory guidance should explicitly require mental health leaders at an executive level.