The task ahead: embedding a public mental health approach in the reorganised NHS
30 May, 2023
These monthly blog posts by the Public Mental Health Implementation Centre (PMHIC), 'Perspectives on public mental health', aim to highlight the voices of practitioners, patients, carers, and public health experts.
Nearly a year since their formalisation as legal entities, what do Integrated Care Systems (ICSs) mean for public mental health? Oliver Chantler, Head of Policy and Public Affairs at the Mental Health Foundation, and Dr Sarah Markham, Patient Representative on the PMHIC Advisory Board, offer their insights and reflections.
This is a personal blog in which all views and opinions are the authors’ own.
Preventing mental health problems is preferable to waiting until they occur and then attempting to treat them – from both a moral and financial perspective.
Yet moving from this widely shared view to reality on the ground is bedevilled with challenges.
Last year, the Government passed the Health and Care Act 2022, to establish integrated care systems (ICSs) to form the basis of how the health system is structured in England. NHS England describes them as “partnerships of organisations that come together to plan and deliver joined up health and care services.”
There are 42 ICSs, all explicitly intended to focus the system more on prevention. Yet despite this intention, there are real challenges baked into the way they are structured and funded.
For example, each ICS has an integrated care board (ICB), composed of people who should be able to provide all the expertise required to deliver care that is integrated across local authorities, clinical services and others working locally. Yet there is no requirement for public health leaders to be members of ICBs. And if public health tends to be the poor relation of clinical health, then public mental health is the poor relation of the poor relation.
Without accountability, matched by funding, the overwhelming likelihood is that we’ll see no change to the current situation of minimal and sometimes non-existent provision.
We welcome the recommendation of the Hewitt review into ICSs accountability, which asks that spend on prevention is increased by at least 1% over 5 years. The Government needs to accept this and ensure that there is ringfencing for public mental health rather than just the protection of physical health.
Experiences of involvement in Brighton and Hove ICS
Despite the challenges caused by the structure of ICSs and their funding model, a great deal of work is being done locally to try to make them the best they can be.
One of this blog’s authors, Sarah Markham, is involved as a Patient Partner in Sussex Health and Care, the Brighton and Hove ICS and can testify to their determination to do much better in mental health improvement:
“ICSs need to extend partnership working to include patients and the wider public. Patient and public involvement (including co-production) to inform and contribute to transformation both at the system and place level in ICSs will help to identify the most salient needs – and, therefore, the consequent priorities.
"Time will tell whether and where the transformation is successful. But time alone is not enough to effect the desired change.
"Central Government needs to put in place flexible support, resource and regulation. And local systems themselves need to take direct responsibility for prevention. This includes making sure they truly understand the needs of their local area, developing and cross-referencing data across a range of types and sources, and identifying potential systematic errors or conflicts.
"In Brighton and Hove, we have a rich and diverse voluntary sector, many of which are already tailored to support those in its most marginalised but populous communities. At Sussex Health and Care, we will use the data on inequalities reported in our Joint Strategic Needs Assessment to inform our strategy and tactics.
"There is a clear recognition that for this to work everyone must do their bit consistently, reliably, and with motivation and dedication. There is no room for slacking-off or for weak links in the chain of collaboration: people’s lives and wellbeing are at stake.”
Head of Policy and Public Affairs, Mental Health Foundation
Patient Representative, PMHIC Advisory Board
- Charles, A. Integrated care systems explained: making sense of systems, places and neighbourhoods. [Web page]. London: The King’s Fund. Published 9 April 2020; updated 19 August 2022.
- Dunn P, Fraser C, Williamson S, Alderwick H. Integrated care systems: what do they look like? [Online article]. London: The Health Foundation. Published 15 June 2022.
- Her Majesty’s Stationery Office. The Health and Care Act. London: The Stationery Office; 2022.
- Hewitt, P. The Hewitt Review: An independent review of integrated care systems. [PDF]. London: Department of Health and Social Care, 2023.
- NHS England. Integrated care. [Web pages]. 2023. NHS England; 2021.
- The Royal College of Psychiatrists. Integrated care and mental health. [Web page]. London: RCPsych. Published 2018, updated 2021.
- The King’s Fund. The Health and Care Act 2022: our work to inform and make sense of the legislation. [Web pages]. London: The King’s Fund; 2022.