RCPsych responds to Darzi review of NHS England

Statement / comment
12 September 2024

Lord Darzi has published a report outlining the results of his investigation into the National Health Service in England.

Responding to the review, Dr Lade Smith CBE, President of the Royal College of Psychiatrists said:

“The Darzi Review has laid bare the scale of the challenges facing the NHS and the impact these issues are having on patients and staff across the country. It rightly highlights the need for direct action to improve the provision of mental healthcare and the long-term benefits this will bring.

“We’re seeing more people in need of mental healthcare than ever before. They deserve compassionate and timely care in spaces which are fit for purpose – we know that early and assertive treatment is effective in stopping people from developing chronic problems. This is not only good for people’s health, but will also improve the nation’s productivity.

“There were 6.8 million referrals to mental healthcare in England in the last year alone, up from 5.5 million in 2019/20. This includes nearly one million referrals to children and young people’s mental health services, which have increased by 140% since the pandemic.

“Many services are struggling to manage this enormous pressure and consequently an estimated 1.6 million people are being forced to wait for essential mental health support. Delays to care put people at greater risk of developing a more severe and chronic condition, and this ultimately puts the NHS under even greater strain.

“People who have a mental illness also often have complex physical and social needs which require support from a variety of services both within and outside the NHS. They should be able to access joined-up care, particularly in the community, which addresses all their needs holistically rather than one at a time.

“Darzi recognises the ‘fundamental problem in the distribution of resources between mental health and physical health’ – Government must now address the historic under-investment in mental health services, chronic workforce shortages and deterioration of the mental health estate, starting with the Emergency Budget and Spending Review. This should include plans to tackle challenges affecting staff wellbeing and retention, ensuring experienced staff remain within the health service.

“Unfortunately, 15% of mental health and learning disability sites were built before the NHS was established while the high and significant risk maintenance backlog has doubled to over £188.6m since the pandemic. It is difficult to provide effective care in such settings and the Government must commit to ring-fenced capital funding for a new Health Infrastructure Plan for Mental Health in the upcoming Budget. This should include a £1bn building and development programme to enable 12 major building and redevelopment schemes.

“While many of these challenges are significant, they can be overcome with targeted action, innovation and funding. For example, the majority of mental healthcare is delivered in the community, yet until 35 years ago, nearly all of mental healthcare was delivered in hospitals. Mental health services continue to refine community care and have seen great results in areas where the new Community Mental Health Framework has been implemented effectively, such as Tees Esk and Wear. There have also been significant improvements in the provision of physical health checks for people who have a severe mental illness.

“We all understand these are difficult financial times, but it is important to acknowledge the difference between spending and investment because investment can have significant benefits. This is especially pertinent given the impact that mental health problems have on productivity.

“The £87 million from the recovery package provided to mental health services during the pandemic helped prevent delayed discharges from rising, but when this was not renewed, delayed discharges increased by 70% in the following two years. Today, around one in ten adult acute mental health beds are now occupied by someone who is clinically fit for discharge – reducing the therapeutic benefits of care and costing the NHS unnecessarily.

“Rectifying the issues which the Darzi Review has clearly outlined must serve as the first step towards the development of the longer-term plan for the NHS, and the College looks forward to continuing to support DHSC with this vital work.”

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