“NHS planning guidance gives commissioners autonomy but must not come at expense of people with mental illness” says RCPsych

Statement / comment
31 January 2025

NHS England has published new planning guidance which sets out its priorities for 2025/26. 

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

“The latest NHS planning guidance gives commissioners more autonomy to focus on local population healthcare needs, which should, if done in accordance with the prevalence and severity of healthcare need, benefit those with mental illness. However, we are deeply concerned that without mandated guidance about how to prioritise investment, this autonomy will come at the expense of people who have a mental illness.

“There has been a substantial rise in the number of people with significant and severe mental ill-health in recent years, including those in crisis. Mental health care receives 10% of health spend, despite 20% of the population per year having a significant mental health problem. These people urgently need better access to high-quality services, but they are marginalised and often the first to be overlooked when resources are rationed at a local level. Delaying treatment results in disability.

“We’ve seen in the past that people’s long-term health and that of the economy is put at great risk when funding is diverted away from mental health care, particularly during a time of chronic under-investment. The Government must ensure commissioners prioritise the significant mental health needs of their local population and allocate resources appropriately.

“We’re also worried that targets which require services to provide essential care to those with severe mental illness, such as annual physical health checks, have been cut from the planning guidance. While the removal of excessive numbers of targets is necessary, they can help drive improvements in patient safety and quality of care, therefore it is crucial that the right targets are kept. 

“The exclusion of targets to diagnose dementia, the leading cause of death in England and Wales, as well as the removal of mandates to roll out women’s health hubs is particularly concerning. It is crucial that some of these ambitions are retained and reinforced elsewhere, such as in the upcoming NHS 10-Year Health Plan.

“The Mental Health Investment Standard (MHIS) has helped services meet some of these targets in previous years and the Government’s commitment to it is reassuring. The MHIS has also supported the expansion of several different services which have enhanced patient care and outcomes, and we must build on this progress rather than allowing it to falter.

“The Government’s focus on increasing access to children and young people’s mental health services, improving discharge times for mental health patients, and reducing waiting times in A&E is positive. We welcome this prioritisation and hope it will be extended to the 1.6 million people waiting for mental health care who are not currently part of the Elective Reform Plan. This would clearly demonstrate the government’s understanding of the impact of mental illness on productivity and economic growth. 

“Unfortunately, ICBs are under enormous pressure due to rising demand, health provider staff shortages and a lack of resources. Any changes to make services more efficient and productive must also deliver better outcomes for patients. Services will need to be provided with additional support to deliver this and take full advantage of the MHIS.

“The Royal College of Psychiatrists is ready to use its expertise and experience to assist commissioners and providers in making evidence-based, intelligence-led commissioning decisions. 

“It is evidential that by improving access to care, we can prevent people from becoming seriously unwell and falling out of work - supporting them to lead healthier lives and enhancing the productivity of the nation.

“The College will continue to argue for mental healthcare to be prioritised in line with the actual prevalence of mental illness in the population and work with services to support the implementation of this new guidance, but more than anything, what is needed for people with mental illness and those who support them to thrive.” 

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