As clinical commissioning groups and NHS England take on their new responsibilities for real, the NHS mandate has become the key to ensuring that the new NHS commissioners make progress against the Government’s priorities for better healthcare in England.

‘Many of the objectives of the mandate require mental and physical health support to be far better integrated’

The mandate provides the vital link between the NHS and the public nationally, setting out what NHS England in particular will be accountable to the secretary of state (and Parliament) for achieving over the next two to three years.

As a briefing paper published by Centre for Mental Health this month shows, the objectives set out in the mandate cannot be achieved without a major focus on mental health for people of all ages throughout the NHS.

Following the government’s pledge to work towards “parity of esteem” between physical and mental health, the mandate includes a far larger number of commitments to improving mental health support than any of the operating frameworks that were its nearest equivalent in previous years. These include the expectation that NHS England and CCGs will continue to make progress on improving access to psychological therapies, not just for working age adults with depression but for children, older adults, people with long-term physical conditions and those with severe mental illness.

New challenges

The mandate requires the NHS to make progress in securing employment for more people with mental health conditions and to offer more personalised support to people in mental health services, including through the use of personal health budgets. It also seeks to ensure the service looks beyond its conventional boundaries, for example to work with colleagues in public health to improve support for young families and to continue the nationwide expansion of liaison and diversion services in police stations and courts.

It sets some important new challenges to NHS England in improving access to mental health care and bringing greater parity to waiting times. This will take action on several fronts, from speeding up access to care in a crisis to bringing down waiting times for psychological therapies and other forms of mental health support.

‘In the everyday actions of commissioners and providers the separation and inequality between the two will be tackled most effectively’

Many of the objectives of the mandate require mental and physical health support to be far better integrated. From improving maternal mental health to taking action to address the 15-year mortality gap for people with a severe mental illness, the artificial separation of mental and physical healthcare will need to be addressed throughout the NHS. Nowhere in the 21st century NHS should a person’s mental health needs be neglected or professionals lack confidence in dealing with a patient’s emotional or psychological needs.

The mandate will not on its own bring about parity between mental and physical health in the NHS. It is in the everyday actions of commissioners and providers at every level of service that the separation and inequality between the two will be tackled most effectively.

It will require local commissioners to look at where they invest scarce resources to get best effect. It will require continued action to collect robust and useful outcomes data both for mental health services and for people with co-morbidity conditions. And it will require concerted leadership and sustained commitment from NHS England and CCG boards to challenge existing ways of working that stand in the way of parity and integration.

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