Challenging cuts to mental health services
Sometimes local authorities or the NHS make cuts or closures to mental health services. They may say this is needed to modernise services, or for financial reasons. It is possible for you to challenge cuts or closures and this section suggests ways you can do this. This information is for adults affected by mental illness in England. It’s also for their loved ones and carers and anyone interested in this subject.
If you would like more advice or information you can contact our Advice and Information Service by clicking here.
- Sometimes speaking to service managers, the media, social media or contacting your MP is the quickest and cheapest way to challenge decisions.
- There may be a public consultation before services are cut. A consultation tells the public about the proposals and asks for their views.
- If there is a consultation, you should be given enough time to respond to it.
- You may be able to apply for judicial review if the local authority or NHS acts unlawfully. Or doesn’t do a consultation when they should have.
- If you want to request a judicial review, it’s best to get a solicitor. You might get the fees paid by Legal Aid. But if not, you might have to pay the fees yourself.
Why do cuts happen?
Why do some mental health services get cut?
What is NHS policy on funding of services?
The NHS Constitution has principles on how the NHS should be run. Principle 6 talks about:
“providing best value for taxpayers’ money….. [and] the most effective, fair and sustainable use of finite resources.”
This means the NHS must review its services regularly. Sometimes services no longer fit with the NHS plans or budgets.
NHS Clinical Commissioning Groups (CCGs) and local authorities decide which services they will offer in your local area. The people who make these decisions are called commissioners. If commissioners make cuts, they will sometimes close services and replace them with a cheaper alternative.
What if I am using the service?
What will happen if I am using the service?
It isn’t possible to say exactly what will happen to your mental health care if the service is due to be cut or closed. But the NHS and the local authority have a duty of care to signpost you to alternative services and support.
What will happen if I’m using an NHS service?
If an NHS service is cut or closed and they can’t support you anymore, they will need to follow their discharge policy. You can ask them how you will get help for your mental health in the future.
What will happen if I’m using a social care service?
You might receive social care. Your local authority has a legal obligation under The Care Act to meet any eligible needs that you have.
A service you use to meet your needs might close or be cut because of financial issues. If all your needs are no longer met, the local authority need to ensure another service meets your needs.
You can find more information about ‘Social care and support planning’ by clicking here.
Can I challenge cuts?
How can I challenge cuts or closures?
There are several things you can try. Don’t give up hope if one doesn’t work as a different one might.
How can I contact the service provider directly?
A good way to start challenging possible cuts is to contact the managers who run the service. You can try to talk to them in person or over the phone. Or you can email them or send them a letter.
The managers may also be against the cuts and may want to help you or put you in touch with other people who feel the same way. They might to hear your views, and the views of others, so they can use these to challenge commissioners.
What are Patient Participation Groups?
Patients must be involved in the commissioning process. You can join a patient participation group (PPG) at your GP’s surgery, which every surgery must have. This may give you access to the CCG and an input in the commissioning process.
What is campaigning?
Campaigning is trying to reach a goal by gaining support for an issue you believe in.
If you decide that you want to campaign, it is important to do some background work. You need to make sure that you have evidence to back up what you say. There is information on how to get evidence in next section of this page.
There’s information on Rethink Mental Illness’ website about starting your own campaign: www.rethink.org/media/2114/rethink-mental-illness-take-action-guide.pdf
Also, you can find information about Rethink Mental Illness’ current campaigns here: www.rethink.org/get-involved/campaign-with-us/
There may be a local service user group or NHS patient campaigning group in your area. If there is, they may already be campaigning on the issue or they may be able to support you with your campaign.
Campaigning can take up a lot of time and be tiring. But it can help if you campaign with others who have the same views as you. Think about how you can best balance campaigning with your mental health needs.
What is a public consultation?
A consultation tells the public about proposed changes and asks for their views. The NHS should only make significant cuts if they consult the public first.
The information about the consultation will tell you how you can provide your views and feedback. This could be by an online survey, email or letter. They should give you enough time and information to provide your views and feedback.
There is more information about consultations further down this page.
Who are Healthwatch?
Healthwatch find out what matters to people who use NHS and social services. They help make sure people’s views shape these services.
Local Healthwatch services are there to find out what people like about services, and what could be improved. They share these views with those who can make change happen.
You can contact your local Healthwatch to tell them about your views on cuts to services. They may be escalated to the national Healthwatch service.
Your local Healthwatch has a seat on your local Health and Wellbeing Board. This means your local Healthwatch and can challenge clinical commissioning decisions.
You can find your local Healthwatch here: www.healthwatch.co.uk/find-local-healthwatch
What are Health and Wellbeing Boards (HWB)?
Health and Wellbeing Boards are a partnership between the NHS, public health and local government. Together with Clinical Commissioning Groups (CCGs), they have a legal duty to produce a joint health and wellbeing strategy for their local population.
The members of a local HWB should include:
- senior health and social care managers,
- someone from the local Healthwatch,
- someone from the CCG, and
- at least one councillor.
HWBs have the right to challenge the CCG’s decisions to cut services.
You can speak to your local councillor or MP about your concerns. They could pass on your concerns to the HWB.
You can find out who your local MP is by using this link:
You can find out who your local councillors are by using this link:
What is Judicial review?
Judicial review is a type of legal case. It means that a judge decides whether a government body has acted legally.
You might have tried all the steps above and feel that they haven’t worked. You can think about asking for a judicial review.
There is more information about judicial review further down on this page.
How can I get evidence for a campaign?
If you want to start your own campaign about cuts or closures of local services, you will need to gather evidence. Evidence will help you to show the impact the proposed cuts or closures will have on local people.
For example, the local authority or NHS may think they are saving money by cutting a service. While the cut might save money in the short term, it could cost them more in the long term.
People may have to use crisis services more often if the service is no longer there to keep them well. Any evidence that the service stops people from using crisis or hospital services may be helpful.
Think about getting the following information as evidence for your campaign.
- The benefits the service has for people.
- What will happen if people can’t use it anymore.
- Information about the financial effects of the cuts. How does the service save money?
You could get this from different sources, including:
- evidence from focus groups, and
- case studies.
What is a service evaluation?
A service evaluation says how a service has been performing. They are written by organisations that ‘inspect’ or ‘audit’ the service.
If the service has any evaluations that it is willing to share, these may have useful information you can use in your campaign. You may be able to get copies of the service evaluation from your local Clinical Commissioning Group (CCG).
How can I do a survey?
Surveys can be a quick way to get evidence from a large group of people.
You can send out surveys online or by post. But online surveys tend to reach a wider audience and are quicker and cheaper to do.
The more people you get to do the survey, the better. If you keep the survey short more people are likely to complete it.
There are websites which you can use to make online surveys such as:
You can get useful tips about what makes a good online survey here:
What are focus groups?
A focus group is a way to gather a small group of people to discuss a topic that affects them, such as NHS cuts. You could arrange a focus group in your local area to interview people affected by the proposed closures or cuts. Focus groups work best when the groups are small, ideally less than 10 people at a time.
For useful tips on how to run a focus group, Citizens Advice provide a free guide here:
What are case studies?
It can be useful to share personal stories of people who have used the service that’s at risk. You can ask them about the impact this service has had on their lives. You can also ask them to think about how their life will be different without being able to use the service.
If you want to share someone’s case study, make sure that you get the person’s permission first. If the person would prefer not to give their name, you could change it when you write the story.
How can I raise awareness about my campaign?
It can help to get other people or groups to support your campaign. This could help to make your argument stronger. You can share information about your campaign through social networking sites like Facebook and Twitter.
How can I write a ‘brief’?
If you want other people to get involved in your campaign, you could write a brief. A brief helps to provide a summary of what your campaign is about. It sets out your argument and tells other people how they can help.
When writing a brief, you should include:
- what will change if the cuts happen,
- how people will be affected by the change,
- what evidence you have found,
- how people can take part in the campaign, and
- how people can contact you.
Be careful to present your findings accurately and honestly. Keep people’s information secret if they prefer this. You can do this by removing names and other identifying information.
How can I contact my MP?
You can contact your MP to tell them about your concerns. They may support your campaign or write to services on your behalf.
How can I find out who my MP is?
You can search to see who your local MP is at www.parliament.uk/mps-lords-and-offices/mps or contact the House of Commons Information Office. Their details can be found in the Useful contacts section at the bottom of this page.
How can I contact my MP?
There are different ways you can contact your MP. You could try the following.
- Use an online template. You can find one here:
- Send an email. You can share it with other people who support you if you want to.
- Meet your MP in person at a ‘surgery’. All MPs hold surgeries where people in their constituency can meet them face-toface to discuss issues. You can search online to find out when your MP holds their surgeries. Or contact them and ask.
- Write a letter. Their address will be: [Your MP’s name], House of Commons, London, SW1A 0AA
How can I use the media?
You could contact local newspapers, radio or television to see if they are interested in running a story on the planned cuts.
If the campaign has a lot of local support or involves lots of local people, then they are more likely to be interested. They are also likely to want to speak to someone who is part of the campaign and may ask you to do an interview.
How can I use social networking sites?
Social networks such as Facebook or Twitter are a good way of making people aware of the proposed cuts.
You can use social media to contact campaigners and groups, who can help to publicise your cause. Social media can be an effective way to organise campaigns and actions.
Should there be a consultation before a service is closed or cut?
What is a consultation?
A consultation tells the public what the local authority or NHS is planning and asks people to put their views forward.
The law says that the local authority or NHS should consult the public if they are making a significant change.
Once a local authority or the NHS decides to consult the public, they should:
- consult the public in good time, so they can look at responses before making the final decision,
- give you enough information so you can respond in an informed way,
- give you enough time to respond, and
- think about all the responses.
When does there have to be a consultation?
Your local authority or the NHS must consult local people if:
- the law says they must,
- they promised to,
- it would be unfair if they didn’t consult, or
- the changes will have a serious impact on people.
What is judicial review?
Judicial review is a type of court process. At a hearing a judge will decide if a public body has followed the law when making a decision or taking an action.
Judicial review focuses on whether the law has been correctly applied, and if the right procedures have been followed. It doesn’t decide if the decision is right or wrong.
A local authority or the NHS might not have done a proper consultation before cutting a service. If this is the case, judicial review is an option you can use.
Where do I start?
The process is complicated, and you must act quickly. You only have 3 months from the start of the decision you are challenging to apply for judicial review.
If you can, you should get advice from a solicitor who specialises in ‘public law’. See the section ‘Do I need legal advice?’ below.
You need to have ‘sufficient interest’ in the case. This means you need to be directly or indirectly affected by the decision. Usually you will be the person using the services or their carer.
What will happen?
There are 2 stages.
First, the judge must agree that you have a case. If they think you do, there can be a full hearing. You don’t normally have to go in person to the court or give evidence.
The judge will think about whether the local authority or NHS made the decision in the right way. This includes whether they:
- didn’t have the power to make the decision,
- followed a very rigid policy when they shouldn’t have,
- thought about equality issues,
- thought about the wrong things,
- didn’t consult local people, or
- refused to take important evidence into account.
The judge can’t say that cutting a service is the wrong decision. So, in some cases, challenging the decision may just delay it. If the judge thinks the local authority or NHS has made the decision in the wrong way, they may just do it again properly.
You can find out more about the judicial review process here:
What is an injunction?
Once a judicial review case has started, it is possible to ask the court for an order, known as an ‘injunction.’ This is to stop the cut being made while the judicial review case is ongoing. These orders can be made quickly if necessary.
An injunction could be important, as sometimes it can take a long time for courts to hear judicial review cases.
Is judicial review the right option for me?
Judicial review might be the right decision for you, and others who might support you. Don’t be put off by challenging a big organisation like the NHS. People do win judicial review cases.
But you should be aware that you can’t get financial compensation from judicial review. They can take a long time and a lot of work. So, think carefully before you go down this route.
Do I need legal advice?
If you want to go to court, we recommend you get advice from a solicitor. Try to get advice from a solicitor who has experience of judicial review of NHS or local authorities.
You can search for a solicitor on the Law Society website: www.solicitors.lawsociety.org.uk/. Where it says, ‘Your legal issue’, choose, ‘Social welfare, health and benefits’ from the drop-down menu.
What is legal aid?
Judicial review cases can be very expensive to do, so a solicitor might be expensive.
But if you can’t afford to pay for a solicitor, you may be able to get legal aid. Legal aid can help meet the costs of legal advice, and representation in a court or tribunal. You will need to find a solicitor who does legal aid work.
You can check to see if you can get Legal Aid by using this website: www.gov.uk/check-legal-aid. Or by contacting the Civil Legal Advice Service. You can find their contact details in the Useful contacts section at the bottom of this page.
If you can’t get legal aid, some charities or interest groups may be willing to fund judicial review on your behalf. You can find out how you might be able to get free legal help in our ‘Legal advice’ factsheet.
You can find more information about ‘Legal advice’ by clicking here.
Care Quality Commission (CQC)
Responsible for completing checks and reports on standards of NHS services and care homes.
Telephone: 03000 616161 (Open 8.30am to 5.30 pm Monday to Friday, excluding bank holidays)
Address: CQC National Customer Service Centre, Citygate, Gallowgate,
Newcastle upon Tyne, NE1 4PA
Civil Legal Advice (CLA)
Provides information and advice on Legal Aid
Tel: 0345 345 4 345 (9am to 8pm Monday to Friday and 9am to 12:30pm Saturday)
Minicom: 0345 609 6677
A digital campaign platform to start your own campaign or support a local campaign.
House of Commons Enquiry Service
Can provide advice to the public about the House of Commons and help put you in touch with your MP.
Telephone: 0800 112 4272 (Freephone) (10am to 12midday and 2pm to 4pm Monday to Friday)
Address: House of Commons Information Office, House of Commons, London, SW1A 0AA
Information Commissioner’s Office (ICO)
An independent authority that protects an individual’s right to have their data protected.
Online resource for making and sharing petitions. Each local authority should have a petition scheme which states how many signatures are needed to respond to different petitions.
The Law Society maintains a list of practising solicitors in England and Wales. You can use their website to find a local solicitor.