Reform in the midst of Covid-19: cause for cautious optimism?


Rethink Mental Illness Deputy CEO, Brian Dow, tells us why the recent NHS health and social care white paper gives us cause for cautious optimism, and explains the three things that are vital for the government to remember when it comes to mental health care.

Even at the worst of times, it’s entirely possible that things aren’t as bad as you think. In his book Factfulness: Ten Reasons We’re Wrong About The World – and Why Things Are Better Than You Think, the renowned Swedish statistician and international health expert Professor Hans Rosling suggested the vast majority of human beings are wrong about the state of the world. Central to Rosling’s theory is the bias that’s created in our mind by the constant reporting of bad news. Famines, earthquakes, perhaps now even pandemics encourage us to overlook the slow and gradual progress that has been transforming the world across the last 100 years or so.

Fair to say that the last year has provided a bounty of the stuff. The pandemic has caused huge suffering and grief across the globe, turned billions of lives upside down and forced almost all of us to find different ways of living our lives, disrupting carefully laid plans and forcing all of us to reassess our priorities. Given the pressure that our NHS has been placed under and the well-reported impact of a year of disruption, isolation and anxiety on the nation’s mental health, the unexpected publication at great haste of planned health and social care reforms in the midst of a national crisis doesn’t seem to be the news we needed to lift the gloom. As the joke goes – déjà vu – all over again. Well no, not really!

  • With some profound caveats appropriately front-loaded, it is just possible that this reorganisation is something to feel optimistic about.

The central tenet of the reform is integration – the widespread creation of Integrated Care Systems which bring together players in the health and social care field under one roof. It is recognition at long last that the needs of people do not stop when they are discharged from hospital or walk out their GP practice.

One of the things that the pandemic has put into sharp relief is the complexity of our lives, and volatile and unpredictable set of factors that influence our wellbeing. Our mental health depends not just on good quality care of NHS services which can be accessed quickly and close to home, but knowing that we can pay the bills, that we have a safe space to call home, and that we’re connected to the world around us. Our physical health is perhaps the only one of these factors where your worries would lead you directly to the NHS and book an appointment with your GP. It’s unreasonable to expect the NHS alone to provide support for every single element that influences our mental health. Yet so often they are seen as the solution to our collective mental health crisis.

And in truth while the White Paper and its timing made headlines, integration has already begun. Slowly but surely, over the last three or four years, mini versions of these, called Sustainability and Transformation Partnerships (STPs) have been developed to help deliver community care and the first tranche of those Integrated Care Systems (ICSs), which are central to the reforms, were unveiled last year.

  • Simon Stevens, the Chief Executive of the NHS, is on record in saying that one of the most important things to help the NHS deliver effective care is a well-funded social care system.

In welcoming the proposed new reform, which Rethink Mental Illness has done, we need reminding of three things that are vital to remember when it comes to what this means for mental health care.

Firstly, greater integration between health and social care can only succeed with the investment that the social care system has been crying out for. With Local Authority budgets cut so drastically over the last decade and an ageing population turning for social care support in growing numbers, a perfect storm is not just brewing, the first drops are raining down on us. Indeed, if social care isn’t given the funding it needs, we’re in real danger of simply shifting a problem onto a platform which cannot support it. That would be disastrous.

Secondly, when thinking about social care reform, we must take a broad view. For many people severely affected by mental illness, social care is where they find the crucial support they need to stay well and out of hospital. This includes vital services for working-age adults, who are so often left out of this conversation.

And finally, adjusting the balance of power back to the centre should be done in order to drive innovation. The efforts of frontline staff have been utterly astounding over the last year, and one hopes that will be properly recognised at some stage soon, but behind that frontline is an entire economy of care individuals and the wider voluntary sector which has done so much to innovate and meet the seismic shift in demand. Relationships of trust and equality will be critical to the long-term task of integration. As will investment and resource for frontline community services and the voluntary sector rather than hefty contracts to the private sector, which ultimately end up taking more money away from where it’s most needed.

The health and social care system has long been a football kicked in one direction or another every five or 10 years. But despite the scale of the crisis we’ve faced in the last 12 months, progress has quietly been made in the background. If reform is delivered in the right way, we might find ourselves closer to a common set of rules and a framework which will provide us with a health and social care system fit for purpose in our hopefully soon to be post-Covid lives.