The Major Conditions Strategy: Too narrow, but a move in the right direction

In January 2023, the government announced it would be shelving its 10-year plan for Mental Health and Wellbeing, replacing it with a new shorter-term Major Conditions Strategy that would look at mental health alongside a number of health conditions. In this blog, Kirsten from our policy team looks at the new proposals and asks, could this change in direction deliver better outcomes for people living with mental illness?

Having reviewed the government’s new plan for a Major Conditions Strategy, we can now share feedback from the 10-year Cross Government plan for Mental Health and Wellbeing consultation and explain why we still believe that a cross-government plan will lead to better outcomes for people with severe mental illness.

In April 2022, the Department of Health and Social Care (DHSC) published a call for evidence to gather the public’s views on what can be done to improve people’s mental health and wellbeing and prevent suicide. We responded enthusiastically and encouraged others to do so  as well.

The evidence was to feed into a 10-year Cross Government plan for Mental Health and Wellbeing and a separate suicide prevention strategy. The government has re-committed to publishing the suicide prevention strategy (although we haven’t seen it yet), but we were disappointed that they shelved the 10-year Cross Government plan for Mental Health and Wellbeing.

Instead, they announced a new ‘Major Conditions Strategy’ which is shorter-term, and less likely to involve actions across government to tackle the causes of poor health. DHSC tell us that the contributions from people with lived experience will be incorporated into this strategy, but mental health will be included as just one ‘condition’ alongside others.

Why do we still believe a 10-year cross-government plan is needed?

The Major Conditions Strategy is less than we hoped for. Whilst it hopefully can deliver some shorter-term improvements, we don’t believe that it will deliver what is needed for mental health in the longer-term.  

The demand for mental health support is rising. The National Audit Office (NAO) recently estimated that up to eight million people with mental health needs are currently not in contact with mental health services. Last October, the Royal College of Psychiatrists found that 43% of adults with mental illness cited the long wait for treatment as making their mental health worse with 23% having to wait more than 12 weeks to start treatment.

Factors such as good housing, support to find and keep the right job, social care, as well as timely access to treatment and support from the NHS, can all affect a person’s mental health.  Each of the government departments responsible for these areas need to be reflected in a cross-government plan. Additionally, they need to put mental health at the heart of their policy-making and commit to providing adequate funding for effective action.

What is the Major Conditions Strategy?

The government has launched a call for evidence for their new Major Conditions Strategy which we encourage you to respond to. The ‘Major Conditions Strategy’ aims to address ill-health and early mortality in England.

The strategy targets six ‘major conditions’:

• Cancer
• Cardiovascular diseases, including stroke and diabetes
• Chronic respiratory diseases
• Dementia
• Mental ill health
• Musculoskeletal disorders

The strategy reflects the fact that many people live with more than one condition, and that the conditions may be linked. For example, we know that living with a serious physical condition can affect someone’s mental health, and vice-versa.

The Strategy also comes at an interesting time. Since its launch in 2019, NHS England’s Long Term Plan has shaped much of the work that the health service has been doing. Most of the commitments in this plan are intended to be achieved by next March, but there is still much to do, some targets will remain unmet, and it is unclear what will happen after that point.

With an election on the horizon, the ‘Major Conditions Strategy’ could fill the gap and ensure that where progress has been made, such as the significantly higher numbers of people with mental illness now receiving an annual Physical Health Check, and the huge success in some areas in ‘transforming’ community mental health services, continues.

A cross-government plan for mental health – what did you have to say?

Over 4500 individuals and almost 600 organisations responded to the DHSC consultation for the now-abandoned 10-year Cross Government plan for Mental Health and Wellbeing.

From reviewing the responses from organisations and individuals, we have identified these key themes;

Ensuring care is individualised and holistic

People want services to be joined-up support and consider all the needs of the person.  They want support to meet the needs of people from different cultures and backgrounds and be accessible for disabled people.

Tackling stigma and discrimination

Respondents believe that the government needs to do more to tackle stigma and discrimination about mental illness. Stigma can create fear and prevent people from accessing the support they need when they first need it. Greater public awareness of mental illness is needed to reduce stigma and encourage people to seek help.

Addressing the social determinants of mental health

People felt that more should be done to tackle the issues that contribute to poor mental health, such as housing, finances, employment, education and physical health.

Improving mental health services

People want to see a range of improvements to mental health services, including better access to services, shorter waiting times, a greater range of treatment and support options and more focus on prevention and early intervention. Our research shows that people wait too long to receive mental health support and too many people fall through the gaps in treatment and care. We must have a properly funded and resourced mental health system to make sure that people can access the right treatment, in the right place, and at the right time.

What conclusions can we draw from the consultation?

These responses tell us that the Major Conditions Strategy is a move in the right direction, but still not enough. The government’s approach is too narrow and appears to focus on the NHS. While the strategy might offer continuity as we approach the end of NHS England’s previous Long Term Plan, it cannot possibly deliver on its person-centred promise if it considers the person’s health in isolation to their wider life. 

This is why our ‘Keep Your Promise’ campaign continues to call on the government to deliver a 10-year cross-government plan for mental health. This has the potential to bring government departments together with the NHS and other bodies to ensure that all people, including those living with a mental illness, can live well and thrive in their local communities.