The ups and downs of the latest NHS planning guidance

Last week the NHS published its national planning guidance for 2025/26.

This may not sound like the most groundbreaking thing in the world, given the volume of guidance documents that get churned out by public bodies, but if you were going to pay attention to a small number of them, this would be a good one to put on that list.

The planning guidance sets the priorities for NHS systems (Integrated Care Boards) over the coming year. It is the roadmap the NHS uses to decide what to fund and target at a local level.

As the first set of guidance published under our new government, this year’s edition might prove particularly revealing the likely direction of travel.

So, what do we think of it?

One major positive

The Mental Health Investment Standard  has been retained. The MHIS ringfences funding for mental health as a proportion of every Integrated Care Board’s budget. It has been crucial since its introduction several years ago in protecting mental health spending in the NHS.

When worrying reports emerged late last year that the MHIS was under threat, we, alongside a number of charities in the sector, campaigned vociferously that it must be kept. We are thankful to all of our campaigners who made their voices heard, and delighted that the MHIS is remaining in place.

And if any evidence was needed to demonstrate why the MHIS is so important, the rest of this year’s planning guidance does exactly that, because the general direction of the guidance is quite concerning.

Causes for concern

A number of targets which were previously in place for mental health have been dropped, including improving access to community mental health services, anti-racism initiatives, and physical health checks for those living with severe mental illness.

The net reduction in targets is a general theme in the guidance, and reflects the stated desire of the new Government to devolve more decision making to individual NHS systems.

Our concerns arise because this delegation of decision making is not consistent. There are still priorities being imposed from the centre, most notably on bringing down waiting lists for ‘elective care’ (non-emergency interventions which are booked in advance), but mental health waiting lists have been excluded from this.

We are therefore experiencing a double whammy whereby mental health targets are rolled back, at the same time that more emphasis is being placed on waiting lists for physical health only.

A call for clarity

Given the Labour Party manifesto promised to treat mental health with the same attention and focus as physical health, we would like to hear urgent clarity on how the Government intends to bring down waiting lists for mental health as well.

What’s more, we would like clarity on how the Government can ensure progress in community mental health, on anti racism, and on physical health checks, in the absence of set targets in planning guidance. 

The Mental Health Investment Standard will go some way to preventing local systems from raiding mental health budgets as a result of the guidance. However, the MHIS is a floor, not a ceiling, and the relative lack of priority systems will be able to afford mental health is something we will seek to address.

We will continue to campaign, both externally and behind the scenes, for positive change on mental illness, and while there are undoubtedly challenges ahead, we are optimistic that the voice of the mental health sector and our campaigners is powerful and can make a difference.