The Hewitt Review: What does it mean for people severely affected by mental illness and what’s next?
When people can get the support they need, whether it’s a talking therapy, housing support or speaking to a peer, their recovery journey is smoother and their quality of life improves. This is the outcome we know the public, NHS and Ministers all want to see. It’s not only what people living with severe mental illness should be entitled to, but it also benefits the wider health and care system by reducing the need for crisis services, A&E and expensive hospital beds.
In Autumn 2022, the former Secretary of State for Health, Rt Hon Patricia Hewitt, was tasked by the government to conduct an independent review of the implementation of Integrated Care Systems (ICSs) and set out recommendations for how ICSs should operate going forward. To our delight, the report which was published on Tuesday (4 April), has championed a shift to invest in care ‘upstream’ to more preventative support. ICSs are the vehicle which integrates health and care to improve population health based on local need and where they are investing in this shift, we’re starting to see huge benefits.
What is the impact on mental health care when there’s better cooperation?
Somerset is just one example where the Integrated Care Board (ICB) – the part of the ICS which plans and commissions local NHS provision – has brought together the local authority and an alliance of voluntary, community, faith and social enterprise (VCSFE) organisations along with people with lived experience to co-produce a transformation in community mental health. It has broken down barriers to accessing mental health support and improved prevention, early intervention and the provision of holistic support across mental health. The area is now seeing around a 15% decrease in Emergency Department presentations and 10% reduction in admissions for adults presenting with mental health need. The difference is even more significant for older adults, who have seen a ~25% decrease in presentations and a ~40% decrease in admissions. While the causal link cannot be definitively proved, it appears likely that this is a significant factor, particularly as this change is not mirrored in services for children and young people where this way of working hasn’t yet been implemented.
Therefore, with the significant focus outlined in the Hewitt Review on prioritising mental health, social care and prevention, we warmly welcome the Review’s findings. However, while what is happening in Somerset is being replicated in many ICSs around the country, it is certainly not widespread. Many ICBs continue to, as Hewitt says, ‘focus on improving flow through acute hospitals’ which ‘will simply channel more and more of an older and increasingly unhealthy population into acute hospitals, which will never be large or efficient enough to cope’. We are therefore concerned that without adequate accountability, funding and strategic oversight, ICSs will struggle to prioritise the needs of those living with severe mental illness.
We urge the government to take up many of the Hewitt Review’s findings, as outlined below, but we are also keen for there to be much more clarity on where national oversight and accountability lies.
What are the key points for people living with severe mental illness?
Retaining mental health and social care as national priorities
We are pleased to see this as our, and our partners’, experience is that even with current policy commitments and targets set out by the NHS Long Term Plan, it can still be challenging to ensure that mental health is prominent on ICS agendas due to other competing pressures. The focus on striving to achieve parity of esteem - where mental health is valued equally to physical health - is also welcome.
Advocating a more holistic approach to health
The report states that there is a growing number of people living with complex, long-term conditions and highlights the impact of wider determinants on health, such as economic deprivation. We know that people severely affected by mental illness want to have their wider needs met and have designed our vision for Communities That Care so that it accounts for a range of issues that impact on people’s mental health. We are therefore pleased to see this ethos reflected in this report.
Promoting a strategic approach to healthcare
We have consistently called for the revival of the recently abandoned 10-year cross-government Mental Health and Wellbeing Plan and so we welcome the report’s call for a national, cross-government mission that would provide strategic direction around health improvement.
We also welcome the Hewitt Review’s support for the NHS Assembly as a forum that brings together a range of partners from inside and beyond the NHS to act as a critical friend to NHS England. We support the Review’s call for a Health, Wellbeing and Care Assembly to facilitate the transition to focusing on prevention, population health and health inequalities.
Promoting co-design and co-production with local communities
As one of the core purposes of ICSs is to reduce inequalities in terms of patient outcomes, ensuring that people severely affected by mental illness - and their wider support networks - can shape the design and delivery of services they use, is vital to identifying key barriers that might prevent anyone from accessing the help they need.
What is needed to support ICSs going forward?
We are concerned that without adequate planning and investment, ICSs will struggle to implement the steps outlined above; the following conditions are needed to make these a reality.
There must be sufficient scrutiny over mental health to ensure that progress is being made against key metrics. We would urge that NHS England’s Mental Health Independent Advisory and Oversight Group continues to provide this national oversight.
The current picture for healthcare funding is looking bleak. On top of existing pressures, ICBs are expected to receive a 30% funding cut by 2025/6 (unless the government takes up Hewitt’s recommendation to reconsider the final 10% of cuts) and the planned social care workforce funding will be half the amount as expected. In addition, a wide body of organisations including those representing patients and their carers are highly concerned that we still don’t yet have a comprehensive resourced plan to address serious shortages across the health and care workforce.
Long-term strategic vision
We remain deeply disappointed by the shelving of the 10-year cross-government Mental Health and Wellbeing Plan and are concerned that the Major Conditions Strategy that was announced in its place will not sufficiently focus on mental health or cross-governmental collaboration; this type of cross-societal approach is vital given the importance of addressing the wider determinants of physical and mental illness rather than piling ever more demand on the NHS.
What happens next?
We look forward to hearing the government’s response to this independent review and we hope the response reflects the seriousness and the urgency of the situation.
While we would warmly welcome the implementation of many of these recommendations, we urge the government to consider the wider systemic changes that need to be put in place for ICSs to deliver on their promise and ensure that people severely affected by mental illness are able to get the support they need.
If you would like to know more
For more information on how ICSs operate, please click here.