About the strategy
NHS England and NHS Improvement published its first Advancing Mental Health Equalities Strategy in October 2020, which summarises the core actions the NHS needs to take to bridge the gaps for communities fairing worse than others in mental health services.
The strategy sits alongside the NHS Mental Health Implementation Plan 2019/20 – 2023/24, which sets expectations for reducing mental health inequalities in local communities by 2023/24. Those leading *integrated care systems (ICS) have also been required to plan to step up action to address health inequalities as part of their response to COVID-19.
NHS England and Improvement has committed to take a range of actions in three areas to support the delivery of the strategy:
Supporting local health systems
NHS England and NHS Improvement will develop its patient and carers race equality framework and use it to support mental health services to improve Black, Asian and minority ethnic communities' experiences of care. NHS England and NHS Improvement also commits to developing a framework to capture the impact of partnership between providers with regards to inequalities, directly support and fund schemes that can address inequalities, as well as document and share positive practice.
Data and information
NHS England and Improvement commits to improving the quality and flow of data and to develop headline indicators of mental health equality to monitor changes in mental health equality over time, and identify where improvements need to be made. These indicators will be made publicly available by the end of 2020/21. NHS England and Improvement has said financial incentives will also be used, where possible and appropriate, to encourage improvements.
Workforce
NHS England and Improvement has said it will circulate emerging evidence of positive practice in advancing disability and race equality in the workforce, and support systems to review routes into training. NHS England and Improvement commits to developing a workforce reflective of local communities that is equipped with the skills and knowledge required to advance mental health equalities. It will also identify opportunities to embed equalities thinking in teaching developments for new staff and encourage uptake of positive practice models.
What the strategy means for providers
We welcomed NHS England and Improvement setting out in more detail how it plans to support those leading local ICSs to better address inequalities in access, experience and outcomes of mental healthcare. Targeted action is crucial to addressing the substantial 'care deficit' that remains in mental health, despite growing aspirations and welcome progress made in recent years. NHS England and Improvement is right to be taking further steps to improve all people's access to high quality care and support, and ensure the provision of mental health services that advance equality is adequately prioritised across the country.
It will be important for NHS England and Improvement to fully involve trusts in taking forward the actions outlined in the strategy to ensure they are delivered successfully.
Senior Policy Advisor (Mental Health)
NHS England and Improvement's focus on supporting greater integration and on improving data and information is welcome, given the need for a greater understanding within systems of mental health and wellbeing needs, and the prioritisation of services locally to meet these needs. The emphasis on NHS England and Improvement's role in identifying and sharing positive practice so leaders can learn from what works in a systematic and coordinated way is also welcome. It will be important for NHS England and Improvement to fully involve trusts in taking forward the actions outlined in the strategy to ensure they are delivered successfully.
What this means for governors
The strategy rightly underlines the NHS' duty to advance equalities in the services it provides, though it is recognised that the NHS cannot alone solve the causal factors which increase the likelihood of developing a mental health problem. Broader action is required to tackle the wider causes of mental ill health, including national policy focused on increased support for both mental health and public health. Further key priorities for action to address the historical, structural disadvantage facing mental health provision include: ensuring the sector receives its fair share of revenue and capital investment; improving and making funding processes more transparent; and setting clear expectations around the delivery of national investment and initiatives.
Governors can use their holding non-executive directors to account duty to seek assurance on how their trust is working to support the delivery of the strategy, and if any new steps are being taken by their trust's board in light of its publication. Once developed and published, the headline indicators of mental health inequalities, and structures concerning patient and carer race equality, will be particularly useful sources of information for governors, which can be viewed alongside other third party sources of assurance.
*The NHS long-term plan has reinforced the role of integrated care systems (ICSs) in establishing more joined up working and care for patients and their local populations. ICSs will cover the whole of England by 2021.
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