Blog post

The elective backlog casts a long shadow

While all eyes are on reducing the 6.6 million elective care backlog, we also need to ensure that out of (acute) hospital does not mean out of mind.
Victor Adebowale CBE

2 August 2022

Lord Victor Adebowale emphasises the significance of upgrading mental health services within the NHS, pointing out that increasing living costs have simply widened the gap for mental health facilities.

National efforts to eliminate elective waits are incredibly important and colleagues across the NHS are working hard to make it happen. But there is a risk that the 6.6 million elective backlog casts a long shadow over the demand gap in other services.

The most recent NHS data suggests more than 900,000 people are awaiting community treatments or therapies while there are 1.6 million people waiting for mental health services. We have seen an 80 per cent rise in children and young people referred to mental health services since the pandemic began and heard stories such as the woman who had to wait for eight days in accident and emergency because there were no mental health beds for her.

Mental health has not been part of the dialogue in the ongoing contest for our new Prime Minister

Unlike for the elective recovery, there is no dedicated funding to restore backlogs of care in mental health or community services, or to deal with the spike in demand. Mental health has not been part of the dialogue in the ongoing contest for our new Prime Minister.

It is scarcely believable that 70 per cent of under 18s needing specialist physical healthcare would be unable to access it, yet that’s exactly what’s happening with children and young people who need mental health support.

Rising complexity

The cost-of-living crisis will only exacerbate the demand gap for mental health services, and our members in the mental health sector tell us it is unhelpful to just talk about rising demand; we also need to talk about rising complexity. They tell us patients are needing a higher intensity of support, requiring more resource.

There have been modest but valuable funding increases for mental health services over the past few years, and the sector is treating more and more people each year, but inflation is eating away at budgets, we have a workforce crisis, and the assumptions of the NHS Long Term Plan are not fit for the world we now live in.

There is a real risk that mental health will not be seen as priority and resources will be quietly reallocated

There is hope on the latter, with the refresh of the NHS Long Term Plan, and we need to see the update pay attention to the circumstances in the mental health sector. There is a real risk that mental health will not be seen as priority and resources will be quietly reallocated.

While staffing shortages, increased demand and constrained funding are unlikely to be solved in the snap of the new Prime Minister’s fingers (though we will keep lobbying for a fully funded workforce plan and investment in services), there are policy changes that NHS England, including through the long-term plan refresh, can do.

The solutions are known

We know what the solutions are: there are brilliant people doing brilliant things all over the country and the benefits of treating people with mental illness are spread far and wide. National plans need to take account of them and enable them to happen all over the country.

  • Around 40 per cent of GP appointments are related to mental health. Mental health practitioners in primary care increase capacity in GP practices and free up staff to support those with less complex needs.
  • Psychiatric liaison teams in acute hospitals have a return on investment of £3 saved for every £1 invested by improving patient flow and speeding up discharge.
  • Around 45 per cent of all GP appointments and half of all new visits to hospital clinics in the UK are due to medically unexplained symptoms, and the most effective treatment is psychological support.
  • About two-thirds of people with a physical health long-term condition also have a mental health problem. Psychological support needs to be embedded into diabetes and other long-term condition pathways.
  • People with mental health issues are three times more likely to attend A&E. Better mental health crisis care reduces demand for emergency departments, which are seeing unprecedented levels of demand.

I am reassured when I have conversations with integrated care system leaders about their commitment to increasing access to good quality mental health support, but they need to be given the tools, expertise and resources to allow improvements to flourish. They need the latitude to do what’s best for their communities, too, and work across sectors.

The voluntary sector is undoubtably part of the solution. It supports the social determinates of health and is better at supporting people from groups that are too often failed by statutory services, including people from ethnic minorities and children and young people.

Expanding the provision of supported housing and the availability of high-quality digital support within mental health pathways will also help reduce demand for more expensive secondary services.

Given the pressures the NHS faces from all angles, there is no doubt that driving forward these kinds of ideas, including the NHS Long Term Plan refresh, will be challenging. But allowing this level of need to go unmet cannot continue.

Despite political myth and rhetoric, major investment is needed across the NHS from the government

It is true too that without major investment there is a ceiling on services’ ability to provide for more people, even with changes in policy. Despite political myth and rhetoric, major investment is needed across the NHS from the government. In a survey of NHS Confederation members recently, nine in 10 said their ability to address the size of the waiting list is being hindered by a lack of investment in buildings and estate.

The NHS Confederation has been calling for a realism reset and for politicians to level with the public and the NHS about what the challenges are and to fund the service they say they want.

Lord Victor Adebowale is chair of the NHS Confederation. You can follow Victor on Twitter @Voa1234

This article was first published in HSJ on 1 August 2022.