Lord Darzi 's NHS review | News

The Cavendish Square Group – the collaboration of all of the NHS Mental Health Trusts in London – welcomes the Independent investigation of the National Health Service in England review by the Rt Hon. Professor the Lord Darzi of Denham. We know the NHS has many strengths, but it is important to acknowledge and consider remedial action against the challenges the service faces.  We support Lord Darzi’s analysis that the NHS supports us both when we are suffering from not just physical pain but also mental distress, and we hope that parity of esteem between the two is central to the proposed 10-year health plan. 

We recognise the review’s analysis that mental health needs have been rising, unfortunately especially amongst children and young people. The report cites that the rate of referrals for children and young people has increased by 11.7 per cent a year relative to 3.3 per cent for adults per year. A consequence of this has been that while NHS activity has risen, unfortunately waiting times have also risen because of the sharp rise in demand. The report draws attention to the fact that in April 2024, about one million people were waiting for mental health services and that there is a risk that long waiting times becomesnormalised. The report says that there were 345,000 referrals where people are waiting more than a year for first contact with mental health services – more than the entire population of Leicester – and 109,000 of those were for children and young people under the age of 18.  We know in London we have seen a significant increase amongst children and young people with a mental health need.  

It is vitally important that the NHS has a sustainable plan and investment, going beyond the volatility of single year budget settlements, to meet rising needs so waiting times can be reduced to support early treatment and prevention, something which is as important for physical health as it is for mental health. This needs to include investment in the NHS workforce plan, as Lord Darzi points out the number of mental health nurses has just returned to its 2010 level.  

Lord Darzi’s report reiterates that the NHS’s historical focus on acute care in hospital settings needs to change and investment mental health services, community health and social care need to be prioritised. We support the long-standing aspiration to move care out of hospitals and into community-based services, as well as prevention.  

The review cites that too many buildings are no longer fit for purpose which results in some mental health patients still being accommodated in Victorian-era institutions.  We know there has been insufficient capital investment in the NHS, including for mental health services, and Lord Darzi’s report also highlights the impact on NHS productivity. The NHS needs capital investment to drive improvements in productivity and to support the workforce to reduce waiting times and deliver quality care.  The review draws attention to the significant backlog bill for the NHS, which he cites now stands at more than £11.6 billion.  Greater capital investment could enable the NHS to invest in new technology to drive improvements in productivity, such as digital, which is as important to mental health care, as it is for physical care.

Capital investment also supports NHS Trusts to deliver benefits as ‘Anchor’ institutions, providing opportunities to manage our land and buildings in a way that has lasting and positive social, economic and environmental impacts. This includes supporting Net Zero ambitions, boosting local employment and creating environments and facilities that break mental health stigma, as well as improving patient experience.    

We recognise that a significant portion of the rise in people who were economically inactive can be accounted for by mental health conditions.  We support the assertion that for some people being in work can be good for wellbeing. We would welcome greater support for people with mental health conditions who are supported in the community and with acquiring suitable work, where it is appropriate. 

We accept that the NHS can do more to listen to patients. Many of the NHS Mental Health Trusts in London are investing in listening and engaging with patients, carers and the public to aid improvements. For example, NHS Mental Health trusts are investing in ‘Listening into Action’ initiatives to gather the views of patients and the public to inform changes and improvements. However, we know we need to do more so patients, carers and the public are always central to driving improvement in NHS mental health care. 

We welcome the review’s recognition that there have been some improvements, including in relation to inpatient safety, such as a reduction in the number of suicides in inpatient mental health facilities. However, we also know there is much more to do to address improvements in safety and this has been a key focus for the Cavendish Square Group.  We also know that we need to reach out and foster greater improvements in services and outcomes for some of the most vulnerable members of our community.  It is unacceptable that people from minority ethnic groups experience worse outcomes and wait longer for assessment. While the drivers of such inequalities are multi-dimensional, we know that NHS Mental Health Trusts have a leadership role to play to become anti-racist and tackle inequalities in the delivery of NHS care and services.  

The Cavendish Square Group recognises the importance of everyone in the NHS working together in partnership to improve services and support patients, carers and the public and we will continue to work with stakeholders. We will work to inform the government’s proposed ten-year plan so we can deliver excellent NHS mental health care.