Parent Infant Partnership’s Analysis of the NHS Long Term Plan
Today saw the launch of the NHS Long Term Plan, which sets out how patient care will be redesigned to “future-proof the NHS for the decade ahead.” This is accompanied by an increase in NHS funding, averaging 3.4% a year in the next five years, which equates to £20bn additional funding in 2023/4.
The plan is over 120 pages long and contains a huge range of commitments around changes to the services the NHS delivers, and how it is structured, funded and run – including staffing and use of technology. Below we set out Parent Infant Partnership’s analysis of, and response to, the announcements.
Scope and Fragmentation
It is important to understand that the scope of this document is limited to the provision of NHS services in England only. Importantly, for those of us concerned about the first 1001 days of life, it doesn’t cover services delivered by local authorities, including children’s services and health visiting. This clearly illustrates the fragmentation of strategy, planning and service delivery.
Interestingly, paragraph 2.4, which acknowledges the important public health role played by local authorities, says that “Government and the NHS will consider whether there is a stronger role for the NHS in commissioning… health visiting… and what best future commissioning arrangements for these services might be.” It also reminds us that future budgets for these services – which have suffered from huge cuts – will be decided in the next spending review. A boost to public health budgets to match that given to the NHS would be widely welcomed.
The First 1001 Days
The Long Term Plan contains disappointingly little mention of the early years of life, or recognition of young children in their own right. There is a fleeting reference on page 48 to “the cross-government ambition for women and children focusing on the first 1001 critical days of a child’s life.” The document isn’t clear what this ambition is (and why it doesn’t also include fathers).
The importance of childhood – especially early childhood – is conspicuously absent in many places. It feels odd that a plan that talks extensively about population health and prevention of issues like obesity, smoking, alcohol use, mental illness, cancer and heart disease – does not recognise the strong relationship between adverse childhood experiences and these problems.
Maternity Care and Perinatal Mental Health Provision
There is a lot to be welcomed in the document, particularly relating to maternity care and mental health provision.
The plan sets out a range of improvements in maternity and neonatal care – repeating and building on much of the Better Births Agenda - including increased continuity of care, coordination of services in community hubs in the most disadvantaged areas, and improved support for families with babies in neonatal care. These improvements should bring physical and emotional benefits to mothers and babies. It is important that the mental health of mothers, fathers and babies (ALL babies) is embedded across this agenda, for example, through training all maternity and neonatal professionals to protect and promote parent infant relationships and babies’ social and emotional wellbeing.
The mental health of new mothers can, in some circumstances, have significant impact on their babies, so it is excellent to see an increase in access to specialist perinatal services up to 24 months; mental health assessment and signposting for fathers/partners of women seen by specialist services, and an increase in access to evidence based psychological therapies in these services, including parent-infant and couple therapies. The latter is particularly important, as evidence shows that attending to mums’ mental health problems alone is sometimes not enough to improve the parent-infant relationship.
These improvements, however, are only for the families of women who have moderate or severe perinatal mental illnesses that make them eligible for specialist perinatal mental health services. These are a minority of the overall population of women affected by perinatal mental illnesses – perhaps only a quarter. In addition, there will be babies who experience complex risk factors and poor parent-infant relationships, for reasons other than maternal mental illness. It is important that parent-infant psychological support is available for all these babies, but the document says nothing about this wider group.
Children and Young People’s Mental Health
The Children and Young People’s Mental Health part of the plan states, in para 3.25 that “By 2023/24 at least an additional 345,000 children and young people aged 0-25 will be able to access support via NHS funded mental health services and school or college based mental health support teams. Over the coming decade the goal is to ensure that 100% of children and young people who need specialist care can access it.”
To deliver on this goal of 100% access to appropriate specialist care from age 0, there must be a significant expansion in specialist mental health services for pre-school children, including parent-infant services. There is no single mention of such services in the document, which seems to focus on school age children (just as the Children and Young People’s Mental Health Green Paper was widely criticised for). It will be important for the new Children and Young People’s Transformation Programme to think carefully about how support is made available to ALL children, including the youngest.
Roll out of Integrated Care Systems
The Long Term Plan acknowledges the value of better coordination between primary and secondary health care; physical and mental health, and health and wider services. It announces the roll-out of Integrated Care Systems across England by 2021. These structures bring different commissioners and providers together to improve shared decision making. Some early ICSs such as Surrey Heartlands focused on the first 1000 days of life and joined-up action on wider determinants of health. An expansion of similar approaches would be welcome.
In short, there are positive announcements in the Long Term Plan for families in the first 1001 days of life. NHS leaders have clearly listened to clinicians and service users’ views about how maternity and perinatal services could be improved. But the document contains very little about the mental health and wellbeing of babies and very young children. Perhaps some of our frustrations with the document aren’t fair, given its limited scope. They reflect a wider disappointment about the lack of a joined-up strategy to prioritise the first 1001 days of life, and take a holistic, life-course approach to population health and wellbeing. Perhaps this is something that might come from the Cross Government Ministerial Group on the first 1001 days - we certainly hope so!!
Our response to the NHS Long Term Plan consultation dueing 2018 can be found below.