Today’s warning from every former Health Secretary from the past 20 years about inadequate mental health provision raises a number of questions. The first is whether the government really is serious about its pledge to make parity of esteem between physical and mental health a priority. Mental health has become more of a political issue in recent years, which is a good thing: parties now worry about their standing on the issue because society has become better at talking about mental illness, and therefore more people are aware of the shockingly inadequate treatment that their friends and family are receiving when they fall ill. The Tories became anxious in 2015 that the Lib Dems had owned mental health as an issue. That sort of competitive instinct is a good thing in politics: it means ministers and advisers are more likely to pay attention to an issue.
But the second question is what happens when disparity of esteem continues in the NHS? I asked Norman Lamb about this when I interviewed him about his role as health minister at the Liberal Democrat conference in 2014. The NHS mandate says that NHS England’s objective is to put mental health on a par with physical health, but there is no explanation of what happens when NHS England fails to reach that objective. Is there a penalty for NHS England? Is there someone who is clearly personally accountable for this, who might have to resign as a result of that failure? If the answer to both of these questions is no (Lamb cares a great deal about this issue, but his answers weren’t particularly clear back in 2014, and he’s no longer in government), then how is the mandate a mandate and not just a nice aspiration that can be forgotten quite easily?
These questions are ones that should be asked more often about many other policies. Too often in policymaking, the answer is that there is no-one who can be held accountable if something goes wrong: policies take a long time to implement, while ministers only spend a short time in a department before being reshuffled. So by the time a policy has failed, the minister responsible has moved on. In the case of the NHS, ministers can say that it is the head of the health service itself who should be accountable, rather than themselves, even if they are the ones who are failing to ensure adequate funding for key services. What this absence of accountability means is that the people who are penalised for continuing disparity of esteem in the NHS are the patients stuck in the system, not those with the power to change it.