Rethink Mental Illness – Written Submission

Long-term funding of adult social care inquiry             

HCLG Select Committee

 

 

Introduction

Rethink Mental Illness is a leading charity provider of mental health services in England. We support tens of thousands of people through our groups, services, advice, and information. We train employees, employers, and members of the public on how best to support someone affected by mental illness. All of this work guides our campaigning for the rights of people living with mental illness and their carers.

 

We welcome the opportunity to feed into this inquiry, and will focus our response on the following questions:

 

Recommendations and key messages

 

 

 

 

Pre-legislative scrutiny of forthcoming adult social care legislation

As part of this submission, we would like to highlight our enthusiasm for securing pre-legislative scrutiny from the Housing, Communities and Local Government Committee jointly with the Health and Social Care Committee ahead of any forthcoming proposals for the adult social care sector, and to offer our help in working towards that end. 

 

There is a desperate need for a long-term plan and funding for social care. Whilst Rethink Mental Illness are supportive of the intent outlined in the Queen’s Speech to bring forward proposals, this is not nearly the level of detail or urgency needed considering the shortcomings in the existing system, which have been so severely exposed and exacerbated by the pandemic.

 

As a charity that works people who need support from social care because of their mental illness we are particularly keen to make sure that any proposals brought forward address the needs of this group, who are too often overlooked. 

When legislative proposals are brought forward, we believe that they would greatly benefit from pre-legislative scrutiny by the HCLG Committee and the H&SC Committee to help secure cross-party support ahead of any new legislation, and to ensure the necessary commitments from government to reforming adult social care in a way that will address issues for working age adults, not just older people.

 

What is mental health social care?

Mental health social care plays a vital role in supporting people living with severe mental illness to recover following hospital care, stay well and prevent further crises. Unfortunately, however, mental health is an often-overlooked aspect of adult social care. There is a relentless focus on older people’s experiences of the care system, which though important, means that adult social care’s vital provision for people with severe mental illness is too often ignored.

While Covid-19 has given social care a greater public and political attention than previously, Covid-19’s disproportion impact on care homes for older people has exacerbated the tendency to overlook the importance of social care for working age people and particularly those living with severe mental illness. This cannot continue.

Mental health social care must be at the centre of Government plans for social care reform with appropriate funding to ensure the provision of services under the Care Act 2014, Mental Health Act and Mental Capacity Act, such as:

 

Covid-19’s impact on  adult social care

The Covid-19 pandemic has greatly increased the number of people dealing with mental ill health and Covid-19 is significantly worsening mental health outcomes.

 

 

Even prior to the COVID-19 pandemic, we found that adult social care services have struggled to meet demand, meaning that significant pressure has been placed on expensive NHS emergency and inpatient services, alongside continued missed Government targets such as ending out of area placements. However, this situation has become even more acute in in the midst of increased needs due to the Covid-19 pandemic.[5]

 

Adult social care funding and stabilisation 

Social care reform must include provision for working age adults and an appropriate funding settlement that goes further than just a cap on care costs, as many people severely affected by mental illness are unlikely to have the financial assets to meet that threshold. As recognised by the Dilnot Commission, it is wrong to expect younger people to be able to contribute in the same way as those who need care later:

 

“Many people can expect to develop some sort of care and support need in their later lives, and we think it is reasonable to expect someone to prepare for this eventuality. The same cannot be said for younger people – for those either born with a disability or who develop one early in life.”[6]

 

It also means ensuring that those in receipt of welfare benefits should not be asked to use these to pay for the social care support they receive so that they are not faced with the choice of increased financial difficulty or going without support.

 

Why now?             

The NHS Long term plan committed nearly £1 billion every year for the next three years for the NHS to transform community mental health care for adults and older adults. Its vision is for a “radical change in the design of community mental health care by moving away from siloed, hard-to-reach services towards joined up care and whole population approaches, and establishing a revitalised purpose and identity for community mental health services”[ii]. Yet this is juxtaposed with local authorities making significant cutbacks[iii] to mental health social care over this same period. The NHS mental health funding taps are on, but the plug is missing.

 

Social Care for Mental Health and Wellbeing Policy & Oversight Group

While fixing the issues facing the social care sector will be complex, significant new investment is fundamental and must be at the core of the Comprehensive Spending Review later this year. Last year the Social Care for Mental Health and Wellbeing Policy & Oversight Group, which advises the Department for Health and Social Care, recommended that £1.1bn of additional funding should be invested in mental health social care budgets annually. We agree with this assessment and believe that a portion of this must be invested at the next Spending Review to help ensure than these vital services are not lost.

 

Case study: A local authority making cuts

One local authority that Rethink Mental Illness works with has announced a move to end certain mental health social care contracts by March 2022. They will only be funding services for those who are Care Act eligible, which will result in hundreds of existing service users with severe mental illness being left without access to support. This includes people being supported by a Rethink Mental Illness community recovery service which helps people to move into independent living through one-to-one and group support to access employment, housing and financial advice.

This approach of providing the minimum necessary by law is compounded by the fact that the local authority is doing little to engage with the STP’s Community Mental Health transformation and see this as solely as an NHS initiative, going against the ambitions set out in the Government’s NHS and social care reform white paper.

But while some responsibility for these decisions sits locally, even leaders in areas where integration of NHS, local authority and voluntary sector mental health support has gone furthest warn that “financial challenges will severely limit [local authorities] ability to fund the mental health social care services and non-clinical support which are key to the Community Mental Health Framework”.[iv]

Until local authorities have a funding settlement that enables social care to work as an equal partner with health services, integration will be limited and many people living with severe mental illness will not receive the support they need to live independently.

 

 


[1] Centre for Mental Health, Covid-19 and the nation's mental health: October 2020

[2] Rethink Mental Illness (2020), COVID-19 briefings: Access to NHS mental health services for people living with severe mental Illness.

[3] Office of National Statistics (2021) Coronavirus and depression in adults, Great Britain: January to March 2021

[4] Strategy Unit (2020) Mental health surge model – November 2020

[5] Health Service Journal, Exclusive: Key NHS long-term plan target to be missed ‘due to covid’, February 2021

[6] Fairer Care Funding: The Report of the Commission on Funding of Care and Support, July 2011, (p23)

 


[i] National Audit Office, Financial sustainability of local authorities 2018, August 2018

[ii] NHS England and NHS Improvement, The community mental health framework for adults and older adults, September 2019

[iii] National Audit Office, The adult social care market in England, March 2021, https://www.communitycare.co.uk/2021/03/11/budget-cuts-planned-social-care-councils-count-cost-pandemic-public-spending-watchdog-finds/

‘We’re being impoverished’: how English councils have cut care during the pandemic, https://www.theguardian.com/society/2021/jan/06/were-being-impoverished-how-english-councils-have-cut-care-during-the-pandemic, 6 January 2021

[iv] Private letter from NHS, local authority and voluntary sector leaders to the Chancellor, February 2021