Mental Health Must Be at the Heart of NHS Reform

💙 Dedicated to my wonderful friends across the NHS who I respect and admire. Thank you. 💙

The Government’s decision to bring an end to NHS England is a seismic shift in the way our healthcare system is run. It raises huge questions for us all. I am torn between this being a bold step towards person-centred care—and my very real and justified fear that there will be a further retreat into cost-cutting that side-lines mental health. There are a number of worrying signals that the government do not see mental health as a serious priority.

Most of us leading organisations right now are facing a similar challenge: transform or face decline. Change is necessary for everyone in health and care—not just in systems and processes but in how we measure success and experience for the population. I listened to Wes Streeting today and thought his remarks were not dissimilar to what I recently said to my own workforce. These wild times demand new ideas, brave and bold decisions and we need to let go of what isn’t working, it’s existential.

This bonfire to bureaucracy I can sign up to. Delayering organisations is right and urgent to accelerate progress and the possibilities that technology bring, whilst largely unknown, instinctively we all know are huge and radical. But we can’t forget the importance of specialist and experienced knowledge, much of which has been held within NHSE for many years. How can we be sure we won’t lose sight of mental health in this transition? I am yet to hear any words that reassure me. Algorithms aren’t going to save us, humans will. We can’t chatbot our way out of the mental health crisis.

The NHS England Origin Story

NHS England was established in 2013 as part of the Health and Social Care Act, merging multiple arms-length bodies into a single entity responsible for commissioning healthcare services. It was created to streamline decision-making, drive efficiencies, and ensure national consistency in NHS priorities – sound familiar? Over the years, it became the key driver of major policy shifts, including those that shaped mental health services. Its where the Five Year Forward View, the Long Term Plan for Mental health and the Patient and Carer Race Equality Framework came from.

For mental health, NHS England was both a battleground and a breakthrough space. Dedicated professionals within NHSE fought—and won—significant battles for investment, for parity of esteem, for expanding services like crisis care and community support. They ensured that mental health was not just an afterthought in wider NHS plans. Without their leadership, we would not have the progress we see today.

We owe these folk a great deal of gratitude—they know who they are. Those late-night emergency calls, the spreadsheets we tore apart, the relentless back-and-forth to get mental health in the room—you fought, and won on this front many times. We must hold onto that. As the system undergoes transformation, we cannot afford to let these hard-won gains be erased or this knowledge disappear.

I send my personal thanks and love to the mental health team and the many others across NHSE that I have had the privilege to work with including those in specialist commissioning in criminal justice and veterans mental health.

Mental Health Cannot Disappear from the Narrative

For decades, so many of us have fought to get mental health the recognition it deserves. But funding has never been aligned to need or demand, ever. Lord Darzi found that despite mental health accounting for 20% of health, it has just 8.6% of total NHS spend. The math ain’t mathing as the kids might say, it never has—will it ever? And now, the latest planning guidance has sent chills across the system. Mental health is losing out yet again. There is no parity of esteem in sight.

The public hear a lot about the 7 million people on NHS waiting lists, yet do not hear about the additional 1.8 million people waiting for mental health support, some in crisis. Why aren’t they counted? Why aren’t they prioritised too? Why are they invisible in the story the government is telling about getting these waiting lists down? We also have over 600,000 people who have serious mental illness, and the CQC data shared today paints a bleak picture, the years of under investment taking its toll on all levels, quality, outcomes and experience. So what next?

The Role of the Voluntary Sector – Will We Be Shut Out?

One of NHS England’s most important contributions was its role in holding the line for the voluntary sector in mental health. It insisted on charity engagement in models of care, commissioning, and interventions that support people in communities. NHSE helped make sure that charities weren’t just an afterthought—that our expertise, reach, and relationships were valued as part of the solution. But now, who will fight our corner?

We have the government's charity commitment, but we are not seeing the same engagement in mental health. Without NHSE, we risk a retrenchment to a time when charities were undermined and excluded from key decisions about health and care, yet left to pick up the pieces in communities across the land.

ICBs and ICSs now hold a lot of the power—but can they be trusted to include us? Will they recognise the voluntary sector’s role in prevention, crisis response, and recovery? This is not just about representation, it’s about what works. what do they need to make this shift? Charities reach people the NHS never will. We are often the trusted front door for many communities, especially those who have been failed by statutory services. If we are pushed out, people will suffer. We want to be seen as part of the solution. We also want to make sure the voices of people are heard.

A Personal Challenge to the Government

Mental health cannot be left behind—again.

So here’s my challenge:

💷 Mental health must finally get its fair share of total healthcare spend—based on need, not just demand.

📊 Mental health waiting lists must be reported publicly and in full transparency

🤝 ICB’s and ICS’s must be resourced to build better services from communities upwards.

🤲 The voluntary sector must be engaged right away in the rebuilding of the system and engagement of people and their communities.

📋 The Government must commit to a full impact assessment across all departments to understand the immediate and long-term risks all of these radical changes will cause to mental health and plan accordingly.

These aren’t minor details. They will define the future of mental health care in this country.

🛟 We at Mind will work with government on every aspect of the next stage, we will bring the full force of our knowledge, expertise and capacity in readiness to serve the mental health agenda. We await the call.

Final Word of Caution: Retaining Humanity, Dignity, and Respect

There’s an energy that’s prolific in 2025 politics, the influence of Musk-Trump is undeniable. But, we must remember and hold true that there’s a world of difference between radical thinking and courageous decisions and the slash-and-burn approach we are seeing in the US. We must guard against trashing what works in the hope for better, we must be more sophisticated than that.

Transformation is necessary. Most of us in health and care are already doing it. But we must retain our humanity, dignity, and respect for one another in the process. People are not dispensable,

The eye on the prize has to be a better experience for people and a healthier nation overall.

I always finish a substack with a playlist and this one’s no different, a playlist for my NHSE colleagues, hope it will bring you a moment of comfort and joy. NHSE 2025