Earlier this month the government responded to growing evidence of mounting pressures on accident and emergency services by pledging an extra £500m to help reduce delays. The money will be spent on a mixture of improvements to A&E departments themselves and other services that can help mitigate the pressures they face.
The new investment follows the conclusion of NHS England’s consultation about the future of urgent and emergency care, which included all levels of activity from self-care to 999 services and emergency admissions.
In both the short term effort to manage pressures on A&E now, and the much longer term aim of transforming urgent care services, mental health support must be seen as an inextricable part of a whole system of crisis care, in every locality and every health economy.
Urgent care services for physical and mental health needs have for too long been fragmented and disjointed. Crisis resolution and home treatment teams, mandated in the national service framework for working age adult mental healthcare in 1999, can provide excellent care in a crisis. But for people who do not receive their support (for example, those not of working age) there is no equivalent in many areas.
The government has already accepted the need to invest in liaison psychiatry services in hospital, as illustrated in the refreshed NHS mandate and June’s comprehensive spending review. Every hospital needs an all-age liaison psychiatry service, available 24/7 throughout the hospital, including to people in A&E. Some of the £500m investment could help to speed up the development of these services where they do not currently exist or where there is limited coverage.
As many have acknowledged, however, solutions to the pressures urgent care services face lie predominantly outside hospital walls.
Improved collaborative care for people with co-existing long term physical and mental health conditions, for example, is vital to offering the best possible help to those who most often have the worst overall health. We need now to identify promising approaches to collaborative care and find ways of scaling those up.
Concerns about A&E have been mirrored by concerns about mental health crisis care − not least the growing awareness of the need to address the use of section 136 of the Mental Health Act and the respective roles of the police and health services. Both the Home Office and the Department of Health have signalled a clear willingness to find ways of improving the situation, such as through the piloting of “street triage”.
Urgent care is therefore the focus of considerable effort in many different places. It is crucial that in the process we look across the health and care system and identify improvements that will deliver the best possible value for money, rather than trying to solve each issue separately.
Offering good care in a crisis is fundamental to the mission of the NHS. Nobody should be left without adequate care and support when they are at their most vulnerable. With some new investment and an openness to look again at how we deliver crisis care, we must not miss this opportunity to ensure that urgent care needs of all kinds receive an equivalent and, where necessary, integrated response.
There can be fewer more important tests of parity in the NHS today.