What is it?
The national service framework for mental health (NSF), launched by the government in September 1999, is the first comprehensive statement describing what's expected of health and social services in England. It sets out how they will be planned, delivered and monitored, until 2009. Similar documents have, or will be, produced in other healthcare specialties. Mental health and coronary heart disease, as significant causes of illness and disability, are the first two.
What does it say?
Seven standards set targets for the mental health care of adults, aged up to 65. These span five areas - health promotion and stigma, primary care and access to specialist services, needs of those with severe and enduring mental illness, carers' needs, and suicide reduction. The standards are relevant to all providers: the NHS, social services and the independent sector.
Improving services for people with severe and enduring mental illness is the first big milestone. Full implementation across the NHS and social services, and throughout other relevant agencies, could take up to 10 years.
The NSF gets a big boost from the new NHS plan. Local milestones for each standard will be reached in timescales agreed with the NHS executive and social care regional offices. Progress will be monitored, milestones will be reviewed and new ones will be set regularly. Five underpinning programmes will support change: these cover finance, workforce, research and development, clinical decision support, and information strategies.
How did the NSF come about and how will it go forward?
The NSF was developed with the advice of an external reference group chaired by Professor Graham Thornicroft of London's Institute of Psychiatry. The group included health and social care professionals, managers, service users and carers. A wide range of evidence was drawn together and graded, using systems such as Bandolier (an evidence-grading system).
The NSF fleshes out policies announced in Modernising Mental Health Services, a government white paper. Some £700m has been allocated over three years to help it meet its early targets.
From this budget, £40m will go via the NHS modernisation fund, mainly to promote services for the severely mentally ill, such as assertive outreach, 24-hour access and secure beds. £106m will go to social care in two sections: £22m will go via the mental health grant to the target fund to improve services in areas of poor provision, to help the homeless mentally ill outside London and to boost social care partnerships. The remaining £84m will support core services.
Change in mental health services is overdue. According to Frank Dobson, secretary of state for health when the NSF was launched, many people who suffer from mental illness "have not been getting the treatment and care they need". Dobson said that: "The government is committed to do whatever is necessary to deliver a modern and dependable health service for the new century. Mental health services, and the professionals who provide them, will get the attention and resources they deserve."
How's it going?
One year on, the NSF has been complemented by, and will now move ahead in parallel with, the NHS plan. Word on the street seems to be that, together, they have the potential to revolutionise mental health care. Regional implementation teams are unveiling local plans and getting things moving across the seven standards.
Workforce planning, education and training (among the five national underpinning supports for local action) are critical for NSF progress. A key update came in September 2000, with an interim report by the workforce action team. Their main message was that "local services should feel empowered to adopt flexible and innovative approaches to workforce planning to deliver services which meet the needs of service users". The team will finalise its recommendations by spring 2001.
