Coordinated cross-government action

Connecting the dots: tackling mental health inequalities in Wales

This is the seventh chapter of the Health and Social Care Committee ‘Connecting the dots: tackling mental health inequalities in Wales’ report.

 

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On this page:

— Coordinated cross-government action

— Welsh Government strategy

— ‘Mental health in all policies’

— Scaling up and rolling out

— Reporting and data

— Our view

— Report contents

 

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Coordinated cross-government action 

Welsh Government strategy

136. The Welsh Government’s current Together for Mental Health strategy comes to an end this year. Stakeholders described the strategy’s review and refresh as an opportunity to address the needs of a wider range of communities who experience discrimination and/or disadvantage, including, for example, older people, Gypsies and Travellers, and people living with chronic conditions. It also provides opportunities to learn from the COVID-19 pandemic, particularly “the entrenched and widening existing economic, social, cultural and environmental inequalities that have led to poorer mental health”.[197]

137. Stakeholders broadly welcome the Welsh Government’s vision for improving mental health, including the Wellbeing of Future Generations (Wales) Act 2015 and the whole-school approach to emotional and mental wellbeing.[198] However, we heard concerns that policy is not always translated into practice, and that more needs to be done to bring together the various action plans and policies relating to mental health, health inequalities, and to particular groups and communities who may experience discrimination or disadvantage.[199]

138. A number of the Royal Colleges, including the Royal College of Physicians, are jointly calling for a cross-government strategy to tackle mental and physical health inequalities.[200] The Deputy Minister for MHW dismissed the need for such a strategy as having a strategy would not “guarantee delivery”. She added that the Welsh Government was already “driving forward work in this area”, including Healthy Weight, Healthy Wales, the Welsh Government’s tobacco control plan, and a joint Welsh Government and NHS working group. She said:

“So, I think the important thing now is to focus on action. I think we know what we need to do and we need to get on with it, and we don't need another new strategy.”[201]

 

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'Mental health in all policies'

139. We heard different views on whether a ‘mental health in all policies’ approach was needed. Andy Bell said that it could mean that Welsh Government would need to “deliberately and explicitly” identify how policies and decisions would seek to improve mental health, reduce inequalities and improve things for people living with mental illness.[202] Others cautioned that the approach could be a tick-box exercise, and suggested instead identifying what is needed in practice to create the circumstances for good mental health and wellbeing, and ensuring that this informs policy and practice.[203]

 

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Scaling up and rolling out

140. It is not always clear what structures or processes are in place to support the timely evaluation and roll out of successful projects or models of care. Many stakeholders spoke about a need to ensure effective interventions and ways of working are rolled out more widely. The Older People’s Commissioner for Wales described implementation as “key”, and called for more focus on “what are the support, services and interventions that are proven to work, and how can those be better rolled out across Wales”.[204]

141. The Deputy Minister for MHW acknowledged that “good practice doesn’t travel well”. She said the Welsh Government was looking at ways to improve this, including establishing communities of practice as part of the HCRIF as well as ongoing challenge to Regional Partnership Boards and others to encourage them to share good practice and work in a collaborative way.[205]

 

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Reporting and data

142. Many people and organisations were concerned that available data provides an inadequate understanding of the extent of mental ill health in Wales, how well different groups are able to access mental health services and have their needs met, and whether there is variation across Wales.[206] Mind Cymru summarised the issue:

“…there is no routine, reliable and comparable measure of the prevalence (both treated and untreated) of mental health problems within the Welsh population. As a result, the true scale of mental health problems, inequalities between groups and changes over time remains unclear”.[207]

 

143. Limitations include a lack of demographic disaggregation, including socioeconomic disadvantage, ethnic background, age, and other diagnoses (including neurodevelopmental conditions, or sensory impairment or loss). Such data as is available also focuses on outputs rather than clinical or social outcomes. This is problematic in terms of the wider determinants of mental health and mental health inequalities. Professor Rob Poole said:

“Social outcomes are much more important to people than clinical outcomes. […] People are concerned about how they live their lives. And if we put greater emphasis on how people live, then we're going to get a much better measure of how we're doing”.[208]

 

144. The development of a core mental health dataset for Wales is widely welcomed, but we heard concerns about ongoing delays to its development and implementation. Sue O’Leary of Mind Cymru told us the need to make progress with the dataset and measure demographic data was her key message to Welsh Government, as assessing the true picture of mental health inequality would enable it to be addressed.[209]

145. The Deputy Minister for MHW told us in September 2022 that the draft core mental health dataset had been impact tested, and work was underway to strengthen the programme arrangements. She added that health boards were being trained on the recording and use of patient experience outcomes and data, and that she had commissioned work from the University of South Wales on measuring patient outcomes.[210]

 

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Our view

146. The review and refresh of the Welsh Government’s mental health strategy provides a valuable opportunity to tackle mental health inequalities, and embed the needs of diverse communities into Wales’ approach to mental health. Achieving this will need more than a strategy and a plan—it needs an effective, cross-government approach, and coordination with plans and policies relating to groups who experience disadvantage. Adequate funding must be available, but against a backdrop of financial constraints all spending must be considered and monitored in terms of value for money and outcomes to ensure that it is targeted where it is most needed, and spent in ways that make a positive difference. We also agree with the Deputy Ministers that working with people with lived experience and lived expertise to co-produce the strategy is essential.

147. Throughout our inquiry we have heard about a range of frameworks, including a trauma-informed framework, the NEST/NYTH framework, and a social prescribing framework. The ideas and aspirations of these frameworks are to be applauded, but we share the concerns of our advisory group that it is not always clear how such frameworks work together or translate into meaningful action or tangible impacts in communities. The Programme for Government states that:

“…responsibility for the commitments that directly contribute to our wellbeing objectives will rest with the First Minister and the full Cabinet as these will require the highest level of coordination and integration across the whole of government”.[211]

 

148. We agree this is appropriate in terms of overall accountability, as tackling mental health inequalities and addressing the wider determinants of mental health and wellbeing requires action across all Ministerial portfolios. However, where accountability is shared across 14 Ministers and Deputy Ministers there is a risk that unless consideration is routinely given to the impact of decisions on the mental health and wellbeing of the people of Wales, it will be too easy for mental health, and especially mental health inequalities, to be squeezed out by the other pressing priorities facing Ministers.

149. We will monitor the development of the successor mental health strategy and associated plans through our scrutiny of the Ministers with responsibility for health and social care, and further targeted or follow up work as needed. However, as a Senedd, if we want to see a cross-government approach to tackling mental health inequalities, we must also play our part through cross-portfolio scrutiny. We urge all Senedd committees, in their scrutiny of the Welsh Government, to include consideration of the impact and outcomes of policies, legislation, spending and taxation for the mental health and wellbeing of Wales’ population.

150. Innovating for improvement is one of our cross-cutting themes for the Sixth Senedd. Innovation is key to tackling the issues faced by our health and social care sectors, and delivering the high quality, high performing services the people of Wales deserve. We welcome the availability of transformation funding, such as the HCRIF, including the potential for such funding to be allocated on a multiyear basis. However, it is disappointing that we, like our predecessors, are continuing to hear from stakeholders that good practice is slow to spread, and that ambitious and pioneering strategies, policies and frameworks are failing to have the desired impact on the ground. Unless the implementation gap is closed, people and communities across Wales will continue to experience mental health inequalities.

151. We support many of the Welsh Government’s intentions and ambitions for tackling mental health inequalities, but it is clear the available data is inadequate to provide a clear understanding of the extent of mental ill health among the population in Wales, or how well different groups are able to access mental health services and have their needs met. The data that does exist focuses on outputs rather than outcomes. If we are to be able to understand whether progress is being made in addressing the wider determinants of mental health, and reducing the inequalities that disproportionately affect some groups and communities, we must measure not only clinical outcomes, but also social outcomes.

152. In our report on the impact of the NHS waiting times backlog, we recommended that all health data collected and published in Wales should be disaggregated on the basis of diversity characteristics.[212] The Welsh Government partially accepted our recommendation, saying that while it agreed with the aspiration, it was “restricted by the structure of the data collections and systems and local health boards are also independent legal entities in their own right”. It added that “to retrospectively collect data for those data collections in place would be complicated”, but committed to ensuring that diversity data was collected and published in future.[213]

 

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Table of Contents

— Chair's foreword

— Recommendations

— Summary

— Introduction

— Mental health inequalities

— Person-centred services

— Mental health is 'made' in communities

— Social prescribing

— Workforce

— Coordinated cross-government action

— Reform of the Mental Health Act 1983

— Annex: Mental health and emotional support