Promises to improve mental health care for millions of people a year are at risk of being broken as the Government scraps plans to invest money in high-quality research. The coalition's new mental health strategy, expected to be published shortly, fails to recognise the importance of research in reducing the huge burden of mental illness. This flies in the face of its own promises and of compelling evidence, experts warn.
Mental illness is the country's leading cause of personal suffering, economic loss and social problems, costing England alone more than £105bn in 2009. Those with mental health problems are more likely to get cancer or have a heart attack, for reasons that are little understood. Less than £75m of public money is spent each year on relevant research, a fraction of the sums spent on cancer and heart disease.
Labour's 2009 New Horizons strategy promised to address this disparity by increasing government funds spent on mental health research from less than 2 per cent to 11 per cent of the total health research budget.
Having scrapped Labour's strategy, the coalition is not expected to commit any money to research, despite promising to treat mental and physical health equally.
Dr Andrew McCulloch, the head of the Mental Health Foundation, and Professor Til Wykes of the Institute of Psychiatry have written to Paul Burstow, the Care minister, explaining how every pound spent on mental-health research would result in savings after three years.
Ministers "have repeatedly said mental health is to be given parity with physical health," Dr McCulloch said. "We cannot tackle the disease burden and growing costs without research and development."
Critics claim it is the latest in a series of "broken promises" by the Secretary of State for Health, Andrew Lansley, who is attracting brickbats from MPs, think tanks, trade unions, clinicians and patient groups. The growing criticism is adding to pressure on Mr Lansley and David Cameron, who personally promised to invest in the NHS, to protect frontline services and improve patient care.
Dr Hamish Meldrum, the chairman of the British Medical Association, added to the chorus of criticism, warning in his New Year message that the NHS faced a "defining year" of exceptional financial pressures and an "unnecessarily ambitious programme of reform".
The NHS Confederation, which represents 95 per cent of NHS organisations, said last week that the health service was facing "the toughest years in its 62-year history". Such comments are evidence that support for Mr Lansley's reforms has dwindled amid bitter accusations from NHS staff that he has "disregarded" their concerns. His decision to appoint the NHS chief executive, David Nicholson, to head the new independent NHS Commissioning Board, reporting to Mr Lansley, without an open recruitment process, has been criticised as an example of his opaque, top-down style.
Mr Lansley is pressing ahead with plans to axe 150 primary care trusts and 10 strategic health authorities in favour of 500 GP consortia which will be handed £80bn of public money to spend on local health services. To improve efficiency, hospital trusts will be encouraged to undercut each other for GP contracts, raising the prospect of two-for-one deals on surgery and cut-price scans, despite evidence that health price wars reduce quality and increase death rates, according to the King's Fund and London School of Economics.
John Pugh, the chairman of the Lib Dem parliamentary health committee, said: "It's just implausibly silly to pretend [the changes] do not flatly contradict the coalition agreement to avoid top-down restructuring. This can be excused if the Government can get NHS professionals to welcome the changes, or at any rate believe in them. When they don't, the consequences for governments and patients can be fatal."
After six years as shadow Health secretary, Mr Lansley now has free rein, but as civil servants draw up the biggest piece of NHS legislation ever, his decisions, and management style, are coming under closer scrutiny.
John Healey, Labour's spokesman on Health, said: "What [Lansley] is now doing has come as a surprise to many. He made pledges in the coalition programme in May which he broke in July in the White Paper. There is an element of him working in isolation here, running a rogue department."
Before the election, Mr Lansley dismissed accusations of "political convenience" as he travelled around promising to re-open wards and halt hospital closures. As the new Health Secretary, he announced a moratorium on all closures, outlining four tests, including support from GPs, which were required to be met before any NHS services were axed. At least 30 hospitals have approved closures or downgrades since May; none has yet been turned down.
He recently backed plans to centralise maternity services across Kent against the wishes of 90 per cent of local GPs, leaving Maidstone Hospital without a consultant-led service. A Health spokesperson said he did so after "taking independent advice".
In 2008 he signed a petition to re-open the cardiac monitoring and acute medical services at Bridlington Hospital which had been transferred to Scarborough. Support for the move, typical of many across district hospitals in England, saw nearly 20 per cent of the town's population take to the streets. After a change of heart last month, he said: "Things have moved on since then."
Royal Colleges involved in maternity and childcare medicine have all spoken out against another U-turn which means maternity services will be commissioned by GPs rather than by the NHS Commissioning Board. In January 2010, Mr Cameron and Mr Lansley announced a range of maternity policies amid furore about the postcode lottery faced by pregnant women. Mr Cameron's personal promise to increase midwife numbers by 3,000 has not been kept.
Professor Cathy Warwick, the general secretary of the Royal College of Midwives, said: "We are extremely and deeply disappointed the Government has performed a U-turn."
In opposition, Mr Lansley promised the Tories would protect NHS whistleblowers. The coalition programme pledged to introduce protection for whistleblowers across the public sector. Unions and patient-safety campaigners reacted angrily when the pledge did not appear in the Cabinet Office business plan in November.
Another patient-safety pledge, to oblige NHS organisations to tell patients or relatives when mistakes are made, is also in doubt. In Parliament last month it became clear the Government fears it would increase litigation.
The Department of Health said: "We are committed to devolving power to local communities where the people, patients, GPs and councils are best placed to determine improvements in their local NHS services."
Additional reporting by Mark MetcalfReuse content