SEND, Mental Health and Prevention Overlooked in NHS Reforms, say MPs preparing Amendments to Health Bill

The Health and Social Care Committee has today (June 12) published a report outlining amendments to the Health Bill, including legal duties for NHS services to comply with special educational needs and disabilities (SEND) tribunals.

The Government’s Health Bill contains legislation to abolish NHS England, give more powers over national policy to the Secretary of State, and devolve powers to Integrated Care Boards (ICBs).

In addition to SEND, the cross-party Committee’s report outlines amendments that its MPs will put forward regarding:

• Increasing spending on mental health services as a proportion of overall NHS funding
• Closer working and input from local government over health services
• The need for cross-government focus on tackling health inequalities
• Breaking down siloes caused by rigid budget allocations

Health and Social Care Committee Chair, Layla Moran MP, said: “The Health Bill will herald the most far-reaching changes to the health service in nearly 15 years. This is the opportunity to rewire parts of the NHS to tackle chronic problems affecting every area of the country, from SEND and mental health services to better prevention of obesity and frailty. It should be about more than just reshuffling bureaucracy and handing power to the Secretary of State.

“This report sets out a number of amendments to the Health Bill that we believe MPs from across the House will get behind, and will catalyse much needed debate on what the Government is going to do with the NHS.”

The amendments are explained below and the wording of each amendment is included in Appendix 1 of the report.

The amendments will be considered by a separate Public Bill Committee, which begins its deliberations on the Bill on Tuesday 16 June. The Bill Committee must finish its work by Thursday 16 July.

Amendments:

Councillors should continue scrutinising ICBs

A consistent theme of the Committee’s inquiries has been the importance of collaboration between local authorities and NHS services, including in palliative care, adult social care and vaccinations.

The 10-Year Health Plan states the importance of “closer partnerships” with local government. Despite this, the Bill proposes to remove the requirement for at least one local councillor to sit on an ICB – the local NHS bodies that set strategies and local spending. Positions on ICBs would instead be nominated by regional mayors.

The Health Foundation and Local Government Association criticised this move. Unlike local authorities, mayors do not have formal connections with public health and adult social care.

Recommendation: Removing local authority representation from ICBs would be damaging. The statutory requirement for ICBs to have at least one member jointly nominated by local authorities should be retained.

Services too siloed

Another recurring theme the Committee has observed is that collaboration and integration between various health services can be frustrated by budgets and responsibilities being too rigidly allocated. This often leads to tensions over who pays and who delivers. But there is an underused legal mechanism – Section 75 of the 2006 NHS Act – which enables joint commissioning and pooled budgets.

Recommendation: The Secretary of State should review the effective use of Section 75 and to produce guidance to promote the use of pooled budgets and joint commissioning by NHS bodies and local authorities.

SEND tribunals and ICBs

A recent report by the Education Committee identified a systemic lack of accountability in the NHS’s provision of services for children and young people with SEND. When a family is not provided with services they need, as laid out in an Education Health and Care Plan, their only recourse is to take a local authority, which commission SEND services, to a SEND tribunal. But SEND tribunals do not have power over health services, leaving families stuck if they are not provided with the help they are entitled to from the NHS.

Recommendation: ICBs should be legally required to comply with recommendations from SEND Tribunals.

 The Mental Health Investment Standard

Introduced in 2015-16, the Mental Health Investment Standard required the proportion of NHS spending on mental health services to increase every year, relative to the amount spent on physical health. This sought to achieve, over time, parity of esteem between mental and physical health services. Today, mental health accounts for over 20% of the ‘disease burden’ but receives less than 10% of NHS expenditure.

The Investment Standard has been dropped for 2026-27 and subsequent years, with spending on mental health due to rise with inflation – therefore staying at the same proportional level.

Recommendation: Dropping the requirement to increase mental health spending as a proportion of the overall health budget represents an abandonment of the journey towards parity of esteem.

Health inequalities considered across government

It is well documented that a number of demographics, such as ethnic minorities, populations in rural, coastal or inner-city areas, and other examples, experience worse outcomes from NHS services. It is in these areas that there is greatest demand but often poor provision of preventative health services for issues such as obesity or the effects of ageing.

The Health Bill includes a technical change that provides clarity on the Secretary of State’s duty to have regard to the need to reduce inequalities in England. The Committee heard evidence that this should be strengthened to apply across government.

Recommendation: the Secretary of State’s duties in relation to health should be strengthened and that all ministers should be under a duty to consider how policies they enact might contribute to or reduce England’s health inequalities.