It is hard to remember a year in which the contents of the Queen's Speech were so hard to predict. The unexpected political events of the last few months have meant that it will have been revised to a much greater extent than is usual.
One issue that has been a consistent priority raised by the Prime Minister, from her first speech on the steps of Downing Street to her comments after this year's general election, has been mental health. Describing it as one of the 'burning injustices' she was determined to tackle, Theresa May has highlighted the need to improve services for children and young people in particular.
During the election campaign, and as part of Mental Health Awareness Week, Ms May also made a commitment to reform the Mental Health Act. It is therefore not a surprise to see a reform of mental health legislation announced in this week's Queen's Speech. The additional commitment to 'ensure that mental health is prioritised in the NHS in England' is a recognition that the goal of 'parity of esteem' for mental health, as outlined in the 2011 strategy 'No Health without Mental Health' is still a long way from being achieved.
What is less evident at this stage is how far this Government will seek to reform current laws or to expand the scope of mental health legislation from its current narrowly defined legal requirements covering the situations in which it is necessary to detain someone against their will. Any reform of the Act should seek to address concerns about the overuse of detention and restrictions on liberty. In addition, an ambitious administration could create a landmark piece of legislation that seeks to enshrine new rights for people with mental health problems to access treatment and new waiting time standards.
There are some significant barriers to the government adopting such a radical approach, including the political situation, financial and practical considerations. Firstly, this administration may not be in a position to invest energy and commitment in a domestic issue which, while clearly important, has been neglected by successive governments for decades, when we are going through such an unprecedented period of constitutional change and uncertainty. With the Prime Minister unable to rely on a comfortable majority to get legislation through the Houses of Parliament there will be a temptation to retreat to relatively minor changes which are limited in scope and where Ministers can be sure of consensus.
The NHS is facing continued financial pressure from a combination of rising demand, inflationary pressures in the health service, historic trust deficits and a continued squeeze on social care funding. The influential health think tank, the King's Fund, has stated that the NHS is facing the biggest financial challenge in its history. Performance against the key targets of a maximum four hour wait in A&E and 18 weeks for an operation have also deteriorated. These significant pressures will be a potentially insurmountable challenge to NHS leaders tasked with prioritising mental health, an area of the NHS which has traditionally taken the brunt of service cuts to balance the books.
The final challenge is the way in which mental health services in this country have been organised. Traditionally funded through block contracts, NHS commissioners have often seen the provision of mental health services as a black box, where funding is not tied to activity and providers themselves are often the gatekeepers of data on how services are performing. This situation is starting to change as new national datasets start to provide an initial picture of how services compare across the country. Nevertheless, these datasets are still developing and as yet do not allow us to get a consistently reliable understanding of performance across different regions and individual providers. Without a clearer picture, it will be difficult for the Government to establish new legal entitlements for patients. It is hard to set a target for the end of a race if you don't know where the starting line is.
Nevertheless, it is to be hoped that the sustained commitment to mental health demonstrated in speeches by the Prime Minister and the Health Secretary as well as Simon Stevens, Chief Executive of NHS England will mean that there is an opportunity for real reform to occur in this area.
Child and adolescent mental health services have often been described as the "Cinderella of the Cinderella service". Strategies and targets covering adult services often do not include children's services because they are organised and commissioned separately. Before the general election the Government had committed to a Green Paper on mental health and schools this autumn. This is a real opportunity to focus on intervening early and increasing access to mental health care and support for children and young people as problems begin to emerge.
This approach was recommended by the Education Policy Institute's Independent Commission on children's mental health. The Commission recommended a national programme of support for children and young people with mental health problems in schools, including training for teachers, a focus on mental health in the curriculum, school counselling and better links between schools and specialist services.
A joint inquiry by the Health and Education Select Committees which reported in April supported many of our recommendations. The snap election meant that the inquiry was cut short and the committees recommended that this agenda is taken up by the new committees in the forthcoming parliament. We await this activity and the publication of the Green Paper with interest to assess how far our recommendations will be adopted and whether this agenda will be embraced both by the Department of Health but also within the Department for Education in the months and years ahead.
Emily Frith is Director of Mental Health at the Education Policy Institute (EPI)