Our response to Change NHS

This is the Tavistock and Portman NHS Foundation Trust’s response to Change NHS. We are a specialist NHS mental health trust with a focus on training and education as well as providing a full range of mental health services and therapies for children and their families, young people and adults.

We are also a global centre of excellence in clinical practice, training and education, and innovation in the fields of mental health and emotional wellbeing. For 100 years, the Tavistock and Portman clinics have embodied a distinctive way of thinking about and understanding mental distress, mental health and emotional wellbeing. 

Following engagement with our staff, students, members, governors and service users, below we have outlined three key areas of focus we would like to see included in the 10-Year Health Plan.

1: Investment into community clinical structures

When we asked our staff, patients, members and public what works well about the services at the Tavistock and Portman, one of the most popular answers was our “community services” and work with the local authority in Camden (which we refer to in more detail in question 2).

It is clear to see why our staff are so proud of these community services (which span from mental health support teams in schools, to support for asylum seekers and refugees). Collaborating with local authority teams has taught us that reaching out to people in their communities is one of the most effective ways to build trust locally so that people interact with and use their local health services before the point of crisis.

Crucially, working with Camden Council has enabled us – and the teachers, the social workers and foster carers and so on – to spot the signs of mental illness earlier on, through a range of early intervention practices implemented across various settings.

We know that community mental health services are our strength, and want to continue expanding this provision where we can. Additional ideas from our staff and stakeholders on how to evolve this offering at both the Tavistock and Portman and nationally include:

• working more closely with schools and nurseries
• placing child and adolescent therapists in schools
• implementing parent-infant screening, as well as psychological and emotional screening for young children
• more provision for under 5s, and support for parent-infant relationships
• working with community organisations to promote non-clinical interventions – this includes providing information around healthy social media use as well as discussions about diet and exercise
• collaborating with the voluntary sector to ensure vulnerable people are offered support
• doing more with data so that we better understand the populations we serve.

However, as successful and effective as this community-led work is, it is expensive. We need to see investment from government so we can continue to strengthen and expand our community clinical structures. As the above outlines, we know that there’s much we can do, but we need the financial backing and the resource to deliver these services, and to deliver them well.

Within these structures, we would also like to see better integration of mental and physical health services. The two are inextricably linked, and providers must be supported with the tools and resources to communicate and co-work with colleagues in other areas of the NHS, just as we must work alongside social workers, local authorities, community leaders and teachers. A truly preventative approach is not possible without cross discipline working, and we need to push the integration agenda further and faster.

2: More training

At the Tavistock and Portman, we have a brilliant cohort of talented clinicians, many of whom are leading experts in their fields. This, combined with our unique education and training offering, means we can offer the very best quality of care to our patients, which is highly specialised and bespoke to their needs.

Mental health patients across the country should have equity of access to the very best care and treatment. We would therefore welcome investment into the training of the mental health workforce across the country, so that we have the appropriate level of skilled staff who are equipped to deal with the ever-increasing levels of demand and acuity in mental health.

At the Tavistock and Portman, our education and training offering means we are uniquely placed to develop our own diverse and talented workforce, but we recognise this isn’t the picture across the country. During our Change NHS engagement exercise, many of our staff praised our training services and felt disappointed that not all mental health colleagues had the same level of opportunity to upskill. Respondents said that specialist mental health services, like the Tavistock, should be commissioned by government to train up more NHS staff.

Our staff would also like to see more investment into training bursaries, particularly for those from underrepresented backgrounds and local communities, so that our workforce is representative of the people we care for.

Investment into training has real long-term benefits, not only for patients, who will receive better, more specialised care, but for NHS waiting lists and recruitment targets. The health service can only attract the best minds if we offer excellent career opportunities and the ability to progress.

3: Investment into early years, children and young people

Children and young people should be at the heart of all prevention work. In the 10 year plan, we would like to see more preventative measures for children’s mental health in addition to physical wellbeing. This is vital if we are ever to achieve parity of esteem.

For example, during our engagement sessions for the Change NHS programme, many staff asked that the government consider screening programmes which assess both the mental and physical wellbeing of children in schools. This might include screening for autism or learning disabilities, for example. Such programmes would mean that children could receive more tailored support (particularly in educational settings), which would boost mental wellbeing as well as academic outcomes.

We would also like to see government funding for more early years initiatives like our Camden’s ‘Best Start for Baby’ programme, which was designed to provide integrated care across early years services in the community. Through regular check-ins and accessible information, Best Start for Baby helps families at every step of their child’s development, meaning illness can be dealt with first and foremost in the community. It also means health issues and concerns are dealt with before they meet a level of acuity which may demand hospital care.

Our Tavistock and Portman mission outlines the importance of building relationships with local communities and families, and initiatives like Best Start for Baby, whereby we reach out to people in local settings, does just this, laying the foundations for strong relationships between families and NHS services. Community initiatives like these are so crucial as they open doors for support and early intervention in key developmental stages.

At the Tavistock and Portman, our staff tell us that one of our greatest strengths is our place-based approach to care. Throughout this period of engagement, respondents agreed that care in the community allows for more personalised and holistic treatment, which alleviates emotional distress and ultimately keeps people out hospital.

By embedding clinical teams within community settings, we can also do much more preventative work, educating people on how to look after their mental wellbeing and intervening at the early stages of mental illness, before the point of crisis.

One of the biggest enablers for moving care to the community is partnership working. As outlined in our strategic objectives for 2023/24 – and moving ahead in 2025 – we have been focused on forging ‘partnerships for prevention.’ We know that community-based care cannot be delivered in silos but requires strong community clinical structures, which must be built from solid foundations between our clinical teams and local partners.

These partners include Camden Council, with whom we work closely in the Camden Safeguarding Children’s Partnership to co-design and to deliver a range of innovative services. Our Child and Adolescent Mental Health Services (CAMHS) staff support Camden Council staff, plus the families they work with, in a variety of ways, so that children and young people receive the care they need close to home.

Some examples of the services we deliver in partnership with Camden Council are outlined below. At the Tavistock and Portman, we would hope to see these types of initiatives rolled out nationally, and expanded to ensure we reach people across all demographics.

• The Tavistock and Portman Trust Refugee Services – for refugees and asylum-seeking people in Camden
• The Waiting Room – a population health platform designed to improve how the public, patients and professionals understand the full mental health and wellbeing system and access information and support tailored to their needs
• Mental Health Support Teams – we were one of the National Trailblazer sites, and worked with schools across Camden to deliver mental health support in educational settings
• Camden Adolescent Intensive Support Service – to support young people at risk of admission to a unit, working with families and partners to reduce admissions and length of stays
• Thinking Together Consultations – whereby social workers in Camden are able to request to speak to CAMHS staff to seek consultation regarding a young person
• Clinicians embedded in schools – to work alongside teachers and families to support children’s mental health and provide training, consultation, and clinical input, and;
• Support to fosters carers and training to social workers and teaching staff.

If government is committed to delivering more care in the community, it must support providers across the country with the tools and resources to engage with local authorities and the various community organisations, as well as schools, nurseries and social care. This is no mean feat – there are a range of partners and organisations, and communication will be key – but as our work above and subsequent feedback during this engagement period demonstrates, the approach is effective, and will support our colleagues in acute settings to alleviate their waiting lists, which we know is of paramount importance.

Here at the Tavistock and Portman, we want to strengthen our community care offering even further. Many staff and stakeholders recommended expanding our ‘Waiting Room’ service nationally, for example, and they also told us that “better integration with voluntary sector partners” such as local charities will help us to reach more vulnerable people who we currently fail to reach.

We also received feedback recommending engagement with organisations such as libraries and sport groups to provide sessions on emotional wellbeing. Our respondents also felt mother and baby groups should be a government priority, with many feeling this is a particularly vulnerable demographic.

Moreover, many of our Change NHS respondents felt that while progress had been made (particularly during the Covid-19 pandemic) to understand the populations we serve, more peer support work ought to be undertaken so that we can design services which are accessible and meet the needs of local people. One person suggested that the NHS’s Patient and Carer Race Equality Framework was a good opportunity to work to better understand our communities, and collaborate with trusted partners within local neighbourhoods.

Workforce will be a key enabler to delivering care in the community. We know that employing staff who are reflective of the communities we serve will support us to build better relationships with local people, which is why we want to increase the number of staff we employ who live locally.

At the Tavistock and Portman, we’re also unique in offering both mental health and education and training services, and one of our objectives is to train and develop a new, diverse workforce of clinicians, social workers, nurses, teachers and other professionals. Staff and stakeholders also told us they would like to see targeted campaigns aimed at recruiting, and training up, people from underrepresented communities.

Financial challenges persist however. If the shift to community care is to be realised, it will require significant investments in time, training and resources. As one member of staff told us, “mental health care is expensive to deliver well” and “often times funding is pulled,” despite commitment in the NHS Long Term Plan to “boost out of hospital care.”

Indeed, according to the King’s Fund, “the proportion of spending on primary and community health and care has seen slower growth compared with the acute and emergency care sector.” This is “despite the majority of health and care activity happening within primary and community care settings.”

Finally, there exists some risk in moving care away from hospital settings into the community, in that we lack the research, and indeed evidence, on which patients are better suited to community settings, and which to acute ones. To improve our understanding will require a longer-term piece of research – and data gathering – to understand the risks associated with delivering care in various settings.

We’re aware of how technology can be used to support a more seamless health and care experience for NHS patients. At the Tavistock and Portman, we’re currently developing a digital strategy, which assesses how we can use tools to tackle waiting lists, improve patient experience and free up time for our clinicians.

The Waiting Room (referred to in question 2) is an example of how the NHS can use technology to address critical challenges in community mental health and care services. As a platform, it enables seamless integration across NHS, local authority, and voluntary sector providers, ensuring the entire ecosystem collaborates effectively to deliver holistic, patient-centred care.

The platform and its service connect smaller voluntary and community sector (VCSE) providers with larger NHS services, creating an ecosystem where resources, expertise, and services are shared transparently. This simple use of technology eliminates silos and improves care coordination. By aggregating localised health data, the Waiting Room also provides actionable insights into local populations’ needs. These insights then enable commissioners to allocate resources more effectively, as well as design services that better target investment based on need.

Facilitating secure, GDPR-compliant communication between all stakeholders also enhances the continuity of care, particularly for complex cases, ensuring patients and providers are informed and aligned. Ultimately, the Waiting Room empowers commissioners to shift from reactive service delivery to proactive, data-informed decision-making, improving outcomes and cost-efficiency. It demonstrates how technology can drive innovation, collaboration, and better outcomes for mental health care. This is vital for building a resilient and inclusive NHS.

Our staff also felt that there were many ‘quick wins’ to be had when it came to basic use of technology. For example, we’re looking at the use of technologies such as the DrDoctor portal, which the Tavistock and Portman currently uses, to interact more effectively with patients. On DrDoctor, patients can book, cancel or amend appointments without the need for printed letters, and the application can also signpost patients to appropriate contacts and helpful resources. Moreover, we’re also reviewing how the application can be used for outcome monitoring and measuring, and support us to manage waiting lists.

Another enabler is the sheer range of emerging mental health technologies, many of which show promise in enhancing patient wellbeing and improving NHS productivity. There are a number of promising areas we want to explore further, and we’re excited by what these technologies can offer. From AI chatbots providing Cognitive Behavioural Therapy (CBT) to smartphone ‘feeling good’ apps which support people living with depression and anxiety, there is much opportunity for the NHS to harness the power of technology. The recent government budget allocation of £2 billion for digital improvements was a welcome announcement, and we look forward to receiving further details of its implementation plan in the new year.

There are however various challenges we face when it comes to use of technology in health and care settings. Implementing any new technologies will not be a quick task, and a range of teams, including our clinicians, will need to review their safety and effectiveness of use. We will also need to understand how use of any new tools will impact on the relationship between clinician and patient, which must not be sacrificed in search of quick wins.

Cyber security also remains a real threat, and NHS services are increasingly spending more resource on making sure we have a secure environment to keep our patients’ data safe. Government must not forget the risks which remain over data safety, and ensure providers are well-equipped to deal with any arising issues.

Finally, we must remember that digital poverty and exclusion still exists in the UK and if we are to support the most vulnerable in our society, government ought to provide localised support, training and access to technology. This includes sessions in schools or libraries, for example.

We cannot tackle the root causes of ill mental health without addressing the various health inequalities across our society. We know, for example, that people living in poor housing, poverty or with job insecurity or unemployment are much more likely to experience mental ill health, as are certain groups who have experienced structural discrimination and disadvantage. Children who have been exposed to traumatic events or abuse are also at a significantly higher risk (which is why our early intervention work is so critical).

Of course, tackling these big social issues is a huge task, and goes much beyond what we can do at a trust level – it requires ambitious cross working across national and local governments to address the significant disparities which still exist within our society. Without the implementation of government measures, mental illness will continue to be a major issue across our society and providers will struggle with soaring waiting lists.

As a Trust, however, there’s still much prevention work we can do which will enable us to tackle mental illness at the earliest stage, or indeed prevent its development at all. As our work with Camden Council (as outlined in question 2) has demonstrated, strong local partnerships are absolutely foundational to stopping illness before the point of crisis (and the need for hospital).

Our staff and stakeholders told us that the NHS should embed itself even further into local communities, so that we can educate the public on non-clinical interventions, with advice on how to prevent, and care for, ill mental health. We also need to “be using local settings and organisations to spread the word about the various mental health pathways available,” said one respondent, who argued that many people are completely unaware of the services available in their local area.

Another respondent, in a virtual engagement discussion, said: “A lot of people just don’t have any relationship or meaningful interaction with local health services, or don’t have any touch points with us, and that needs to change. We need to be reaching people throughout their lifetimes, and have strong relationships in place so that we can deal with problems before they are at breaking point, at crisis. I think the onus is on us here – we need to be shouting about what we do, and the government needs to help us educate people about mental wellbeing.”

Across the board there was a feeling that, when it comes to mental health, the NHS and government needs to “scale up” its communications, providing information to communities through appropriate channels and platforms. As one member of staff commented: “we need to first be doing an audit of how we engage with local communities – are we using all the appropriate channels? Is there appropriate social media advice, for example, for young people so they’re not swallowed up by misinformation? There’s a really big piece of work to be done here, but if we can put out as much information on how to get help and advice we really can create mentally healthy and strong communities […] we’ve come a long way when it comes to education on mental health but for many, it’s still an unknown.”

Equality of access is also a challenge that many providers are making progress on, but we know more needs to be done. It’s crucial that we ensure people from diverse backgrounds – with different cultures, beliefs, languages and religions – can access the services and support they need, with speed and ease.

Ideas for further preventative health measures from our staff, members, students and patients include:

• equipping schools and parents with the tools to navigate emotional distress
• observation training for teachers
• training GP and other primary care practitioners in recognising mental health issues and in prevention pathways
• developing more peer mentoring programmes for when children may not wish to attend a clinical setting
• providing more tools for education on self-care
• creating more outreach teams.

If we’re truly serious about prevention work, then we must prioritise our children and young people. As the Lord Darzi review outlined, the challenge we face when it comes to children’s ill health – including mental health – is becoming ever-more difficult. In 2023, 1 in 5 children and young people had a probable mental disorder, and there has been an 82% increase in hospital admissions for eating disorders in the past five years. Waiting lists are not just increasing – so are the levels of acuity.

As the Lord Darzi review laid out, action is not only needed from health providers, but government, local authorities and schools, with the decline in children’s mental and physical health being closely associated with the social determinants of health as referred to earlier in this answer.

To focus on children and young people’s mental health, our staff, patients, members, and students told us that the NHS needs to:

• work even more closely with schools and nurseries
• continue to place mental health support teams in schools
• focus on more support for mothers and babies – our early years are incredibly important when it comes to our mental health
• ensure access to early years hubs for all
• have better integration of services for all those involved in looked-after children’s care
• ensure more integration of children’s physical and mental health.

Some of our staff also reported concerns about the impact of social media on children, and we welcome any conversations with government about safeguarding for young people.

While we deliver mental health care here at the Tavistock and Portman, we understand the relationship between physical and mental health. Given that nearly half of people diagnosed with mental illness also have at least one long-term physical condition, it’s of paramount importance that mental health services work much more closely with our acute trust and primary care colleagues.

• Quick to do, that is in the next year or so
• In the middle, that is in the next 2 to 5 years
• Long term change, that will take more than 5 years.

Quick to do:

Relational care

As outlined in our Tavistock and Portman mission, we understand the importance of building relationships with the communities we serve. We know that people’s first contact with NHS services – whether that be via their GP, with administrative staff or a school nurse – often impacts how they then interact with and use health services. It is therefore important that the entire NHS workforce, including those working in physical health and acute settings, as well as non-clinical roles, are educated on mental wellbeing, the support available, and psychotherapy to explore concerns, thoughts and feelings and improve mental health.

In the middle:

Improving the nation’s ‘mental hygiene’

An important piece of prevention work will be to educate the nation on mental health. As the government are taking action against promoting junk food before the watershed and banning energy drink sales to children, we believe similar action can be taken to promote mentally healthier habits.

To do this, government ought to consider implementing awareness raising campaigns on how people can look after their wellbeing. This can include encouraging individual assessment of social media habits, diets, and exercise. It would also require a review into any changes various organisations – from social media companies to employers, schools and even food companies – must make in order to support better mental wellbeing.

Extending Talking Therapies

Improving Access to Psychological Therapies (IAPT), now also known as NHS Talking Therapies, have been transformational in delivering talking therapies for people with mental illness such as depression and anxiety since its inception fifteen years ago.

NHS Talking Therapies offer a range of therapies for mental illness, including CBT, counselling, and couples therapy.

During engagement around Change NHS, our staff recommended a review of Talking Therapies, so that it is available for a range of mental health conditions as well as depression and anxiety. It was suggested that Cognitive Behavioural Therapy (CBT) alone – which is the type of talking therapy used across many mental health conditions, including eating disorders and post-traumatic stress disorder – can feel ‘too textbook’ in its approach.

The IAPT framework is considered more collaborative, and our staff felt it could be adapted for a number of other mental health conditions as well as depression and anxiety. Part of this work would be to consider priority groups to roll-out IAPT to – we recommend that mothers with babies should be among the priority group, with many of our clinical staff feeling this demographic are currently missed most by mental health services.

A number of our staff also recommended implementing psychodynamic psychotherapy into IAPT. This is another type of talking therapy, which aims to identify past influences and experiences which have contributed to a patient’s mental condition.

Long-term change:

Social change

Longer-term, the government must consider how it will deliver the wider social change which supports prevention. If we are to have a mentally healthy nation, we must tackle the socio-economic challenges faced by millions across the country. This means initiatives to ensure people living in the UK have access to secure income, safe housing and good physical health care. Currently, 4.3 million children are growing up in poverty – the greatest preventative measure we can take is to significantly lower this number.

While health providers do all they can to deliver excellent care, with more early intervention and preventative measures, the NHS alone cannot be responsible for improvement of mental wellbeing when no changes are made to the external socio-economic factors which create and exacerbate mental illness.