Dr Marc Goldfinger is a Conservative Councillor for Kensington and Chelsea, and works in the Pharmaceutical industry.
I did not expect to agree with the Prime Minister’s most recent mental health announcement. Last month, the Government committed £343 million to 159 new NHS mental health facilities in England. This included 100 community centres offering walk-in support, situated in libraries, banks and other high street buildings, and 59 dedicated mental health emergency departments for people in crisis.
I think this is right for two reasons. Firstly, versions of it were published under Conservative-led governments before, including the ‘The Five Year Forward View’ under the Coalition and the NHS Long Term Plan in 2019.
Secondly, moving treatment out of hospital and into the community – something called the ‘left shift’ – is a Conservative idea at its very core. Earlier intervention preserves patient independence, keeps people connected to work and family, and stops using the most expensive part of the system as the default response.
The difficulty is that I have watched this story be championed throughout most of my working life in healthcare, and I can tell you how it ends. It will not happen.
It will not happen because the left shift can be a way to reduce hospital capacity before a community alternative exists. If we cannot effectively treat these patients in the community, they will be sent back to the hospitals as their condition worsens.
On top of this, the money follows hospital work, not community care. Every financial incentive in the NHS drags patients back towards the building you were trying to get them out of. More importantly, community teams usually cannot access hospital records resulting in fragmented services. We can put up 100 new buildings but without fixing these issues we merely change the address, not the approach.
And yet the demand is both real and urgent. At the end of May, 2.36m people in England had an open referral with mental health services, an increase from the over 2.10 million a year earlier. The ONS found that, in 2023, 1.35m long-term sick, economically inactive people reported having depression and/or anxiety. These are shocking figures that demand action, yes, but we cannot sacrifice our nation’s prosperity at the altar of mental health.
There is also a real debate as to why reported mental illness has risen so sharply. Is it because prevalence has well and truly grown? Or has diagnosis massively improved? Or have we become too willing to give a clinical name to ordinary unhappiness?
Against my own professional interest, having spent my career in an industry that does better when more people are treated, I can say that we medicalise too readily. We leave patients with nowhere else to go, so a diagnosis and expensive treatments become the only path forward. Adding additional routes is the answer, and that is what a community service is for.
Not getting this right can come at an enormous cost to Britain. The Centre for Mental Health, in research commissioned by the NHS Confederation’s Mental Health Network, found the total cost of mental ill health in England to be £300 billion in 2022, double the entire NHS spend that year.
£110 billion of this is economic costs, including sick leave, high staff turnover and unemployment, disproportionately affecting young adults. The ‘Keep Britain Working’ review found the number of 16- to 34-year-olds who are economically inactive due to long-term mental-health conditions rose by 190,000 between 2019 and 2024 – an increase of 76 per cent. The same review found if an employee is off sick for four to six weeks, they have a 96 per cent chance of returning, dropping below 50 per cent if they have been away more than a year. Delay to care is the enemy to economic activity and ever-growing hospital waiting lists may be the culprit.
The Government’s impact assessment for the Mental Health Bill estimates a saving of around £11,400 for every mental-health patient treated in community-based care rather than a hospital setting. This also means that when we ask whether treatment worked, ‘did they get better’ shouldn’t be the only question.
Did they also keep their home? Did they stay out of hospital? Did they go back to work afterwards? In my experience, these are the questions patients really care about and are key to community-led care. If we can grant access to a shared care record between community sites and hospital care, we can effectively manage and evaluate care in a more holistic manner.
Championing services like the Individual Placement and Support (IPS) puts employment specialists inside mental health teams. IPS treats employment as part of the recovery journey, not an afterthought. Councils have also been working with DWP-funded services like ‘Connect to Work’ which effectively aims to make a similar work-first argument. By linking these together, we can effectively create a less fragmented care system that enables better communication between Government services such as DWP, the NHS and the council. This also has the added benefit of reducing spend on overlapping services.
Community-based treatment also catches things earlier, before a worry becomes a full-blown crisis. Most of what compounds mental health issues is often not medical, but common worries like debt, addiction, insecure housing, losing one’s job etc. These issues are handled better closer to someone’s home rather than at a hospital fifty miles away. Councils are essential to making the left shift work. If we pool resources between the NHS and councils, we can provide services that follow the patients rather than the building.
This presents an opportunity for us Conservatives. Conservative-run councils should work with their NHS and DWP partners to link and champion work-focused services for patients with severe mental illness. Scrutiny committees, including the one I sit on as a councillor, should ask for employment and housing outcomes alongside clinical ones. These figures should be reported as a matter of routine.
The ‘left shift’ should not be about bed closures, nor should it be performative. We must focus on fewer crises, fewer readmissions and improved employment outcomes.
At the next election, the Conservatives should offer a mental health policy anchored on independence. Where we can promise to intervene earlier, keep people near their families and their jobs, and reserve hospital stays for those who really need it. This is a focus on greater independence, not more institutions. A Conservative mental health service would measure itself not by how much care the state provides, but by how far that care helps people live on their own terms
Dr Marc Goldfinger is a Conservative Councillor for Kensington and Chelsea, and works in the Pharmaceutical industry.
I did not expect to agree with the Prime Minister’s most recent mental health announcement. Last month, the Government committed £343 million to 159 new NHS mental health facilities in England. This included 100 community centres offering walk-in support, situated in libraries, banks and other high street buildings, and 59 dedicated mental health emergency departments for people in crisis.
I think this is right for two reasons. Firstly, versions of it were published under Conservative-led governments before, including the ‘The Five Year Forward View’ under the Coalition and the NHS Long Term Plan in 2019.
Secondly, moving treatment out of hospital and into the community – something called the ‘left shift’ – is a Conservative idea at its very core. Earlier intervention preserves patient independence, keeps people connected to work and family, and stops using the most expensive part of the system as the default response.
The difficulty is that I have watched this story be championed throughout most of my working life in healthcare, and I can tell you how it ends. It will not happen.
It will not happen because the left shift can be a way to reduce hospital capacity before a community alternative exists. If we cannot effectively treat these patients in the community, they will be sent back to the hospitals as their condition worsens.
On top of this, the money follows hospital work, not community care. Every financial incentive in the NHS drags patients back towards the building you were trying to get them out of. More importantly, community teams usually cannot access hospital records resulting in fragmented services. We can put up 100 new buildings but without fixing these issues we merely change the address, not the approach.
And yet the demand is both real and urgent. At the end of May, 2.36m people in England had an open referral with mental health services, an increase from the over 2.10 million a year earlier. The ONS found that, in 2023, 1.35m long-term sick, economically inactive people reported having depression and/or anxiety. These are shocking figures that demand action, yes, but we cannot sacrifice our nation’s prosperity at the altar of mental health.
There is also a real debate as to why reported mental illness has risen so sharply. Is it because prevalence has well and truly grown? Or has diagnosis massively improved? Or have we become too willing to give a clinical name to ordinary unhappiness?
Against my own professional interest, having spent my career in an industry that does better when more people are treated, I can say that we medicalise too readily. We leave patients with nowhere else to go, so a diagnosis and expensive treatments become the only path forward. Adding additional routes is the answer, and that is what a community service is for.
Not getting this right can come at an enormous cost to Britain. The Centre for Mental Health, in research commissioned by the NHS Confederation’s Mental Health Network, found the total cost of mental ill health in England to be £300 billion in 2022, double the entire NHS spend that year.
£110 billion of this is economic costs, including sick leave, high staff turnover and unemployment, disproportionately affecting young adults. The ‘Keep Britain Working’ review found the number of 16- to 34-year-olds who are economically inactive due to long-term mental-health conditions rose by 190,000 between 2019 and 2024 – an increase of 76 per cent. The same review found if an employee is off sick for four to six weeks, they have a 96 per cent chance of returning, dropping below 50 per cent if they have been away more than a year. Delay to care is the enemy to economic activity and ever-growing hospital waiting lists may be the culprit.
The Government’s impact assessment for the Mental Health Bill estimates a saving of around £11,400 for every mental-health patient treated in community-based care rather than a hospital setting. This also means that when we ask whether treatment worked, ‘did they get better’ shouldn’t be the only question.
Did they also keep their home? Did they stay out of hospital? Did they go back to work afterwards? In my experience, these are the questions patients really care about and are key to community-led care. If we can grant access to a shared care record between community sites and hospital care, we can effectively manage and evaluate care in a more holistic manner.
Championing services like the Individual Placement and Support (IPS) puts employment specialists inside mental health teams. IPS treats employment as part of the recovery journey, not an afterthought. Councils have also been working with DWP-funded services like ‘Connect to Work’ which effectively aims to make a similar work-first argument. By linking these together, we can effectively create a less fragmented care system that enables better communication between Government services such as DWP, the NHS and the council. This also has the added benefit of reducing spend on overlapping services.
Community-based treatment also catches things earlier, before a worry becomes a full-blown crisis. Most of what compounds mental health issues is often not medical, but common worries like debt, addiction, insecure housing, losing one’s job etc. These issues are handled better closer to someone’s home rather than at a hospital fifty miles away. Councils are essential to making the left shift work. If we pool resources between the NHS and councils, we can provide services that follow the patients rather than the building.
This presents an opportunity for us Conservatives. Conservative-run councils should work with their NHS and DWP partners to link and champion work-focused services for patients with severe mental illness. Scrutiny committees, including the one I sit on as a councillor, should ask for employment and housing outcomes alongside clinical ones. These figures should be reported as a matter of routine.
The ‘left shift’ should not be about bed closures, nor should it be performative. We must focus on fewer crises, fewer readmissions and improved employment outcomes.
At the next election, the Conservatives should offer a mental health policy anchored on independence. Where we can promise to intervene earlier, keep people near their families and their jobs, and reserve hospital stays for those who really need it. This is a focus on greater independence, not more institutions. A Conservative mental health service would measure itself not by how much care the state provides, but by how far that care helps people live on their own terms