Our manifesto

NHS, education, and social care services are overstretched. Consistent cuts have led to the erosion of prevention and early intervention services in many areas. Yet, we know that prevention is more cost-effective than cure. Providing support to those in crisis is vital, but we can prevent many more people reaching that stage by focusing on the nation's wellbeing and preventative services.

Whilst return on investment (ROI) is three times higher for preventative care than specialist treatment, less than 3% of NHS investment is in preventative or health-enhancing interventions.

The most effective way to reduce demand for specialist services is by investing in primary prevention, early intervention, and health promotion services for people of all ages. Early Support Hubs are an example of this, allowing people to access a range of support in their local communities. Failing to invest in preventative and early intervention services will see people becoming sicker and health inequalities continuing to widen.

There is a parallel pattern of underinvestment in prevention and early intervention in the education system. We are seeing a crisis in Special Educational Needs and Disabilities (SEND) provision across schools and local authorities, with a significant increase in identified SEND needs.

The negative psychological impact of poverty should not be underestimated. Not having enough money to make ends meet has a lasting impact, with research showing people far more likely to experience stress, poor mental health and lower educational outcomes as a result. The next government must prioritise tackling the root causes of poverty across our diverse communities to build a society that not only survives but thrives.

Those living in our poorest communities, including children, families, those with disabilities and older people, will only see a significant improvement in their health, wellbeing and educational outcomes when all government departments commit to addressing the underlying determinants of ill-health and inequalities. For those with disabilities and long-term health conditions, investment in prevention

and early intervention services, including providing a financial safety net through the welfare system, reduces health and social care costs and increases the likelihood of returning to work.

We recommend that:

• Early Support Hubs are rolled-out nationally, with long-term and sustainable funding attached, increasing the provision of early intervention support in the community, with services designed to consider the psychological, emotional and wellbeing needs of the early years.
• There is investment in the psychological workforce – including practitioner psychologists and the wider psychological workforce – across the NHS and local authorities as well as within schools, community and prison and probation services, to both provide and design preventative services to tackle public health issues.
• The benefits system should seek to support those with both physical and mental health difficulties, without increasing stress and anxiety to those in need. The basic rate of Universal Credit should always be enough for people to afford the essentials. 

Giving children and young people the best start in life is key to ensuring that they can thrive. Growing numbers of children and young people are needing to access mental health support, and in 2023, around 1 in 5 of those aged 8–25 likely had a mental health problem. We are still paying the price for the disruption the pandemic caused to children, in particular the impact on their education and wellbeing.

The most important way we can support children is by supporting their families and communities. We know that the first 1,001 days are critical to setting the foundations for lifelong emotional and physical wellbeing. A commitment to ensuring prevention and early intervention services, like the Early Support Hubs, are accessible and available is vital. Properly-funded services and support for children, young people and their families within local communities, schools, primary care, the wider NHS, and local authorities are essential to stop those who need these services reaching crisis point.

Schools and local authorities have a pivotal role to play in enabling a truly inclusive education system where every learner can access high-quality educational settings, regardless of need. Children and young people with learning disabilities and neurodiversity currently experience poor access to support in both mainstream and higher education, with 80% of those with SEND finishing primary school not achieving age-related outcomes in reading and writing.

Demand for Education, Health and Care Plans (EHCPs) has increased significantly, particularly since the pandemic. Since 2015 there has been a 283% increase in agreements to requests for Education, Health and Care Needs Assessments, resulting in a 91% increase in the number of Education, Health and Care Plans (EHCPs).

There are currently not enough educational psychologists working in local authorities, which means thousands of children are missing out on the additional educational support they need. Educational psychologists can work proactively to prevent needs and difficulties becoming entrenched, reducing the demand for statutory intervention. 

Mental Health Support Teams – which include a range of multidisciplinary and psychological professionals – are currently only estimated to extend to around 44% of pupils.

The pressures in the system are having an impact on whether children and young people are actually at school at all. The number of children who have been permanently excluded from secondary schools has risen from 2,509 in the spring term of 2016–2017 to 3,039 in the spring term 2022–2023 and over 20% of students recorded as 'persistently absent' are believed to be linked to emotionally based non-school attendance.

And for those children and young people who do reach a crisis point, current available support is severely lacking. Targeted investment is needed in specialist support to tackle the huge waiting lists in Child and Adolescent Mental Health Services (CAMHS), and to better support the transition from child to adult mental health services. According to the Children's Commissioner, more than a quarter of a million (270,300) children and young people are still waiting for mental health support after being referred to CAMHS in 2022–2023.

The next government must also look at the implications of wider funding issues outside of health and education on our children and young people. A prime example is delays in court proceedings, which can have a profound impact on young people and their families whilst cases are progressed.

The next government must be prepared to invest in the education, mental health and physical wellbeing of our children, young people and their families.

We recommend that:

• A cross-departmental Child Health and Wellbeing Strategy is developed, putting children and young people at the centre of policy-making and which includes a focus on the under-5s.
• An expansion of mental health services for mothers and fathers, backed by additional investment is prioritised. Expansion should include growing the maternal health workforce and services for fathers, to enable access to psychologically informed perinatal and postnatal care.
• Increased funding is provided to increase the educational psychology workforce to ensure that every maintained educational setting has a linked Educational Psychologist based in their local authority where they can have maximum impact working in partnership with colleagues in education, health and social care.
• A mandatory and adequately resourced CPD programme on additional learning needs and neurodiversity is implemented for education policy-makers.
• Whole school educational approaches to mental health and wellbeing, as well as inclusive education frameworks, are embedded across all education settings and into Initial Teacher Training (ITT) and Early Careers Teacher curricula to improve the emotional mental health and wellbeing of all learners.
• Mental Health Support Teams (MHSTs) are rolled-out across England, stopping the postcode lottery for access to support in schools.
• Long waiting lists for CAMHS are addressed through targeted investment in an expanded workforce and the implementation of new waiting time standards for access to services. 

A commitment to achieving parity of esteem between mental and physical health care was enshrined in the Health and Social Care Act 2012. Unfortunately, we are still a long way from meeting that commitment. Demand for mental health services is at an all-time high, and we do not believe that current investment is keeping pace with that demand.

We need a psychology workforce fit for the future to enable better, and more equal, access to services at the point of need. The NHS is facing a workforce crisis, and with mental health services unable to keep pace with demand, staff shortages are having a significant impact on patients seeking treatment and support. There are parallel workforce crises within schools and local authorities which are impacting on children and families' access to support.

Current NHS workforce data does not always paint a full, accurate picture of the qualifications of regulated professionals working within services. Recruitment projections and plans based on inaccurate data will not help to address the current gaps in provision. The recently agreed changes to the Electronic Staff Record in categorising the psychological professions should help to change this and should be implemented as a priority for new and existing staff.

The retention of staff is a huge problem for both the health and education sectors. The investment into and expansion of training routes to enable more psychological professionals to enter the workforce is key. However, training new staff will take time. Practitioner psychologists have an important role to play in providing training, consultation, support and supervision for their multi-disciplinary colleagues to enhance their abilities to work more effectively with psychological issues. Psychologists are also well-placed to support in developing workforce planning and job design to help the workforce we have in place now work better.

And it is not only in the health and social care sectors where the psychological workforce has a significant role to play. Psychologists are embedded in roles across the public and private sectors, including in education and criminal justice, working across business, and in research.

We know from examination of the last round of the Research Excellence Framework (REF) that psychological research makes an outstanding contribution to wider society, with more than 85% of psychological research being rated as either 'world-leading' or 'internationally excellent'. The results also highlighted the important contribution of early career researchers.

However, the outlook for universities is currently pessimistic, with the Office for Students recently reporting that 40% of higher education providers are forecasting a deficit in 2023–2024. [16] The student fee limit of £9,250, unchanged since 2017, has been impacted by inflation. Many higher education providers are financially struggling under these challenges to make cost savings.

For psychological research conducted in this country to continue to be world leading and impactful, there needs to be a long-term strategy and commitment for sustainable investment in research.

Policy-makers must recognise the important role universities play in conducting innovative, impactful research and in developing a skilled psychological workforce for the future.

The higher education sector has also grown to rely on income from international students to sustain research activities. Policymakers should be mindful of the contribution of international talent. 

We recommend that: 

• Evidence-based, psychology-led services are embedded in primary care and education support services, with teams meeting patients' and learners' needs at the right time. 
• Physical healthcare services have sufficient access to an appropriately trained psychological workforce to particularly support those with chronic and long-term conditions. 
• Patients across all age groups with neurological conditions have quicker and more consistent access to neuropsychological services. 
• Older peoples' mental health services are sufficiently funded to ensure equality of access to age-appropriate psychological therapies and neuropsychological services, to enable them to age well at home, at work, and in the community. 
• Agreed changes to the Electronic Staff Record in categorising the psychological professions should be implemented as a priority for new and existing staff to ensure the more accurate collection of workforce data. 
• For the safety of the public, ongoing work on regulatory reform of the Health and Care Professions Council is continued at pace, with a particular focus on identifying those professions that aren't currently regulated but may need to be. 
• There is a commitment to sustainable investment in psychological research.

Since 2021, NHS Staff Mental Health and Wellbeing Hubs in England have been – and in some cases continue to be – a lifeline for thousands of health and social care staff struggling with their mental health, alongside existing services and initiatives. Whilst the hubs were set up as a response to covid, the need for mental health and wellbeing support for NHS and social care staff didn't begin with the pandemic, and it hasn't ended with it.

Staff are the lifeblood of our NHS and social care services, and ambitions to improve productivity and retention cannot be achieved without investment in a healthy, supported workforce. We know senior NHS and social care leaders want to provide their workforces with the best possible support.

They recognise how dedicated mental health support can help staff remain in their jobs, return from long term sickness and, crucially, prevent future ill-health. However, we do not believe that they can do this without the support of the next government.

Recent NHS Staff Survey results reflect a burnt out and demoralised workforce. 42% of staff said they have felt unwell because of work-related stress in the last 12 months; nearly one third (30%) of staff said they often or always feel burnt out because of their work. 

Most of the funding for the 40 NHS Staff Mental Health and Wellbeing Hubs was cut in March 2023, with just £2.3m provided to hubs in July 2023, a fraction of the original £38.5million annual budget. Research shows that for every £1 spent on workplace mental health interventions, £5 is saved.

With many staff presenting to the remaining hubs with significant and complex mental health issues, without dedicated services, staff will be added to lengthy waiting lists for mainstream mental health services. This could lead to staff taking more time off sick, or delaying their return to work, at a time when staff shortages and retention issues are a major concern.

A lack of support for our health and care workforce is detrimental to all people who need our health and care services. 

We recommend that: 

• Integrated Care Systems commit to long-term ring-fenced funding for dedicated psychologically-led mental health support for health and care staff, including through the remaining NHS Staff Mental Health and Wellbeing Hubs.
• The next government must invest in long-term ring-fenced funding for dedicated, psychologically led mental health support for health and care staff, to complement local investment. 

While some progress has been made on expanding services and improving access, there are still stark inequalities in those who are likely to develop mental health difficulties and their ability to access care and support. This is something which will only improve with systemic change and significant investment into prevention and early intervention, the wider health service and in community settings.

We know that some groups have a much higher risk of needing mental health support. People from minoritised backgrounds are more likely to experience severe mental illness and less likely to receive care and support when they need it. People who are lesbian, gay, bisexual, transgender, and gender diverse are also at a greater risk of experiencing poor mental health. 

In fact, unmet mental health needs have been reported for people with disabilities, people living with HIV, males, ethnic minorities, and prisoners. We must also recognise that our population is ageing and it is vital that older people have access to services that are targeted at their needs. 

Enacting the socio-economic public duty in the Equality Act would be a positive first step to tackling wider societal inequalities at a time of social and economic crisis continue to deepen, with potential psychological consequences. Ultimately, we believe that to tackle social class-based inequalities, social class must be included as a protected characteristic in the Equality Act (2010). 

A reduction in prejudice and discrimination could not only see an improvement in education, health and work-related outcomes for working class people, but also a longer-term reduction in the psychological damage this causes and the detrimental impact of this damage on our society. 

We recommend that:

• Mental Health Act reform is brought forward to ensure that it is fit for purpose for today, to tackle disparities in the mental health system and address the unacceptable trend of people with severe mental health difficulties ending up in the criminal justice system.
• Legislation on the banning of conversion therapy is brought forward.
• The socio-economic duty in the Equality Act is enacted to support the tackling of social class-based inequalities. This should be a first step towards the inclusion of social class as a protected characteristic under the Equality Act 2010.