Coalition Mid-Term review: David Cameron and Nick Clegg's foreword

"We will continue to put political partisanship to one side to govern in the long-term interests of the country."

Two and a half years ago, our parties came together in the national interest and formed a coalition at a time of real economic danger. The deficit was spiralling out of control, confidence was plummeting, and the world was looking to Britain with growing anxiety about our ability to service our debts.

This Government's most urgent job was to restore stability in our public finances and confidence in the British economy. In just two years we have cut the deficit by a quarter and have set out a credible path towards our goal to balance the current budget over the economic cycle.

Dealing with the deficit may have been our first task, but our most important task is to build a stronger, more balanced economy capable of delivering lasting growth and widely shared prosperity. In essence, this involves two things: growing the private sector, and reforming the public sector so that what the Government does - and the money it spends - boosts, rather than undermines, Britain's competitiveness.

Meeting this challenge is imperative if Britain isn't to fall behind in the global race, for while the Western economies have stalled in recent years, the emerging economies such as India, China, Indonesia, Malaysia, Brazil, Mexico and Turkey have been surging forward. In the coming years, some countries in the developed world will respond to this shift in economic power; but some will not. Those that do will prosper. Those that do not will decline. It is that simple.

That is why we have not baulked at the tough decisions needed to secure Britain's future. Whether it is reducing the deficit, rebalancing the economy, regulating the banks, tackling climate change, modernising our energy and transport infrastructure, putting our universities on a sustainable financial footing or dealing with the challenges of an ageing population and reforming public sector pensions, we have consistently chosen to do what is right over what is easy or popular; what is in our country's long- term interest over our parties' short-term interest.

Ultimately, however, Britain will only prosper in an increasingly competitive global economy if we can realise the full potential of each and every person in our country. That is why our plans for economic recovery are accompanied by a radical agenda of social renewal, to build not only a strong economy, but a fair society in which everyone, no matter what their background, can rise just as high as their aspirations and talents can take them.

Above all, that means having a welfare system that works and schools that teach our children properly. Since we came to office, more than 1 million jobs have been created in the private sector. We are fundamentally changing our welfare system to make work pay. And we have injected new ambition into our education system: making exams and testing more rigorous; backing teachers on discipline; allowing people who are passionate about education to open new schools in the state sector; and, crucially, supporting the poorest pupils through our Pupil Premium. 

We fully recognise that the changes needed to get Britain fit for the global race, combined with the strong economic headwinds we are still facing, have put many families' budgets under strain. That is why we are doing everything we can to help those who are working so hard to help themselves: moving rapidly towards a £10,000 personal income tax allowance, freezing council tax, helping with energy bills and cutting fuel duty.

So we are dealing with the deficit, rebuilding the economy, reforming welfare and education and supporting hard-working families through tough times. And on all of these key aims, our parties, after 32 months of coalition, remain steadfast and united. Of course there have been some issues on which we have not seen eye to eye, and no doubt there will be more. That is the nature of coalition. But on the things that matter most - the big structural reforms needed to secure our country's long-term future - our resolve and sense of shared purpose have, if anything, grown over time.

We came to office at a difficult time for our country. An economy still in shock. The Eurozone facing crisis. The inevitability that difficult cuts would have to be made. Worry, uncertainty and worse for many families and businesses. We have been determined to work in a way that keeps our country together through these times. That is why we have protected the NHS from spending cuts and protected schools, while other departments have faced significant spending reductions. That is why we have made sure that the richest have paid the most towards reducing the deficit. We have protected pensions, with the largest increase in the basic state pension. And we have kept our promises to the poorest in the world - meeting the pledges made about overseas aid. Today, at the half-way point in this Parliament, we are taking stock of the progress we have made in implementing the Coalition Agreement that we signed in May 2010. But we are also initiating a new set of reforms, building on those already under way, to secure our country's future and help people realise their ambitions.

We will support working families with their childcare costs. We will build more houses and make the dream of home ownership a reality for more people. We will set out plans for long-term investment in Britain's transport infrastructure. We will set out two big reforms to provide dignity in old age: an improved state pension that rewards saving, and more help with the costs of long-term care. And as we take these steps to reshape the British state for the 21st century, we will take further steps to limit its scope and extend our freedoms. We will be making announcements about each of these policy initiatives in due course. 

Our mission is clear: to get Britain living within its means and earning its way in the world once again. Our approach is consistent: to help hard-working families get by and get on, so that everyone can reach their full potential. And our resolve is unwavering: we will continue to put political partisanship to one side to govern in the long-term interests of the country.

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British mental health is in crisis

The headlines about "parity of esteem" between mental and physical health remain just that, warns Benedict Cooper. 

I don’t need to look very far to find the little black marks on this government’s mental health record. Just down the road, in fact. A short bus journey away from my flat in Nottingham is the Queens Medical Centre, once the largest hospital in Europe, now an embattled giant.

Not only has the QMC’s formerly world-renowned dermatology service been reduced to a nub since private provider Circle took over – but that’s for another day – it has lost two whole mental health wards in the past year. Add this to the closure of two more wards on the other side of town at the City Hospital, the closure of the Enright Close rehabilitation centre in Newark, plus two more centres proposed for closure in the imminent future, and you’re left with a city already with half as many inpatient mental health beds as it had a year ago and some very concerned citizens.

Not that Nottingham is alone - anything but. Over 2,100 mental health beds had been closed in England between April 2011 and last summer. Everywhere you go there are wards being shuttered; patients are being forced to travel hundreds of miles to get treatment in wards often well over-capacity, incidents of violence against mental health workers is increasing, police officers are becoming de facto frontline mental health crisis teams, and cuts to community services’ budgets are piling the pressure on sufferers and staff alike.

It’s particularly twisted when you think back to solemn promises from on high to work towards “parity of esteem” for mental health – i.e. that it should be held in equal regard as, say, cancer in terms of seriousness and resources. But that’s becoming one of those useful hollow axioms somehow totally disconnected from reality.

NHS England boss Simon Stevens hails the plan of “injecting purchasing power into mental health services to support the move to parity of esteem”; Jeremy Hunt believes “nothing less than true parity of esteem must be our goal”; and in the House of Commons nearly 18 months ago David Cameron went as far as to say “In terms of whether mental health should have parity of esteem with other forms of health care, yes it should, and we have legislated to make that the case”. 

Odd then, that the president of the British Association of Counselling & Psychotherapy (BACP), Dr Michael Shooter, unveiling a major report, “Psychological therapies and parity of esteem: from commitment to reality” nine months later, should say that the gulf between mental and physical health treatment “must be urgently addressed”.  Could there be some disparity at work, between medical reality and government healthtalk?

One of the rhetorical justifications for closures is the fact that surveys show patients preferring to be treated at home, and that with proper early intervention pressure can be reduced on hospital beds. But with overall bed occupancy rates at their highest ever level and the average occupancy in acute admissions wards at 104 per cent - the RCP’s recommended rate is 85 per cent - somehow these ideas don’t seem as important as straight funding and capacity arguments.

Not to say the home-treatment, early-intervention arguments aren’t valid. Integrated community and hospital care has long been the goal, not least in mental health with its multifarious fragments. Indeed, former senior policy advisor at the Department of Health and founder of the Centre for Applied Research and Evaluation International Foundation (Careif) Dr Albert Persaud tells me as early as 2000 there were policies in place for bringing together the various crisis, home, hospital and community services, but much of that work is now unravelling.

“We were on the right path,” he says. “These are people with complex problems who need complex treatment and there were policies for what this should look like. We were creating a movement in mental health which was going to become as powerful as in cancer. We should be building on that now, not looking at what’s been cut”.

But looking at cuts is an unavoidable fact of life in 2015. After a peak of funding for Child and Adolescent Mental Health Service (CAMHS) in 2010, spending fell in real terms by £50 million in the first three years of the Coalition. And in July this year ITV News and children’s mental health charity YoungMinds revealed a total funding cut of £85 million from trusts’ and local authorities’ mental health budgets for children and teenagers since 2010 - a drop of £35 million last year alone. Is it just me, or given all this, and with 75 per cent of the trusts surveyed revealing they had frozen or cut their mental health budgets between 2013-14 and 2014-15, does Stevens’ talk of purchasing “power” sound like a bit of a sick joke?

Not least when you look at figures uncovered by Labour over the weekend, which show the trend is continuing in all areas of mental health. Responses from 130 CCGs revealed a fall in the average proportion of total budgets allocated to mental health, from 11 per cent last year to 10 per cent in 2015/16. Which might not sound a lot in austerity era Britain, but Dr Persaud says this is a major blow after five years of squeezed budgets. “A change of 1 per cent in mental health is big money,” he says. “We’re into the realms of having less staff and having whole services removed. The more you cut and the longer you cut for, the impact is that it will cost more to reinstate these services”.

Mohsin Khan, trainee psychiatrist and founding member of pressure group NHS Survival, says the disparity in funding is now of critical importance. He says: “As a psychiatrist, I've seen the pressures we face, for instance bed pressures or longer waits for children to be seen in clinic. 92 per cent of people with physical health problems receive the care they need - compared to only 36 per cent of those with mental health problems. Yet there are more people with mental health problems than with heart problems”.

The funding picture in NHS trusts is alarming enough. But it sits in yet a wider context: the drastic belt-tightening local authorities and by extension, community mental health services have endured and will continue to endure. And this certainly cannot be ignored: in its interim report this July, the Commission on acute adult psychiatric care in England cited cuts to community services and discharge delays as the number one debilitating factor in finding beds for mental health patients.

And last but not least, there’s the role of the DWP. First there’s what the Wellcome Trust describes as “humiliating and pointless” - and I’ll add, draconian - psychological conditioning on jobseekers, championed by Iain Duncan Smith, which Wellcome Trusts says far from helping people back to work in fact perpetuate “notions of psychological failure”. Not only have vulnerable people been humiliated into proving their mental health conditions in order to draw benefits, figures released earlier in the year, featured in a Radio 4 File on Four special, show that in the first quarter of 2014 out of 15,955 people sanctioned by the DWP, 9,851 had mental health problems – more than 100 a day. And the mental distress attached to the latest proposals - for a woman who has been raped to then potentially have to prove it at a Jobcentre - is almost too sinister to contemplate.

Precarious times to be mentally ill. I found a post on care feedback site Patient Opinion when I was researching this article, by the daughter of a man being moved on from a Mental Health Services for Older People (MHSOP) centre set for closure, who had no idea what was happening next. Under the ‘Initial feelings’ section she had clicked ‘angry, anxious, disappointed, isolated, let down and worried’. The usual reasons were given for the confusion. “Patients and carers tell us that they would prefer to stay at home rather than come into hospital”, the responder said at one point. After four months of this it fizzled out and the daughter, presumably, gave up. But her final post said it all.

“There is no future for my dad just a slow decline before our eyes. We are without doubt powerless – there is no closure just grief”.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.