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Counsellors and Psychotherapists! It’s time to act to protect our NHS and Mental Health Care..

by Janet Tolan
Published on 21 October 2021

With mental health distress skyrocketing, the Health and Care Bill will do nothing to assist struggling services. In a denial of care, it increases cuts in healthcare and puts big business at the heart of NHS decision-making. 


Mental health and IAPT have been at the forefront of this denial, the ‘market of care’, already ‘turning a blind eye to the emotional realities of suffering’1

The Bill is between its second and third reading. It is not YET too late; What we all need to do:


      PCU NHS sub group:

      Health Campaigns Together


The Health and Care Bill undermines our NHS principles of universal care in response to need, free at the point of use. While the rhetoric claims ‘improvement’, in reality it heads us further down the road towards an uncaring, privatised Medicaid type Health Service, run to make profit for companies. It will compound, rather than relieve, the social inequalities already so harmful to our mental wellbeing.


  •     Mental health is exposed to years of underfunding and involvement of private companies. Adult and child services are struggling.
  •     50% of IAPT contracts are outsourced to private companies and the third sector, increasingly to multi-national companies.2
  •     Despite the diligence of counsellors and therapists working there, IAPT is a failing service, based on false claims. Only a third of referrals each year complete a course of treatment, and only 16% achieve, by IAPT’s own definition, “reliable recovery”.2
  •     The IAPT use of manualised and digital therapies is downgrading and de-professionalising clinical jobs.3
  •     pay and working conditions of counsellors and psychotherapists in the public and charity sectors have been deteriorating for years.
  •     The culture of performance management undermines the quality of care.2
  •     CAMHS, “funding has stagnated, leaving services without capacity to support children and young people in need.4
  •     ‘people are consistently reporting poor experiences of NHS community mental health services, with few positive results.’5
  •     97% of ‘locked ward rehabilitation’ (a £304m market) is held by private companies, the largest two of which are now US-owned 5
  •     53% of all beds (locked and unlocked) for mental health rehabilitation are privately provided. 6
  •     Recent years have seen several incidents of appalling lack of care of in-patients in private hospitals, including The Huntercombe Group and Cygnet Healthcare.7

The Health and Care Bill makes all this much worse! 

  •     NHS contracts will be handed to private companies with no transparency or accountability. As in the pandemic, for example, £37 billion was wasted on a ‘test and trace’ service that simply didn’t work.
  •     Patients and the public will have even less say than we do now in what happens to our local health services, as the new boards, covering populations of up to 3 million people, will be remote and centralised, with no obligation to be open, transparent, or accountable to ordinary people. There is no mention of Mental Health representation on the boards.
  •     Each ICS will have a limited budget leading to more cuts to services for patients, longer waiting times, and an unfair postcode lottery. The private sector, which has shown itself to be greedy and inept during the Covid pandemic will benefit as private companies could get seats and influence on the new Integrated Care Boards proposed by the Bill.
  •     NHS staff could find themselves subject to local deals on pay and conditions and this could adversely affect recruitment and retention of NHS staff at a time when this should be one of the highest priorities of the government.
  •     More downgrading of clinical roles as is already happening in mental health and IAPT.
  •     The Bill does nothing to improve social care. In fact, it could make it worse. Hospitals will no longer do social care needs assessments before sending people home – a recipe for the dumping of patients without proper support.


1.      Dr. David Bell (2013) Mental illness and its treatment today. Centre for Health and the Public Interest. Dr Bell is a Consultant psychiatrist at the Tavistock and Portman NHS Foundation Trust and past President of the British Psychoanalytic Society


3.      Cotton E. 2019 The Industrial Relations of Mental Health. In Jackson C and Rizq R (Eds) The Industrialisation of Care: Counselling & Psychotherapy in a Neoliberal Age. PCCS Books.

4.      Local Government Association (2021) 

5.      Care Quality Commission Mental Health Survey 2020

6.      2018 Care Quality Commission Report

7.      NHS For Sale website


Link to PCU recording of NHS Emergency meeting in September here and 5 minute slice of the meeting here.