Parity of Esteem

Since the publication of this blog Dr Martin McShane has left NHS England.

There is the apocryphal story of the janitor at NASA who, when asked by the President what his job was replied, “I help put people on the moon”.

How would I reply to that question in my current role? By saying, “I help create high quality care for all”.

The NHS, however, faces a series of unprecedented challenges and one of those is to address the fact that we do not, yet, provide high quality care for everyone – especially if you have mental health problems. The disparity in approach between people with physical and mental health problems is inequitable and unfair. Let me give you some facts; over 75% of those with heart disease are in treatment, for people with diabetes or hypertension more than 90% are in treatment. Conversely only 25% of people with depression or anxiety receive treatment. If you have mental illness it can reduce your life expectancy by 10 years because of your poor physical health, individuals with mental health issues have the same life expectancy as the general population did 50 years ago. The system is failing these individuals, additionally we also overlook the fact that poor physical health is accompanied by poor mental health and research shows this adversely affects outcomes.

Someone recently described this to me as professional monocularism – we tend to view people through one eye at a time. One eye for physical health problems or one eye for mental health problems. It is time the NHS developed binocular vision. We need to value the importance of mental health on a par with that of physical health.

The value of doing so will help us tackle the challenges the NHS faces. We know that if people are less anxious, have resilience and insight they are better able to manage their physical and mental health problems. We know that if we tackle the physical health of people with mental health problems we will not only enhance their quality of life but also cost to the NHS.

The challenge to be addressed is huge. To enhance the quality of life for people with long term conditions we need to be thinking beyond traditional models which focus on just the patient and professionals. We need to understand and support the importance of carers. We need to understand and mobilise the assets in communities. We need to have a system that is person centred, that starts with what is important to the individual and has meaning for them, their families and their lives. There are many things we could do better but there are also things we must do differently.

To do this we have to think of how we can put people and carers in control. We need to think about how we can support professional collaboration. We need to think about how we can ensure best practice is used. Finally we need to think about how commissioning can create the foundations for this. This is why we have adopted the metaphor or model of the House of Care. It takes commissioning as its foundation, best practice as the roof and placing patients and carers in control as one wall with professional collaboration as the other wall. This construct creates space for person centred coordinated care which is what people have told us they want.

We need to tackle this challenge. We have put people on the moon now all we have to do is put mental health on a par with physical health. That is why NHS England has launched a call to action and why Parity of Esteem is one of the key themes we will be pursuing at a national, local and personal level. Please join us in our pursuit of high quality care for all, now and for future generations.

Dr Martin McShane is speaking at stakeholder event on 25 November on how mental and physical health can be valued equally. During the day, invited service users and clinicians will explore how health and care services could be modernised and adapted to address the whole person and not just episodes of ill health. Feedback and ideas from the event, and the other national events happening as part of the Call to Action will be provided to commissioners to help with their 5 year strategic plans.

Other ways that people can feed in to the Call to Action, include:

  • Leave a comment on the Call to Action pages on NHS Choices
  • Send us a tweet to @NHSEngland using the #CalltoAction hashtag
  • Through your local Clinical Commissioning Group (CCG) – Talk to your local CCG – Find your local CCG now
  • Take part in one of the local engagement events led by CCGs, Health and Wellbeing board, local authorities and other local partners.

Dr Martin McShane was previously National Clinical Director for Long Term Conditions, since the publication of these blogs he has left NHS England.


  1. David Shiers says:

    I am struggling to understand how the priority to reduce the premature mortality of people with severe mental illness squares with the SOS announcement of the 2014/15 GP contract negotiation? The decision to downgrade in the QOF the physical health monitoring of people with severe mental illness left me bemused and sad.

    Bemused because this goes against every piece of evidence I have read over the last 5 years confirming that CVD is the single biggest contributor to the mortality gap – that cardiometabolic risk establishes rapidly into a trajectory which puts this population at 4 fold the rates of the very risks that the BMA/NHS employers ‘retired’, and thus the means to tackle the mortality gap by targeted prevention of CVD risk has now been sacrificed.

    Sad because of the signals it send to people like my daughter (now aged 38) and others with schizophrenia about the lack of regard their national health service holds for them.

    The late Helen Lester in her James McKenzie lecture exactly 12 months ago described it perfectly ‘Being bothered about Billy’. I wonder how Helen would have viewed last Friday’s decision – the first year of her absence from the negotiation? Her you tube is on this website –

    David Shiers Retired GP North Staffordshire

  2. Peter Wildsmith says:

    I am a recently retired Nurse / Senior Lecturer in Nursing.Prompted by today’s news on what Jane Cummings (CNO for England) has stated about nurse staffing levels, I thought I’d add my mantra to this discussion. It is interesting to note that no-one in Nursing took notice of the published research by nurses approx 5 years ago highlighting the connection between extended hospital-patient stays and also high mortality rates, with the low ratio of nurses to patients. It isn’t a matter of putting more nurses (and I mean fully trained nurses) onto hospital wards but to ensure that appointed nurses can and do deliver care to its highest standard.In my teaching of student nurses, I frequently referred to the role of accountability in our work. I defined accountability as a positive concept of the nurses role and should never be seen as negative. Hence, if a nurse practices with accountability (ie, able to justify to others what s/he is doing at any time) then high standards will be maintained. Sadly, no-one seems to respect accountability to the point where a nurse could be demoted or sacked for wrong-doing. As with the very recent history of the Banks, politicians, hospital CEO / Managers, care staff etc. no-one accounts (professionally) for their actions. Poor practice is allowed to flourish unabated and in the worst cases some individuals are rewarded for the mismanagement of their role. Peter Wildsmith MA Philosophy and Health Care (Swansea).