The National Counselling & Psychotherapy Society (NCPS) welcomes the ambition behind Fit for the Future: 10 Year Health Plan for England, and the recognition that meaningful reform is urgently needed. There is much to applaud in the ambition to create a more integrated, accessible, and prevention-focused health and care system, particularly in relation to mental health. The plan rightly acknowledges that the NHS must move away from a reactive model and towards a preventative model, built around our communities, which is something we've been calling for for a long time now. Mental health does feature throughout the document, and it’s encouraging to see commitments aimed at improving access and outcomes, particularly for children and young people.
From a critical perspective, the Plan unfortunately still reflects a narrow, predominantly clinical, view of mental health. It risks overlooking the full spectrum of therapeutic support available and undervaluing the role of counselling & psychotherapy. In our view, this is a missed opportunity to rebalance the system towards earlier, more relational interventions that could reduce pressure on acute services and better support people’s long-term wellbeing.
As the government looks to reimagine the NHS, it must also reimagine mental health care by embedding therapeutic choice, relationship-based support, and local provision at the heart of the new model. Digital delivery will absolutely be a vital tool in the sustainability of the service into the future, but it mustn't be the only tool in the toolkit.
We do welcome the Plan’s expansion of mental health support teams in schools and colleges, although we'd like to see the adoption of Barnardo's MHST+ model as the rollout continues. We're also encouraged by the proposed Young Futures Hubs, and the inclusion of mental health as a priority for the National Quality Board.
When it comes to our concerns, however, the Plan envisions an NHS where support is available digitally and “instantly”, with the NHS App offering a ‘doctor in your pocket’ and continuous monitoring tools that allow clinicians to intervene proactively. While digital access increases convenience and reach, we're concerned about the implications of this approach for mental health services, particularly the concept of 24/7 virtual therapists and therapeutic chatbots. Continuous access to virtual therapy or chatbot-style interventions can blur the boundaries of the therapeutic relationship and lead to over-reliance, particularly among vulnerable clients. Effective therapy relies on trust, containment, and a structured, relational approach. A shift towards ‘always-on’ support may unintentionally undermine these foundations, especially if not delivered alongside clear guidance and ethical oversight. Technology can complement therapy, but it should not be assumed that all clients benefit equally from digital-first or 24/7 models. Any rollout of these services must be underpinned by ethical safeguards, co-design with clients/patients, and an understanding of the relational nature of effective therapy.
We're also concerned that the plan does not reference the Accredited Registers programme, which already provides a quality-assured workforce of trained, supervised, and ethically accountable counsellors & psychotherapists.
This is especially urgent given the long waiting lists, growing demand for relational forms of support, and widespread workforce challenges across statutory mental health services. Counsellors and psychotherapists registered on Accredited Registers are already delivering effective, evidence-based support across education, primary care, workplace wellbeing, voluntary sector provision, and private practice, and they're ready to be mobilised today.
We're pleased to see the plan prioritise the mental health needs of children and young people, including recognition that “almost half of all mental health conditions develop before the age of 18” and that schools must be central to the solution. Commitments to embed mental health support into education, expand early intervention, and increase specialist capacity are going to be key for our collective futures.
Without sufficient investment in counselling & psychotherapy within these settings, however, there's a risk that plans will stall. Schools and colleges need sustained, embedded access to relational support, but what we're potentially looking at is more of the same: short-term programmes, low-intensity therapeutic interventions, and now digital triage tools. We also note that while the Young Futures Hubs concept is promising, the delivery model must ensure that counselling is a core part of that and not just an add-on.
In addition to the above, we are concerned that the Plan continues to frame mental health largely in terms of clinical, statutory provision, without sufficient recognition of the broader ecosystem of support, which includes counselling & psychotherapy. There's no clear commitment to increasing access to talking therapies, despite well-documented waiting lists and drop-out rates within NHS Talking Therapies. The Plan’s ambition to shift care from hospital to community must include substantial investment in counselling & psychotherapy outside of crisis settings. There's also limited reference to therapeutic relationships, despite strong evidence that the relationship between client and therapist is a key factor in positive outcomes. A system focused heavily on digital triage, AI, and apps risks deprioritising human connection, particularly for those whose distress arises from trauma, neglect, or complex relational histories. And finally, there remains a lack of support for choice of therapeutic approach or practitioner, which is vital for patient/client engagement, particularly among those who’ve previously disengaged from NHS mental health services or don’t meet thresholds for diagnosis-led treatment.
Recommendations
As plans move into delivery, we urge DHSC and the NHS to ensure that Accredited Register practitioners are included in workforce planning, commissioning, and implementation of local models. This includes ensuring that counsellors & psychotherapists on Accredited Registers are eligible to deliver commissioned mental health support, including through schools, primary care, and community hubs; creating clear and consistent pathways for clients to access relational, talking-based support outside the NHS Talking Therapies model, and recognising the unique, relational expertise of counsellors & psychotherapists and protecting time-limited funding from being diverted solely to digital or pharmacological solutions.
In summary:
Expand choice and access to counselling & psychotherapy by investing in diverse models of talking therapy, including relational and non-medical approaches. One size does not fit all, especially when it comes to mental health support.
Recognise and promote the role of the Accredited Registers programme, ensuring clients/patients can access safe, ethical support outside of statutory provision, including the funding of a public health campaign to improve awareness of how to find a safe, appropriately qualified therapist, helping people make informed decisions outside of clinical referral pathways.
Embed counselling & psychotherapy in neighbourhood health centres, making it easy for people to self-refer to local, community-based therapists, especially in areas with long waiting times for NHS Talking Therapies.
Ensure Young Futures Hubs are inclusive of counsellors & psychotherapists at the outset
Prioritise practitioner wellbeing, recognising that many therapists, especially in the voluntary and community sectors, work under increasing financial and emotional pressure without clear inclusion in workforce planning or funding models
