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Mental health reforms lack ‘sound foundations’ due to cash and data shortage

Necessary mental health reforms may not be achieved because of the acute funding pressures on the NHS, the influential Commons Public Accounts Committee (PAC) has said in a new report.

Although the government has said that mental and physical health care should be given equal priority and promised an additional £1bn for mental health care, the report said the money is not ring-fenced, meaning it could be spent elsewhere.

As part of its reforms, the government has introduced waiting time targets for areas including psychosis treatment, and is planning to introduce more for conditions such as eating disorders. However, the PAC warned that this could increase the pressure on mental health funding as providers try to meet targets.

“There is a risk that commissioners and providers, already under financial pressure, will have no choice other than to deprioritise other mental or physical health services if they are to meet the new standards,” the report said.

MPs in the committee also argued that despite evidence that spending on mental health services leads to a net gain because of better health outcomes and reduced pressure on other services, there is not sufficient data about mental health spending to allow commissioners to make well-informed decisions.

The PAC said that by the start of 2017-18, the Department of Health and NHS England should gather clear data on how much is currently spent on mental health, how much needs to be spent and how best to prioritise the money available.

It also recommended that NHS England implement open-book reporting by CCGs, particularly around how much is spent on mental health services, and report back in December on its progress.

Meg Hillier MP, chair of the PAC, added: “The government has committed to making much-needed improvements to mental health services but we are concerned it does not yet have sound foundations to build on.

“As a priority the Department of Health and NHS England must achieve a better understanding of the current landscape and the likely costs of achieving its goals.

“If these goals prove beyond the scope of the funds provided then it is vital a plan is in place to make best use of the money available.”

Workforce issues

Staffing levels were highlighted as another area holding back parity of esteem. An estimated 7% increase in mental health nurses is needed to meet the new performance targets, but the NHS as a whole is facing major workforce shortages.

Health Education England (HEE) is now developing a workforce strategy for mental health for the first time since 1999, but the PAC said the department, NHS England and HEE should provide an estimate of the workforce needed and a plan for delivering it by 2017-18.

The PAC also found that the mental health system is “complex, variable and difficult to navigate”, with patients often being referred to multiple clinical services because different services have been commissioned at different times.

It argued that there are few incentives for commissioners and providers to ensure mental health services are of a high quality.

“Governance and accountability structures are complex and lack transparency, undermining confidence that services are being commissioned and provided in the best ways,” MPs added.

Most mental health services are currently paid for by block contracts, where providers receive a fixed sum regardless of the quality of services or how many patients they reach.

Saffron Cordery, director of policy and strategy at NHS Providers, commented: “Local commissioning budgets are under significant strain, and without more clarity on what constitutes front-line mental health services and how much should be spent on them, there are risks that in meeting the government’s access standards other mental health elements may be forced to miss out.”

The report also described systems for a joined-up strategy on mental health care – such as mental health support for ex-prisoners and those out of work – as “weak”, and said a government strategy for integrating mental health work between the departments is needed.

Recommendations ‘already taking shape’

In response, the Department of Health said it was already undertaking the recommended work. In particular, it said it had already established “high-level partnerships” with the Home Office and the departments of Justice, Education, and Work and Pensions, and would publish a five-year data strategy in December.

A spokesperson added: “As the PAC has recognised, we have made important progress in the way we think about and treat mental illness in this country, introducing the first mental health waiting times in the history of the NHS.

“We are determined to accelerate progress further and are backing the NHS’ plan to revolutionise mental health care with an additional £1bn invested every year by 2020 – helping one million more people with mental illness access high quality care.”

Claire Murdoch, national clinical director for mental health at NHS England, also argued that her organisation has “laid out very clear plans to help more than a million extra people and invest more than a billion pounds a year by 2020/21”.

“In the implementation plan published last month we set out how we would expand staff and services for a range of mental health issues to improve care for everyone,” she continued.

"Our plans are fully costed and show how we will collect and publish data on spending and patient outcomes, work with Health Education England to grow the workforce and financially incentivise trusts to focus on key areas of care such as children and young people and crisis care.

“By 2021, working with a range of others organisations, we are committed to raising standards of care and increasing the transparency of the sector.”

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