Over half of CCGs ‘need improvement’ for mental health and maternity

New NHS data reveals the extent of the challenge facing CCGs as they struggle to improve services in the key areas of mental health and maternity.

As part of the new CCG Improvement and Assessment Framework for 2016-17, initial baseline ratings for all CCGs in six clinical areas will be made available. The data is intended to help CCGs self-assess effectively and identify areas for improvement, with support from NHS England.

The figures for mental health and maternity care, published today, show that over half were rated ‘needs improvement’ or ‘greatest need for improvement’.

For mental health, 106 of the 209 CCGs were rated ‘needs improvement’ and 21 had the ‘greatest need for improvement’. Just 13 were marked ‘top performing’ and 69 were marked ‘performing well’.

The ratings focus on elements of two national standards: the number of people who are moving to recovery following treatment from IAPT services, and those receiving treatment within two weeks of referral when experiencing a first episode psychosis.

Professor Tim Kendall, NHS England’s national clinical director for mental health, recognised there is “significant work to be done” to improve mental health services.

“In our five year strategy the Five Year Forward View for mental health we 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.

“NHS England has also launched the first national standards to increase access to evidence-based mental health services which will kick-start the transformation needed to achieve our ambitions for the next five years.

“Although the baseline CCG IAF ratings, published today, highlights the scale of change needed these services, we know that performance has improved in recent months meaning that people are already getting better access to services and recovery rates are rising across the country.”

Dr Phil Moore, chair of the NHS Clinical Commissioners (NHSCC) mental health commissioners network, agreed that the baseline ratings demonstrated “there is already excellent work taking place across the country”, and argued it will be a useful lever “to provide a focus to improve mental health care plans in our local areas”.

“In the future we anticipate being able to track our progress as CCGs to ensure that the right services are being put in place for our populations,” Moore said.

“Mental health has long been characterised as a Cinderella service and only in recent years have we seen it rise on the political agenda and kept firmly in the public eye. While reversing the years of neglect won’t happen overnight, it is crucial that we keep momentum and work together at pace to make sure that we deliver the mental health services that our local patients and populations need.

“The challenging targets that have been set may be tough to achieve but we know that not giving it our best will be even more costly – in both economic and human terms.”

Separately, NHS England also published a new integrated ‘dashboard’ for mental health.

Simon Stevens, NHS England’s chief executive, said: “This new level of local transparency is unprecedented for any mental health service anywhere in the world. Over the next five years, we want to see major improvements in NHS mental services.

“These figures for last year transparently lay out the starting baseline against which everyone will be able to judge whether the NHS is getting better in each and every town, city and county across England.”

‘First clear signs’ of parity

Stephen Dalton, chief executive of NHS Confederation, argued that the datasets were “the first clear signs” that NHS England was determined to give parity between mental and physical health.

“In the face of considerable financial pressure, local commissioners have prioritised investment in mental health and should be recognised, along with England's national director, Claire Murdoch”, he added.

Rebecca Cotton, director of mental health policy for the Mental Health Network, also commented: “Despite hugely challenging financial circumstances, providers have reduced the use of police cells as places of safety, increased employment and improved the number of Early Intervention in Psychosis referrals starting treatment within two weeks.

“There is however still much work to be done, particularly around Mental Health Act detentions, access to therapies in secure settings and declining numbers of full physical health checks for people with severe mental illnesses.

“To improve these areas, it is imperative NHS England and the government make good on their promises to get funding to the frontline where it is urgently needed.”

The government promised an additional £1bn for mental health care earlier this year, but a recent Public Accounts Committee report said that the money is at risk of being spent elsewhere, meaning service reforms will not be achieved.

Concerns about maternity care

Across maternity, just one CCG, West Kent, was ‘top performing’, and 53 were ‘performing well’.

A total of 144 CCGs were rated ‘needs improvement’, and 11 had the ‘greatest need for improvement’.

Cathy Warwick, chief executive of the Royal College of Midwives (RCM), said she was concerned about these findings, adding: “Poorly performing services need to be addressing this variation very urgently. I do also recognise also that some of this is older data and that improvements may have been made since then.

“Services are though up against huge cost savings being demanded from the government, whilst also facing rising demands on their services, leaving them too often under resourced and under-staffed. This is not just about learning from each other to ensure all are performing well, it is also about resourcing services adequately.”

A recent RCM survey found that over a third of maternity units have had to close temporarily in the past year because they couldn’t cope with demand, which the union linked to a lack of funding and staff.

Elizabeth Duff, senior policy adviser at the National Childbirth Trust, emphasised that while it was positive NHS England is delivering on its transparency commitment, parents shouldn’t use the figures along to decide where to have a baby. They are baseline ratings “which don’t take into account every aspect of care”, she argued.

Julie Wood, chief executive of NHSCC, said: “As the National Maternity Review recognised, the quality and outcomes of maternity services have been improving significantly over the last decade. CCGs are committed to improving this yet further and making sure that all women are provided with high-quality maternity care.”

(Image c. Dominic Lipinski from PA Wire)

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