Noel Plumridge: the business of mental health

The significance of the delay, however, reaches beyond finance departments.

Not a mental health expert? Let me refresh your memory. Mental health is big business. We spend some 11 per cent of the NHS secondary care budget on it, along with plenty of primary care time and more than £2bn each year in social care. And demand is growing. Progress in bringing mental health into the payment by results regime has been slow but a proposed tariff for adult care, structured around 21 “clusters” based on severity of condition, forms part of this year’s regime.The intention had been to make it mandatory from next April.

The problem, unsurprisingly, is data quality. Creating a coherent set of categories for mental health is difficult. It is not like orthopaedic surgery. Diagnosis is complex and sometimes controversial. Besides, much mental illness is, sadly, long term, so putting a price on a “spell” becomes meaningless.

However, not everyone will be weeping buckets at the delay. A viable tariff, protecting mental health spending from competing pressures, might be attractive to mental health trusts but commissioners may not concur, especially if the national mental health strategy, No Health Without Mental Health, is not tied to measurable performance.  

Acute foundation trusts may also be content with the status quo. Tariff funding has allowed them to suck in whatever extra funding is around: why share the bunce? And gobbling up the local mental health provider offers a practical route to growth.

Then there’s the commercial sector. Private mental health provision in England is larger than generally acknowledged, much of it hidden away in “placement” budgets. And any qualified provider experience with community nursing and therapies shows the enthusiasm of outsourcing companies for the sweet combination of big budgets and poorly defined tariffs. 

Without a workable tariff, the supposed security of mental health foundation trusts is an illusion.

Noel Plumridge is an independent consultant and former NHS finance director, noelplumridge@aol.com