The must-read stories and debate in health policy and leadership.

The introduction of the mental health investment standard in 2015-16 was a win for the sector and has been important in focusing commissioners’ minds on funding.

Its first iteration meant clinical commissioning groups had to increase the spend by the equivalent of their overall growth in allocation from NHS England to mental health. Commissioners must now spend more than this to achieve the standard.

The MHIVS is a bit of a blunt tool, with some pitfalls, for example meeting the standard does not necessarily mean money is reaching the front line.

In 2019, NHS England announced all CCGs would need an independent audit of claims they met the standard in 2018-19 (perhaps following an inkling the commissioner had that CCGs could quite easily game the standard).

The results of these audits, revealed today by HSJ, show 16 CCGs did not hit the investment standard in 2018-19 despite claiming at the time they had. Whether this is down to accounting mistakes or deliberate misleading is difficult to know but it does raise questions over whether the application of the standard needs to be changed.

One suggestion from sector leaders has been to put mental health investment straight into the hands of the providers.

A volatile issue

It is not unusual for medical devices which involve high levels of oxygen to present a risk of explosion. Training and adaptations are the normal ways to mitigate that risk.

So it is perhaps surprising that the potential issues with EpiShuttles – ordered originally for the transport of covid patients – were not looked at before money changed hands.

As HSJ reported, there are concerns within the ambulance service about the possibility of explosions if the EpiShuttles are used with high concentrations of oxygen. The manufacturer is talking to NHS England about getting the 15 purchased in England into use, and points to ways of dealing with high oxygen levels. The devices have met regulatory standards.

NHS England says the reason they have not been used for high-consequence infectious diseases yet is because staff training has been delayed by covid. However, a number of other countries are using them for the transport of covid patients and NHS England has not yet confirmed they are available should an HCID (and we are talking ebola, pneumonic plague and similar) break out.