This is HSJ’s fortnightly briefing covering quality, performance and finances in the mental health sector
Feedback and comments are welcome, so please feel free to email me in confidence.
It is too easy to give clinical commissioning groups a hard time over how they allocate their cash at a time when the numbers are looking increasingly impossible for everyone.
NHS England’s mental health dashboard, which launched last year, was meant to increase transparency on what was being spent in the sector and whether new cash was reaching frontline services.
But rather than shining a light on CCGs’ performance, it is being used as a blunt instrument with which to browbeat commissioners over their spending.
Either they are not spending enough on mental health services in general, not enough on specific services, not as much as planned, or not raising their spending enough.
In the past week, there have been three high profile stories about mental health spending:
- A Lib Dem freedom of information request found that almost half of CCGs had cut spending on children’s mental health in real terms between 2015-16 and 2016-17.
- The Royal College of Psychiatrists’ analysis found a wide variance in CCG spending on children and young people’s mental health services.
- While a Labour FOI suggests nearly half of CCGs plan to cut mental health spending from 2016-17 to 2017-18.
This is in spite of an overall increase in mental health spending by CCGs – according to the dashboard – from £9.1bn in 2015-16 to £9.7bn in 2016-17.
So while CCGs are being heavily scrutinised for their mental health spending, many are increasing investment.
The trick is making sure it is going to the right places, and the dashboard is unable to tell us that.
Traversing the minefield
I have written many times – and probably will again – about former NHS Confederation chief Stephen Dalton’s “acid test” of new cash having to reach the front line.
This test is becoming more vital as we come to the midpoint of the Five Year Forward View for Mental Health. We need to know that the promised cash from NHS England and the Department of Health for new services is being properly invested and new funding is flowing into CCGs’ allocations.
The dashboard allows us to do this better than ever before. The latest figures, for quarter four of 2016-17, show:
- Only 32 CCGs failed to meet the mental health investment standard of raising their spending on the sector in line with their allocation growth.
- Twelve CCGs cut their mental health budgets in cash terms.
- Twenty two reduced their mental health budgets in real terms.
This is important information, but the data is still a minefield.
Painting a complete picture
The biggest obstacle to transparency is data quality.
When HSJ approached CCGs about general or CYP mental health spending, some said that the data does not paint a complete picture of what they are spending on the sector.
This is a major problem with the dashboard – because if every CCG is submitting different data about its mental health spending we can’t compare like with like.
It makes trying to use the tool impossible because we do not know if we are comparing apples with apples and pears with pears, or apples with pears.
This is not uncommon for the NHS – new datasets are often something of a fruit salad in this regard.
Mental health spending is complicated, with some CCGs pulling multiple services together into a single block contract with a large provider. Other services are paid through primary or community care budgets – such as improving access to psychological therapies – while some mental health spending, such as section 117 after care, is often included in a CCG’s continuing healthcare budget.
So there could be millions of pounds of spending that is not captured by the dashboard.
While it appears to give clarity, it may actually be adding to the confusion over how resources are being used.
Until data quality issues are sorted out and we get complete and comparable data from every CCG in the country, we won’t know if promises are being broken or kept.
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