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.
The moment of truth
The long term plan being drawn up in the wake of the government’s pledge of an extra £20bn of funding for NHS England by 2023-24 is a pivotal moment for the mental health sector.
The sector has seen a massive upsurge in public awareness helped along by the young Royals and prime minister Theresa May making it one of her “burning injustices”.
The Mental Health Forward View and NHS England’s implementation plan have led to new cash and new resources coming through.
But there are still huge challenges to tackle, and the last few years could come to nothing if the promises are not kept, the cash runs out and mental health drops off the list of national priorites.
Jam today, not tomorrow
There has been a niggling fear among many in the sector that the momentum generated by the Mental Health Forward View will fizzle out if there is nothing to replace it.
The new plan is an opportunity to commit to jam today not simply promises of jam tomorrow.
So far all we have heard from the PM is that the new plan must use the cash to make improvements to key services, including mental health.
Mrs May stressed the plan must contain proposals that are more ambitious than before. She suggested attracting more graduates to mental health professionals, finding new ways to integrate services in the community, and more preventative work.
This is easier said than done, and if it is going to be achieved it needs a new funding package for the sector which many leaders feel should go beyond the 3.4 per cent promised to the NHS as a whole.
Research commissioned by the NHS Confederation estimates that to extend treatment to 70 per cent of people with mental health problems funding will have to rise to £32bn by 2033-34, from nine per cent of the health budget to 12 per cent.
Mental Health Network chief executive Sean Duggan has said that to achieve “true” parity of esteem the sector must be given a greater proportion of the NHS budget.
But while the additional 3.4 per cent is very welcome, is it enough to result in a significant proportional increase in mental health spending?
But Mrs May did drop a titillating hint that new waiting times or access targets could be round the corner.
She said: “The long term plan must move us towards new clinically defined access standards for mental health that are as ambitious as those in physical health.”
I have written before about the merits of introducing new targets, but now it looks like new standards will soon be set in stone.
What these targets will look like is the other major question of the new plan.
Will this amount to a four hour target for acute patients like the one suggested by Lord Crisp? Or will different services have different targets such as the proposed but dropped 24 hour mother and baby unit plan?
So far the only thing that seems certain is that the plans will prioritise children and young people’s services and that there will probably be a new access standard as set out in the green paper.
But NHS England, while not ideologically opposed to new targets, will not want to set itself up for failure. Throughout the Mental Health Forward View it has been very protective of its plans, hitting back hard against criticism – most notably at the Care Quality Commission and children’s commissioner Anne Longfield, but also against other organisations.
So the likelihood of it accepting new targets that it could publicly be seen to be failing is virtually nil. Its position has been clear – no new targets without new resources.
We now have new resources, we must now see whether NHS England commits it to mental health.