Revealed: One in 10 CCGs flout key NHS spending pledge

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One in 10 CCGs cut mental health spending from 2016-17 to 2017-18 according to NHS England’s latest mental health dashboard
This is more than double the 10 which cut mental health spending between 2015-16 and 2016-17
The new data reveals 186 of the 207 CCGs met the mental health investment standard

One in 10 clinical commissioning groups have cut their mental health spending according to new figures from NHS England, more than double the previous year.

The national commissioning organisation published its mental health dashboard for quarter four of 2017-18 yesterday, which revealed 24 CCGs had reduced mental health spending from 2016-17 to 2017-18.

It is more than double the ten CCGs which reduced mental health spending from 2015-16 to 2016-17 according to the quarter four dashboard for the previous year.

A total of four CCGs reduced their mental health spending in both years according to the data. They were:

Great Yarmouth and Waveney CCG;
Kernow CCG;
Richmond CCG; and
South Gloucestershire CCG.

Despite mental health funding across all 207 CCGs rising from £9.7bn to £10.1bn from 2016-17 to 2017-18, the 24 CCGs cut £35.5m from their combined mental health budgets.

The mental health investment standard commits commissioners to raising their spending on it in line with their programme allocation growth;

The dashboard also revealed:

The number of commissioners missing the standard fell to 21 between 2016-17 and 2017-18, down from 32 between 2015-16 and 2016-17;
Eight CCGs met the investment target despite having reduced their mental health spending; and
Of those eight, only Castle Point and Rochford CCG was reported as having a drop in its 2017-18 allocation.

NHS England said that the reason some CCGs were meeting the standard while reducing mental health spending was because the standard was based on just mental health spending excluding learning disabilities and dementia. However, the spending data included learning disability and dementia.

The new data has sparked concerns among sector leaders, with the Royal College of Psychiatrists branding it “extremely worrying”.

College president Professor Wendy Burn said it was excellent more CCGs were meeting the standard because only increased spending can “atone for decades of underinvestment”.

But she added: “It is deeply concerning that some commissioners reportedly have been deemed to have met this standard despite cutting their mental health spending – this should not happen.

“It is also extremely worrying that more commissioners appear to be reducing mental health spending, despite the key aim being for them to increase it.”

Professor Burn called on commissioners and NHS England to explain “urgently” how CCGs were judged to have met the standard despite reducing mental health spending.

NHS England national mental health director Claire Murdoch said the mental health investment target had been met nationally and the rise in spending was higher than CCG allocation growth.

She added: “It is an unarguable fact that more CCGs than ever before have met the standard, while overall CCG spending on mental health has gone up year on year.

“The mental health funding taps have been turned on and the rise in mental health spending is higher than the growth in overall CCG funding, and so thanks to the growing investment flowing through the system, new, improved and expanded services are reaching an ever increasing number of people, in good time.”

Mrs Murdoch said in April that meeting the standard was not an “optional extra”.

In a letter to CCGs and sustainability and transformation partnership leaders, seen by HSJ, Mrs Murdoch said nine in 10 meeting the standard was “not enough”.

Mrs Murdoch also told MPs in July that every CCG will meet the standard in 2018-19.

The MHIS was originally introduced in 2015-16 but when challenged by MPs over patchy delivery, NHS England chief executive Simon Stevens said the commitment only applied at a national level, rather than for every CCG.

The 2018-19 planning guidance mandates that every CCG must now meet the standard, although it does not set out what sanctions CCGs will face for breaching it.

If every CCG hits the mental health investment standard total mental health spending should rise to £10.8bn by 2020-21 according to analysis by HSJ. This would equate to an increase of eight per cent on 2017-18 funding levels.

An investigation by HSJ in March this year found that 23 CCGs were predicting they would be cutting mental health spending from 2016-17 to 2017-18.

CCGs reducing mental helath spending from 2016-17 to 2017-18

CCG name	2016-17 actual spend (m)	2017-18 actual spend (m)	Spending decrease (m)	% decrease	MHIS 2017-18
NHS Redbridge CCG	£40.9	£38.2	-£2.7	-6.60%	N
NHS Northumberland CCG	£90.9	£85.3	-£5.6	-6.16%	N
NHS Eastern Cheshire CCG	£39.9	£37.8	-£2.1	-5.26%	N
NHS St Helens CCG	£39.6	£38.0	-£1.6	-4.04%	N
NHS Sandwell and West Birmingham CCG	£100.5	£96.5	-£4.0	-3.98%	N
NHS Kernow CCG	£126.2	£121.4	-£4.8	-3.80%	N
NHS Warwickshire North CCG	£36.0	£34.8	-£1.2	-3.33%	N
NHS Richmond CCG	£28.8	£28.0	-£0.8	-2.78%	N
NHS Swale CCG	£15.4	£15.0	-£0.4	-2.60%	Y
NHS Telford and Wrekin CCG	£24.2	£23.6	-£0.6	-2.48%	N
NHS Croydon CCG	£56.5	£55.1	-£1.4	-2.48%	N
NHS Gloucestershire CCG	£83.8	£81.8	-£2.0	-2.39%	Y
NHS Dartford, Gravesham and Swanley CCG	£31.1	£30.4	-£0.7	-2.25%	Y
NHS Birmingham South and Central CCG	£67.2	£65.9	-£1.3	-1.93%	N
NHS Dorset CCG	£162.1	£159.4	-£2.7	-1.67%	N
NHS North Somerset CCG	£27.6	£27.2	-£0.4	-1.45%	N
NHS Bristol CCG	£99.8	£98.4	-£1.4	-1.40%	N
NHS North East Essex CCG	£51.7	£51.2	-£0.5	-0.97%	Y
NHS North Kirklees CCG	£34.9	£34.6	-£0.3	-0.86%	Y
NHS Castle Point and Rochford CCG	£25.2	£25.0	-£0.2	-0.79%	Y
NHS South Norfolk CCG	£39.5	£39.2	-£0.3	-0.76%	N
NHS South Gloucestershire CCG	£33.3	£33.1	-£0.2	-0.60%	N
NHS Great Yarmouth and Waveney CCG	£47.3	£47.1	-£0.2	-0.42%	Y
NHS Shropshire CCG	£42.0	£41.9	-£0.1	-0.24%	Y

Gloucestershire CCG told HSJ it had increased mental health funding from £64m to £67.4m, but the drop had come from a reduction in its learning disability and dementia spending from £19.8m to £14.4m. A spokeswoman added: “Mental health continues to be a top priority in Gloucestershire and extra money has been allocated to bolster the support and care available for people.”

Kernow CCG said funding to its “core” mental health providers had increased during the last three years despite its challenging financial position. A spokeswoman said the CCG will be investing an extra £6m next year in mental health services to reduce demand on acute care. She added: “Our overall financial position is now improving and, working with our providers, we have agreed a joint plan to make significant investment in mental health, and achieved the mental health investment standard, in 2018-19, earlier than many other areas across the country.”

North East Essex CCG said the dashboard did not include non-recurrent spend on the Essex-wide specialist community perinatal service and the increased cost of mental health drugs. A spokeswoman added: “With these added, actual spend in Mental Health increased by nearly £1 million in 2017-18 in line with the MHIS.” She also said some of the reduction in spend came from reducing out of area placements and reinvesting savings into new pathways.

A spokeswoman for Northumberland CCG said it had began 2017-18 with a deficit control total and was meeting many of the priorities of the Mental Health Forward View. She added: “The CCG has prioritised investment in mental health and learning disability services and plans to deliver the Mental Health Investment Standard in 2018-19.”

Birmingham and Solihull CCG chief executive Paul Jennings said: “Birmingham South Central merged with Birmingham CrossCity and Solihull, to form NHSBirmingham and Solihull CCG on 1 April 2018. It’s really important to Birmingham and Solihull CCG that local people can access high-quality and responsive mental health services; we are pleased to say that we have met the mental health investment standard for 2018/19.”