Hospitals that blinker themselves to the potential of working with mental health providers will usher in their “own financial demise”, the NHS England official overseeing the service has warned.
In an exclusive interview with HSJ, NHS England director for long term conditions Martin McShane said acute trusts had to abandon their “fortress” attitude and “monocular vision” to work across organisational boundaries.
“Unless they take a population view rather than just a service view they will be the creators of their own financial demise,” he added.
“The acute sector needs to look at its contribution to the overall health economy, it is not an island. Fortress acute trusts are no longer viable.
“They need to come out and look at how they can contribute to a sustainable health and care economy.”
Dr McShane said the new models of care were needed in the NHS if a “sustainable system” was to be created.
“[This] is not going to happen by people pulling up the draw bridge.”
Key to the new system will be the development of better payment systems, which are currently being explored by monitor, Dr McShane said.
He distanced himself from using only a “clustering” method to align mental health patients to cost payments. This must not be seen as the “default” option, he said, adding that providers “must move away from a simple block contract and start to link quality to cost”.
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“What I support is local ownership of the right payment system which everyone will collaborate on to make work for the patients and taxpayers benefit.
“Would I dictate that from the centre? No,” he said.
He accepted there were likely to be both “beneficial and unintended” consequences from any new payment regime, adding: “What we have to do is learn quickly how to adapt and move forward.”
Dr McShane said NHS England was committed to its parity of esteem agenda for mental health and that had detected signs of changing attitudes, particularly among commissioners.
A review of clinical commissioning groups’ commitments by NHS England had found that CCGs intend to spend an extra £120m, or 1.4 per cent, in cash terms on mental health this year.
Dr McShane said: “The whole system is under massive pressure.
“We have worked with CCGs this year on the finding and overall we have protected funding for mental health more than physical health in 2014-15.”
NHS England had listened to the “disquiet” over funding, he added.
“We are trying to purposefully address it. We have listened and we are doing this differently and we intend to make progress.”
Dr McShane said the policy on maximum waits for talking therapies and early intervention psychosis help was the “base camp for the ascent we need to make”, adding that the new standards were “anchors in the ground… to stop is moving backwards.”
The tariff deflator was ‘moment in time’
NHS England has learned from recent mental health funding rows, according to national director Dr Martin McShane.
He spoke out after repeated criticism of NHS England’s decision to apply a differential tariff to mental health trusts this year, cutting their funding by 20 per cent more than acute trusts.
An investigation by HSJ in August revealed mental health trusts had experienced a 2.3 per cent real terms cut in funding with similar declines in beds, nurses and doctors.
Dr McShane said it was “not appropriate” to label the decision over the tariff deflator as a mistake but said: “It was a moment in time and we are well past it.
“Have we learned from it? Absolutely. Are we doing things differently as a result? Yes.”
He denied relationships with the sector had been damaged but said: “There have been consequences as a result which have led to new ways of thinking, new perceptions new assumptions and that may be beneficial to the system.”
He said constructive criticism of NHS England was “entirely justified and valid”, adding: “There has been a right and proper challenge to the system over funding for mental health services but it is now getting the attention it deserves and NHS England is totally committed to that agenda.”
On parity of esteem he added: “We have taken some fairly heavy brick bats about it but we haven’t wavered from our purpose.”
Exclusive: Acute trusts told to abandon 'fortress' mentality
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