The government has failed to issue guidance on the operation of a new legal right of choice for mental health patients, ahead of it coming into force next week.
This has sparked confusion among mental health providers about how widely patients will in reality be given choice, how it will be offered in practice, and how providers will be paid.
The change, announced in December 2012, removes an exemption on mental health patients being able to exercise choice in the NHS, and is a central part of the government’s policy of “parity of esteem” for mental and physical health.
However, HSJ has learned that with less than a week to go the Department of Health has not issued any guidance on how it will operate.
There is concern in the sector about whether the NHS will meaningfully offer choice and how providers will be paid.
Rebecca Cotton, policy director at the Mental Health Network, which represents providers, said: “We are very concerned that guidance has not yet been issued and [about] the impact this could have. A large number of our members are also concerned that the right payment mechanisms are not in place to enable this to work smoothly.”
Mental health providers are largely paid under block contracts with commissioners, with no mechanism to fund patients who choose to go elsewhere.
HSJ understands the new right will be given what was described by a source as a “soft launch”, with little publicity, while the DH works to draw up guidance in coming months.
Requirements to extend choice and implement new access and waiting time targets for mental health services are included in the government’s mandate to NHS England, which sets out what the national commissioning body must deliver.
Leeds and York Partnership Foundation Trust chief executive Chris Butler said while he was in favour of choice he was “extremely concerned about the timescales involved”.
He added: “In terms of it being available from 1 April I think it is going to be very problematic. The essential preparatory work has just not been done. This is aspiration running ahead of practicality.”
Royal College of Psychiatrists president Sue Bailey highlighted the lack of capacity in the system to make choice a reality. She said: “It is a bitter irony that choice is coming in on 1 April when on the ground the choice for adolescents with mental health problems, for example, is to be treated on an adult ward or go on a motorway for 150 miles.”
Department of Health said guidance was being tested with a range of stakeholders, including the NHS and GPs, to be issued this spring to support commissioners, providers and GPs in implementing the new rights.