Mental health trusts have complained their commissioners are disregarding national guidance requiring them to increase real terms spending on mental health in 2015-16 and help fund the delivery of new targets.
The complaints come amid warnings that clinical commissioning groups are holding off on agreeing mental health contracts until they know how much they will have to pay for acute services in the wake of an acute provider revolt over 2015-16 tariff prices.
From April, new targets will require 95 per cent of patients referred to talking therapies to be seen with 18 weeks, and 50 per cent of people experiencing a first episode of psychosis to receive treatment approved by the National Institute for Health and Care Excellence within two weeks. NHS England has earmarked £80m to help deliver the new targets, with £40m to meet the psychosis target expected to come through locally agreed contracts.
NHS planning guidance also says each CCG should increase mental health spending in real terms – by at least as much as its own allocation increase – to ensure movement towards parity of esteem for mental and physical health.
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But a number of mental health trust chief executives have told HSJ their commissioners have been reluctant to agree real terms increases or any funding to help with the new targets.
Rachel Newson, chief executive of Coventry and Warwickshire Partnership Trust, said her commissioners were not offering the trust real terms increases.
She said: “None of the CCGs want to talk about a real terms uplift. Most are saying ‘here is our offer and that is what we have been instructed to do’.”
The trust faces having to make £9m savings and receiving no extra funds for the new targets.
“This means on the one hand we are trying to find ways of taking money out, while on the other being asked to do more without any funding. It’s a bit hard to see how we are going to make that happen.”
Black Country Partnership Trust chief executive Karen Dowman said some local CCGs were considering “significant cuts” to the trust’s funding. Overall, she expected the trust to have to make £5m savings, or 5 per cent of turnover.
She added: “To find ourselves in this position is incredibly depressing. The significant cuts in social care infrastructure have also meant the burden on us has never been greater.
“The issue for the mental health sector is [that] this is year on year reductions. Part of me feels very let down; not for me or my organisation but for the people we serve who yet again lose out.”
A third chief executive, who did not want to be named, told HSJ it was likely their organisation would go into dispute with commissioners over their refusal to fund the new targets and match investment with allocations increases.
Saffron Cordery, director of policy and strategy at NHS Providers, said CCGs were delaying telling mental health trusts what their allocations might be until funding issues with the acute sector were resolved.
She said: “They’re saying acute trusts need the allocations first and then they’ll work out what is left for mental health. That isn’t parity.
“What we are seeing is… absolute paralysis because of where we are with the tariff, the traditional focus on the acute sector, and the lack of understanding about the fact there are new statutory targets that CCGs have to fund.”
An NHS England spokeswoman said it would be acceptable for a CCG to give a mental health trust lower funding growth than the CCG itself received, if it was spending the balance on other mental health services.
She continued: “CCGs may not wish to fund individual providers on the basis of real terms growth in line with the CCG’s allocation, but overall spending must increase on this basis.”
She added it would “generally not be acceptable” for commissioners to seek mental health contract terms that are were in line with the national guidance, and NHS England would be “checking through the planning process the level of increase in [mental health] spend that each CCG is planning”.