More than half of NHS mental health trusts fear their commissioners will not pass on funding increases for 2015-16, according to a survey of the sector.
In addition, 19 per cent of the providers said they believed investment was being withheld due to the local clinical commissioning group’s financial position.
The survey by NHS Providers, shared exclusively with HSJ, indicates some CCGs may not be carrying out instructions from NHS England in the 2015-16 planning guidance to increase spending on mental health in real terms. However, 63 per cent of respondents said they were confident groups would apply the 0.35 per cent uplift for mental health trusts to meet new waiting time targets.
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The survey received responses from 19 mental health trusts - around a third of the sector - and was completed at the end of March. Contract negotiations are still ongoing between most trusts and their CCGs.
Chancellor George Osborne announced an extra £1.25bn investment for mental health over the next five years in March, and NHS England has instructed CCGs to deliver real terms growth in mental health spending this year by at least as much as the increase in their allocation.
HSJ has identified examples of CCGs struggling to meet spending requirements. A report to Bexley CCG board last month said NHS England might “insist that the CCG invests an additional 5.58 per cent in mental health services rather than the 1.94 per cent the CCG has set aside”.
Croydon CCG board reported last month it was “not able to fully deliver the required 7 per cent growth in funding” for South London and Maudsley Foundation Trust, but had set aside £2.4m for specific service improvements.
An HSJ survey of 67 CCGs last month found that 51 per cent planned to increase spending on mental health by between 1 or 2 per cent in cash terms this year, while 16 per cent said it would rise by less than 1 per cent. The remaining CCGs (31 per cent) said funding would rise by more than 3 per cent.
In five proposed contracts examined by NHS Providers, the plans showed a significant shortfall between the increased allocation for CCGs and the contract value. All five had a shortfall of more than 7 per cent and one contract for adults and older people’s services had a shortfall of more than 14 per cent.
One finance director told NHS Providers: “I would expect commissioners to be facing so much uncertainty that they will be putting as much money as possible into reserves. They can badge a proportion of this ‘mental health’ so that NHS England is content with their plan, but will anyone check what the reserves are actually spent on?”
NHS Providers said in the report that CCGs need to be held to account where they do not invest in services, adding that NHS England should check individual CCG spending and not rely on a total spend calculation.
Saffron Cordery, director of policy and strategy at NHS Providers, told HSJ: “Trusts aren’t getting what was promised and the approaches that are being taken are very patchy. The guidance and rules set out by NHS England aren’t being followed. We need tighter requirements so we understand what commissioners are planning to do and what they are spending.
“This highlights what we know needs to happen and reinforces what we said when the planning guidance first came out, which is that NHS England doesn’t have quite tight enough grip or assurance of commissioner plans.”