Funding for mental health services needs to change to remove an “institutional bias” in the NHS, health minister Norman Lamb has told HSJ.
He also suggested the government could abandon plans to introduce a mandatory national payment by results tariff across the mental health sector and instead favour a mixed payment system.
Asked about the finding earlier this year that mental health funding had fallen in real terms for the first time in a decade, Mr Lamb blamed commissioners and what he said was an “institutional bias” against the services.
He told HSJ: “This is not directed from the centre, this is about local commissioners and it’s what I mean when I talk about an institutional bias in the NHS.
“We have very powerful drivers with physical health, like the 18-week target, which drives money through the system and mental health gets what is left.
“There is a complete bias in the way money is spent in the NHS and we have got to change that.”
Mr Lamb said he hoped it would be tackled by the government’s recent mandate which made “very clear we expect the system to deliver parity of esteem for mental health”.
Meanwhile, Mr Lamb cast doubt on plans to introduce payment by results across mental health, as has been a government aim for several years.
Instead he indicated there could be an element of payment by results tariff alongside so-called capitated budgets, where funding is provided on a per-head basis. Block contracts could also survive in a limited form.
Mr Lamb said: “PbR may well play a role but I’m not wedded to one type of payment system. Payment by results in physical health has driven up access and created more demand but we have to move on from that.”
He said the government would examine how PbR, capitated budgets and other funding systems could work, including examining practices in other countries.
Earlier this year it was announced the rollout of a national PbR tariff in 2013-14 would not go ahead due to data quality concerns with the minimum mental health dataset, which would underpin PbR.
There were fears the system of clustering patients depending on the care they required was not accurate, and that more work was needed to ensure the prices were correct.
Mr Lamb was speaking to HSJ during a visit to the South London and Maudsley Foundation Trust for the launch of a £1.2m pilot project to extend access to psychological therapies to those with serious mental illnesses such as psychosis, personality and bipolar disorders.