This is HSJ’s new fortnightly briefing covering quality, performance and finances in the mental health sector.
Feedback and comments are welcome, so please feel free to email me in confidence.
Rising from the cinders
Once upon a time mental health was a Cinderella service.
But these days it feels impossible to continue to call it one, with the increased media attention and high profile proponents transforming it into a national priority.
I have written previously that mental health is transforming into the belle of the ball but it will take a while for this mindset to filter through the system.
An underdog story
It is all too easy to get stuck in the underdog mindset – the belief that you have to keep fighting for every inch of ground, without a chance of winning. And it will be hard for the mental health sector – used to seeing its budgets raided to prop up the acute sector or being left out of major policy announcements – to adjust its mindset from underdog to top seed.
It will be a long journey and there are many hurdles to cross along the way.
But as national mental health director Claire Murdoch told HSJ this week, it is “I am apologetically saying, yes, it’s very important we look after people in other sectors, but it’s mental health’s moment now”.
She added: “There is huge energy, huge belief that now is our moment.
”I honestly believe, the system, my chief executive colleagues, others beyond – housing, the third sector – do believe our moment is here.
”It has arrived at a tough time for the NHS and there is a realism about how hard they will have to work to drive value into every penny they spend
”I have never known a time when there is such a sense that now is our moment. The royals are talking about mental health, the public is talking about mental health.”
The telling part of this statement is the “apologetically”. It is born from a sector used to being on the receiving end of that word – “sorry, but there’s no new cash for mental health because we need to bail out our hospitals”.
This has been the hardest part of transforming mental health services – making people (both in and out the sector) believe that change is coming. There are still sceptics, who are waiting for the bubble to burst. But on the whole the sector and its partners in the private and third sector are optimistic that the tide is turning.
A lot of this is down to the detailed Five Year Forward View for Mental Health which is being driven through by Ms Murdoch and her team. But even when the plan was published, there was deep scepticism that all the cash promised would reach the front lines. Former NHS Confederation chief executive Stephen Dalton told HSJ this would be the “acid test” for the plans.
A long way to go
That is not to say there are not huge hurdles to overcome. Ms Murdoch admitted that the FYFV is simply one step on the journey.
But she said there is a lot of momentum behind mental health, with Simon Stevens, prime minister Theresa May and health secretary Jeremy Hunt all making mental health a priority and backing the plans.
She added: ”There’s power in the system, I feel I am being given a lot of backing along with my colleagues and team and we are having some clout in a system under a great deal of pressure.”
The big issues are still money and workforce. The sector needs more than the 10,000 new staff promised by prime minister Theresa May last month if it is going to fully implement its plans. With 20,000 vacancies to fill there is no question a monumental recruitment drive is needed to make sure the sector has the staff it needs to drive forward these changes.
Brexit is going to make things harder. But the sector is doing a lot of work to drive down attrition to retain more staff as well as take steps to improve productivity. This is not going to be easy, but leaders are under no illusions and across the sector there is broad support for making sure the workforce is where it needs to be.
Questions remain about the total figure, which HSJ understands could be as high as 20,000, but the Health Education England workforce strategy – expected later this summer – should shed light on this.
Money will always be a bone of contention. HSJ has reported this week that more and more CCGs are expecting to hit the mental health investment standard. But it is clear areas with deficits, low growth or which are not able to achieve the 1 per cent of their allocation risk reserve are still struggling.
A quiet revolution
But there are positives. The next wave of 11 regions to be given devolved commissioning powers for tertiary mental health services has been welcomed by the sector. This will see another £300m of specialised commissioning mental health budgets handed to providers for low and medium secure adult, tier four child and adolescent mental health services or adult eating disorder services.
Ms Murdoch called the new care models a “quiet revolution”, putting more power into the hands of local areas.
Now nearly 40 per cent of the spec-comm budget has been devolved and if these pilots are successful more areas could bid for these powers. But, as the Royal College of Psychiatrists has pointed out today, new care models need to be evaluated to make sure their impact is understood and they cna be replicated elsewhere.
The risk is that if each area has its own pathway without clear and consistent national clinical standards in place to protect patients from area to area the system will descend into a postcode lottery.
The devolution process also leaves the commissioning a bit messier than it was before, with some tertiary services now the responsibility of local providers and others still with NHS England.
However, leaders are confident this devolution - or revolution - will allow them to save cash, reduce bed use and repatriate out of area patients by creating smoother pathways and bolstering crisis and home treatment teams.
There will always be hurdles, but the sector is beginning to understand its growing power.