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.

Lip service

A new report has shone a light on how many of the vanguards are prioritising mental health - sparking accusations the new care models are merely paying it lip service.

The joint study published last week by the King’s Fund and Royal College of Psychiatrists, investigated the role of mental health in the national primary and acute care systems and multispecialty community providers vanguards.

Remember the Five Year Forward View – which those vanguards are supposed to be making a reality – described three divides which need to be bridged: between health and social care, primary and acute care, and physical and mental health.

But it seems that the PACS and MCP sites are making more headway on the first two than the third.

The study found:

  • The level of priority given to mental health varied and was not always “sufficiently high”;
  • Tokenism was “an ever-present danger – the risk being that references to mental health are included in strategic documents, but without a clear plan for delivering these ambitions;”
  • Mental health leaders told authors they needed to be physically present at meetings to keep mental health on the agenda; and
  • It was not always clear that changes introduced through the vanguards went “substantially further” than those in other areas, or beyond the expectations of national policy.

The report paints a dismal picture and gives strong credence to the whispered fears of mental health staff and leaders that it is not being made a priority in many of the emerging new care models.

In response, RCP president Sir Simon Wessely told me many vanguards are only paying “lip service” to mental health.

Where the vanguard goes the army follows

The intention is that the rest of the NHS follows the path beaten by the vanguards.

The main vehicle for implementing new care models will be the sustainability and transformation partnerships. NHS England has already flagged up nine which are expected to become the first wave of accountable care systems.

But there is a very real fear that the STPs will fall into the same trap as the vanguards. While many, if not all, have included dedicated chapters on mental health with plans to meet the recommendations of the Mental Health Taskforce, not many spell out how they plan to achieve these ambitions.

National leaders are aware of this. There is a clear high level commitment to mental health, from the royal family to the prime minister down to NHS England, but the fear is that this commitment is not filtering through to local decision makers who have to balance mental health with other priorities.

I understand that NHS England last year rated the STPs’ mental health plans, Care Quality Commission style, from outstanding to inadequate. While two were placed in the top category, the vast majority fell into the “requires improvement” or “inadequate” brackets.

Making dreams a reality

The problem is that while national leaders can invest in specialised commissioning services directly, they do not appear to be using their full powers to force CCGs to make mental health investment a top priority. With ringfencing the cash looking unlikely, all they are doing is cajoling and persuading, but we have not seen any teeth as of yet.

Mental health providers say that while national funding can arrive quickly and allow them to invest in new services fast, new cash coming from clinical commissioning groups can take much longer to work its way through the system.

The wider problem is that vanguards are under just the same pressure, and have the same basic cultural problems around mental health, as the rest of the NHS. So if vanguards cannot or will not make mental health a central priority, then it seems unlikely that other areas will when they come to set up those new systems. This could mean that the new accountable care systems, building on the templates set out by the leading vanguards, might also sell mental health short.

The RCP/King’s Fund report sets out a series of recommendations to NHS England, including only to support STPs rolling out a PACS or MCP if they have articulated a clear ambition for integrating mental health.

But we’ve not yet heard anything which suggests this is an option being actively discussed by system leaders.