HSJ’s fortnightly briefing covering safety, quality, performance and finances in the mental health sector.

NHS England published the last quarter of its 2018-19 mental health dashboard this month. This revealed all clinical commissioning groups, for the first time, were recorded to have hit the national investment standard.

As a reminder, in 2015-16 NHSE introduced its mental health investment standard, which said spending on the sector needed to increase by at least as much as commissioners’ allocation growth.

The 2018-19 financial year was the first in which NHSE’s planning guidance was prescriptive that all CCGs had to meet the standard, and it seems to have worked.

This is an achievement and, as Claire Murdoch, national lead for the sector, told HSJ, it is a sign things are moving in the right direction.

Before getting too carried away, however, there are some clear caveats to the data, which can make deciphering actual spending increases in the MH budget a bit of a minefield.

For reasons unexplained by NHSE, the total spending figures for mental health in the dashboard include learning disabilities and dementia. They also include one-off transformation funding.

However, none of these elements are included in calculations on whether a CCG hit the standard. This explains why some areas appear to have met the MHIVS but have recorded a decrease in funding in 2017-18 compared to 2018-19.

Both of these facts mean we can’t get a real picture of how much the recurrent mental health budget has grown by.

We also don’t have an idea as to whether increases in spending are reaching the front line, and readers might want to note several mental health trusts which saw a decrease in their income.

The results of CCGs’ investment standard audits are expected later this year, which should hopefully reveal if figures have been fiddled.

The picture by numbers

For the reasons above, we have to be careful when ranking CCGs. However, it is still useful to see which areas had the biggest increases and decreases across mental health, LD and dementia services.

Click here to see a comparison for 2017-18 compared to 2018-19.

According to the data, there were 30 CCG areas with a decrease in their overall mental health, plus LD and dementia, spend. Taking into account the above, this either means the CCGs cut spending for LD and dementia services in 2018-19 compared to the previous year or they had an injection of one-off transformation funding in 2017-18.

What is perhaps more interesting is to see in which areas mental health spend took up the biggest proportion of overall allocations. 

 CCG name Spend on MH, LD and Dementia as % of programme allocation 2018-19
South Tees CCG 20.3%
West London CCG 19.8%
Central London (Westminster) CCG 19.7%
Norwich CCG 19.5%
Camden CCG 19.1%

Those with the lowest percentages were:

CCG name Spend on MH, LD and Dementia as % of programme allocation 2018-19
South Sefton CCG 10.0%
North West Surrey CCG 9.9%
West Cheshire CCG 9.3%
Castle Point and Rochford CCG 9.0%
Medway CCG 7.9%

The average across all CCGs was 13 per cent. 

The above tables could suggest the geographies in which MH, LD and dementia have been given the highest priority. Although again, the data should be caveated by the fact spend includes transformation funding. 

It is also difficult to draw firm conclusions without having an idea of the demand for services in each CCG area. For example, three of the CCGs where the percentage of mental health spend is the highest are in London. 

Long-term priority

Children and young people’s mental health services have been prioritised in the long-term plan. Nationally, investment in CYP has increased in the last three years from £640m to £702m.

However, commissioners in 2019-20 have been set a tougher bar and will be required to increase their spend on children’s and young people’s mental health services by more than the growth in overall mental health spend. 

Figures in the dashboard reveal five areas which might find it particularly difficult having seen a decrease in CYP spend in both 2017-18 and 2018-19. The figures do not include spending on children’s eating disorder services and learning disabilities, while the same caveats to the overall mental health figures apply to CYP figures also. 

Children and young people’s mental health investment
CCG name2016-172017-182018-19

Blackburn with Darwen CCG

£1,781,000

£1,741,000

£1,707,000

Coventry and Rugby CCG

£4,302,000

£4,122,840

£4,102,000

Dorset CCG

£9,784,000

£9,439,532

£8,766,000

High Weald Lewes Havens CCG

£2,387,000

£2,081,000

£1,757,566

St Helens CCG 

£1,946,000

£1,780,421

£504,352

The learning disability and autism investment standard

Despite learning disability and autism services being a national priority in the long-term plan, there is very little granular detail on spending levels across these two areas.

In answer to HSJ queries, NHSE said spending on learning disability services went from £1.3bn in 2017-18 to £1.6bn in 2018-19. We’ve no idea whether this includes spending on autism.

We also don’t know how much has been spent by each CCG, or Transforming Care programme area, on services. As these services aren’t protected by the mental health investment standard, commissioners are free to cut or increase investment in this area at their will.

For 2019-20, NHSE has promised to maintain 2018-19 budget levels for LD services. It also says £40m in transformation funding will be allocated this year (£20m coming from NHSE and £20m from local commissioning areas.)

While there admittedly can’t be an investment standard for all services, considering the media spotlight and series of care scandals over the last year, NHSE might want to consider setting one for LD and autism. 

Mental Health Matters is written by HSJ’s mental health correspondent Rebecca Thomas. Tell her what you think, or suggest issues she could cover, by emailing her in confidence at rebecca.thomas@wilmingtonhealthcare.com or by sending a direct message on Twitter.

Join us at the HSJ Transforming Mental Health Summit (28-29 November 2019, Hilton Leeds) as senior peers from across the NHS, local authority and wider mental health service delivery landscape discuss the remaining challenges as we reach the end of the Five Year Forward View. Register your interest here: http://bit.ly/2KbYAzJ