Crisis referrals leap by almost 75pc

Documents submitted to NHS England and Improvement’s November board meeting capture the scale of demand facing the sector, which national director Claire Murdoch described to fellow leaders as “huge”.

Bed occupancy rates in adult acute services have remained above the recommended ‘safe’ level of 85 per cent since June 2020, performance reports suggest.

Above that threshold, experts warn that patient safety, out of area placements, and surge demand risks are likely to increase.

Ms Murdoch wrote in her report to the board that between 180,000 and 200,000 calls per month were being fielded by covid-19 response crisis lines in the first quarter of 2021-22 — more than 6,000 each day.

She added that there had been a 74 per cent increase in referrals to crisis services ‘post-pandemic’: ”We’re now seeing huge demand and we’re back to pre-covid levels.” She said some people had not sought help during pandemic peak periods and this was leading to more severe demand. 

To tackle pressures this winter, she said, seasonal funding of around £50m has been allocated to tackle bed occupancy rates and boost emergency care by – for example, moving mental health experts into ambulance control rooms, over the next three to six months.

Almost four-fifths of hospitals now have a 24/7 mental health liaison service, which leaders say is helping to address pressures in A&E, while crisis resolution and home treatment teams have also been strengthened during the pandemic, she said.

‘If we were only seeing 40% of people with cancer, we’d get lynched’

National clinical director Professor Tim Kendall warned the board that current levels of unmet mental health needs in children and adults remained high, lagging behind physical health. 

“If you said you were only seeing 40 per cent of people with cancer, we’d get lynched, and understandably,” he said. “It just wouldn’t be tolerable.”

Teams were seeing around one in four children with mental health problems in 2016, he said, and that measure has now been boosted to around 40 per cent.

Meanwhile, in adults, the figure has increased from just under 40 per cent to almost half.

Professor Kendall added: “We will get there in the end, but it takes a huge amount of time training staff and getting the investment in the right place.”

The additional seasonal funding is on top of £87m announced in the government’s covid-19 recovery plan for 2021-22.

The board paper, summarising progress and risks for the sector, said: “Workforce is the single biggest risk and opportunity for the mental health programme. Workforce growth has been promising in recent years, with latest available data showing increase of more than 18,000 mental health staff since 2016…

“Expanding the workforce, however, remains critical to delivering the [long-term plan mental health commitments] and coping with the additional post-pandemic pressures. The LTP alone is estimated to require an additional 27,000 WTE by 2023-24, making use of innovative new roles to transform mental health service delivery.

“Multi-year HEE education and training funding is needed to support development of these roles for the future.”

At present, no budget has been confirmed with HEE for next year, let alone subsequent years. The organisation is now due to be merged into NHSE.

The overall funding settlement for mental health services in 2022-23 is also unclear. The additional revenue spending government announced this autumn was largely earmarked for elective catch-up, with no matching spending allocated for mental health or other services. This could potentially undermine previous commitments to maintain or grow mental health’s share of total NHS spending, but Sajid Javid has said he wants the sector’s budget to be protected.