- Commissioners in deficit or under financial pressure are less likely to meet mental health investment standard, new research finds
- Royal College of Psychiatrists analysis is based on FOI requests to all 209 CCGs
- The number of CCGs failing to raise mental health budgets each year by the same percentage as their overall allocation increase is expected to decrease
EXCLUSIVE: Commissioners facing deficits or struggling to balance their books are the most likely to be failing to meet the national mental health spending mandate.
New analysis from the Royal College of Psychiatrists shows the most common reasons for clinical commissioning groups failing to hit the mental health investment standard was being in deficit, low budget growth or not being able to achieve the 1 per cent of their allocation risk reserve.
The data, seen by HSJ, found the number of CCGs failing to raise their mental health budgets each year by the same percentage as their overall allocation increase is expected to drop from 46 in 2016-17 to 21 in 2018-19. There are 209 CCGs in the country.
Increasing mental health spending at least in line with CCGs’ overall budgets is NHS England’s key measure, introduced in 2017-19 planning guidance, for assessing whether commissioners are upholding the policy of “parity of esteem” for mental and physical health.
The RCPsych analysis is based on freedom of information requests to all 209 CCGs asking if they will achieve the standard up to 2018-19. It shows most CCGs expect to meet the standard each year.
The analysis follows HSJ revealing last year that more than a fifth of commissioners failed to raise their budgets to the mental health investment standard from 2015-16 to 2016-17.
The new analysis found:
- Seven CCGs will fail to meet the standard in 2016-17, 2017-18 and 2018-19 (see list below).
- Of the 29 CCGs failing to meet the standard in 2017-18, 16 said it was due to being in deficit, unable to achieve the 1 per cent risk reserve, or low allocation growth.
- In 2018-19 this changes to 12 out of 21 CCGs.
- Of the 15 CCGs missing the target in both 2017-18 and 2018-19, nine said this was due to being in deficit, unable to achieve the 1 per cent metric, or low growth.
RCPsych president Professor Sir Simon Wessely said it was good to see so many CCGs meeting the mental health investment standard.
But he pledged that the college will campaign until every single CCG is meeting the standard.
He added: “All of us will remain constantly vigilant to ensure that the additional funding underpinning the delivery of the Five Year Forward View for Mental Health is not used to supplant existing spend or balance the books elsewhere.”
Map: CCG performance against the mental health investment standard
Phil Moore, chair of NHS Clinical Commissioners’ mental health commissioners network, said the analysis demonstrated the huge pressures CCGs were under and it was no surprise those in deficit or with low growth were not hitting the standard.
He said: “Despite their strong commitment to mental health, it is inevitable that with the tough financial climate they are working in and the sheer number of high priority competing demands on their finite budgets, there are cases where CCGs will be unable to meet the mental health investment standard.”
The new analysis reveals 12 mental health trusts have not signed off their CCG’s planned mental health spending, with two CCGs having part of their plans approved.
This follows NHS England writing to CCG leaders in February to tell them mental health trust chiefs must sign off their spending for the sector to confirm they agree with their mental health finance returns.
The seven CCGs which said they would fail to achieve the mental health investment standard from 2016-17 to 2018-19 are:
- Castle Point and Rochford;
- North Somerset;
- Scarborough and Ryedale; and
- Southport and Formby.
Luton, Scarborough and Ryedale, and Southport and Formby CCGs said this was due to being in deficit, not achieving the 1 per cent risk reserve or having low growth.
NHS England’s national mental health director Claire Murdoch told HSJ that even areas that are struggling will be expected to hit the investment standard.
She said it was promising so many CGGs were already achieving it, especially when the NHS is under the severe financial pressure it is facing “You might flip this and say well done, it’s amazing 80 per cent of CCGs, in the toughest financial times we have ever known, have met this standard,” she added.
Herefordshire CCG said it was investing in mental health services, but was unable to commit to the entirety of the forward view due to its “challenging financial position”.
Scarborough and Ryedale CCG said the data did not take account of what the organisation is doing with its commissioning partners, including the local authority, to improve mental health services.
A spokeswoman said the CCG and council were investing in mental health at schools, adding: “The service will also work with individual children and young people who are experiencing low level anxiety/depression and/or are at risk of experiencing mental illness by providing evidenced based brief interventions on a one-to-one and group work basis. This aims to build their resilience, learn new ways of coping and support referrals to specialist services where necessary.”
Luton CCG said it was investing £3.8m in the delivery of mental health services from 2015 to 2018, including in liaison psychiatry, inpatient capacity and early intervention programmes.
A spokeswoman added: “Due to the way in which the mental health investment standard is calculated the increase set for Luton is one of the highest in the country. In fact, Luton CCG consistently spends more per capita on mental health services than any other CCG in the Central Midlands area.”