This is HSJ’s 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.
Loaves and fishes
NHS England’s latest update to the mental health dashboard shows that 32 CCGs were forecasting not increasing mental health spending in line with their programme allocation growth for 2017-18.
This follows 32 not hitting the mental health investment standard in 2016-17, with nine expecting to miss it both years.
In a letter to local leaders, national mental health director Claire Murdoch said even 85 per cent hitting the standard was not good enough when it has been made a national requirement in the 2018-19 planning guidance.
She’s not wrong – the mental health investment standard is a national mandate and every CCG should hit it. A lot of the new cash for the mental health forward view is dependent on CCGs raising their investment in the sector.
Ms Murdoch said she will call up system leaders and get them to justify themselves if they are struggling to hit it.
CCGs may counter that they are under similarly intense pressure to resource all services properly, and they can’t pull off a five loaves and two fishes trick when there isn’t enough cash in the system.
Throwing money at the problem
Focusing on CCGs’ mental health spending ignores the wider picture of what that cash is being spent on. Provider leaders also have a responsibility to make sure they spending the money in the best possible way.
We should not just assume that simply giving mental health trusts more cash will solve the sector’s problems.
Of course more cash would be welcome – there is a long history of the sector losing out on money because what extra resource is made available goes to cover acute contract overspends. An investigation by the Royal College of Psychiatrists found mental health trusts had less income in real terms in 2016-17 than in 2011-12.
But last week, analysis by the royal college also revealed there is a “postcode lottery” for children accessing eating disorder services.
While nationally the sector is on track to hit the new access and waiting time standard for eating disorders, the rest of the country lags behind London.
This is a pertinent finding because eating disorders is one of the priorities of the forward view and is receiving an extra £30m a year in new cash. But problems with recruiting staff to eating disorder teams mean simply providing new money is not the whole solution.
Pulling the levers
It is clear that other services are just not very good. For instance, HSJ has revealed a number of problems in independent inpatient CAMHS units, including the permanent closure of the Cygnet CAMHS unit at its hospital in Woking last year. It is not clear that the only reason for this is a lack of funds, yet we do not hear much from national leaders about what should be done about these safety issues.
Patients are still being sent out of area, there is no national plan to address the “funded and forgotten” in locked rehab units. No one can give an adequate reason as to why more and more people are being detained under the Mental Health Act.
Ms Murdoch has been a tireless voice constantly campaigning to make sure the forward view is implemented.
But there is a danger that we focus too much how much money is coming in and not how it is being spent.
The Care Quality Commission checks on quality – and regularly calls out unacceptable care. But while their ratings are transparent, and NHS England’s mental health dashboard brings clarity on funding, there isn’t the same openness about where in the country the money spent leads to the best services.
A major new report from NHS Improvement said: “We believe that there is a world class model for mental health service delivery in England, the problem is that different bits of it are in different organisations.”
The ingredients are there, but need to be pulled together, matching the cash with the workforce with the best practice.