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.
HSJ has revealed two things this week:
- if clinical commissioning groups hit the mental health investment standard, funding for the sector will grow by 8 per cent by 2020-21; but
- 24 CCGs are forecasting reducing mental health spending for 2017-18 and 21 are predicting they will not hit the standard.
The first story is essentially good news: if clinical commissioning groups invest as they have been directed by NHS England, there will be enough cash to meet the spending commitments of the Five Year Forward View for Mental Health implementation plan.
The second story is bad news: a small proportion of commissioners are failing to hit the standard and 24 are predicting cash terms cuts to mental health budgets.
But reading between the lines, you get a much messier picture of what is going on.
Cushioning the impact
It is worth stressing that things are – on paper at least – moving in the right direction. CCG mental health spending has increased in both 2016-17 and 2017-18. Only 21 CCGs are predicting they will not meet the mental health investment standard this year, according to HSJ’s freedom of information requests.
The forward view requires CCGs to spend an extra £1bn a year by 2020-21 from the 2015-16 baseline.
If they all hit the investment standard they will have increased mental health spending by £1.6bn in this period. This would be an 18 per cent increase, outstripping overall CCG allocation growth of 14 per cent over the same period.
So that’s £600m over the minimum needed to fund the forward view – if CCGs continue to struggle to meet the mandated target at least the plans stand a good chance of not being derailed.
But so much depends on this investment standard. This might be why NHS England mandated it in the 2018-19 planning guidance last month.
It was a huge step and welcomed by many who remember the days when mental health budgets would be cut to make up for acute overspending.
This protects mental health budgets from being pillaged for acute overspends.
It also makes inroads into identifying where the new money in the implementation plan comes from, with many questioning whether the new money was contingent on making the required savings.
We can now see that it is not, and new money will come – so long as CCGs meet their mandate.
Not a perfect world
What HSJ’s information requests also show is that this is easier said than done. There are risks and HSJ’s forecasts are speculative, so only apply to a perfect world where everything goes to plan.
This is unlikely to be the case, a number of CCGs are struggling to hit the mandate and many are worried that as allocation growth is expected to slow down over the next three years it will become harder to meet the standard.
This is worrying because much of the savings predicted in the forward view implementation plan will not be in the sector.
The plans are forecast to generate £744m by 2020-21 across improving access to psychological therapies, liaison psychiatry and crisis care. But most of the gains will be made across the acute sector and primary care through reducing emergency attendances, GP appointments and emergency admissions for mental health patients.
On one hand, this is also good news because it not only relieves the pressure on GPs and emergency departments, and could potentially give CCGs millions more to spend across the board.
However, it is unlikely that CCGs are going to renegotiate acute or primary care contracts so the savings made through improved mental health services will benefit these sectors and not filter back to mental health.
That places even more importance on hitting the mental health investment standard: if savings achieved through enhanced preventative mental health services are not likely to benefit the sector, hitting the standard is the only way mental health services are going to get any more money.
Value for money
There is also the issue that because much of mental health funding is tied up in workforce, just having the new money there is not enough to improve services – the staff need to be there to provide them too.
While I have written before that the workforce is going in a positive direction, the pressure is mounting to make sure staff are going to be there in 2020-21 to finish the plan.
Without the workforce, there will be very little to spend the new money on, even if there is loads of it.