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.
Mental health’s breakthrough year
The last year has been a tumultuous one for the mental health sector. It is hard to believe it was only 12 months ago that prime minister Theresa May announced a string of new policies for mental health.
Five months later, she said she would “rip up and replace” the Mental Health Act 1983 and pledged 10,000 more staff for the sector.
To some, this was a watershed moment for the sector, a clear sign that it has won the attention of the PM, the royals and key policymakers. Others remained sceptical that so many warm words would not actually turn out to be hot air.
All of these promises are well underway, or in some cases finished – and the Five Year Forward View for Mental Health implementation plan continues at pace.
There is much to be optimistic about, but the sector still has the twin problems of making sure it has the staff and funding to meet rising demand.
Things to watch out for in 2018
There are a number of major reports due out in 2018 which will have a big impact on the future of the sector, including:
- the government’s response to the CAMHS green paper;
- Professor Sir Simon Wessely’s independent review of the Mental Health Act;
- the CQC’s CAMHS thematic review; and
- Lord Carter’s efficiency review of mental health and community trusts.
These will be milestones for the sector and are likely to set the tone of policy for the rest of the 5YFV period.
The major question hanging over these reviews will be whether there will be new cash to implement their recommendations.
We know there is some for CAMHS, but will there be a significant enough investment to hit a new waiting time standard? Lord Carter is expected to say there are about £200m of savings mental health and community trusts can make, but it is not clear how quickly those efficiencies can be made – and therefore at what point these savings can be ploughed back into services.
There are two documents that should appear on this list, which do not for the simple reason that we do not even know if they are being written yet.
These are a long term mental health workforce strategy – promised in Health Education England’s mental health workforce strategy in July – and the next Five Year Forward View for Mental Health.
I have written before that HEE’s mental health workforce plan is optimistic in the assumptions it makes about providing 21,000 new posts and reducing the existing 20,000 vacancies.
A long term plan, beyond 2020-21, is vital because when it comes to training new psychiatrists and psychiatric nurses, none of the students who start this year or next will be ready by that deadline.
This is why HEE must fulfil its commitment to produce a long-term workforce strategy for the sector.
Policy and pumpkins
Many leaders across the sector feel a new forward view, looking at 2021-22 to 2025-26, is vital if the good work currently underway is to continue.
Some are sceptical that it will, after seeing many of the improvements brought through the 1999 national service framework for mental health underdone after the plan came to an end in 2009.
The big worry is that once the 5YFV period ends, all the cash prioritised for mental health will be diverted back to other services and it will be left like Cinderella at midnight with a pumpkin, having got used to expecting a coach.
If the centre is serious about mental health – from the PM and Department of Health to NHS England and the other arm’s length bodies – it needs to begin looking at this soon.
A proper five year plan will need to be hammered out in plenty of time for providers and commissioners to begin preparing for its implementation. If work does not star in the next 12 months, we will be cutting it fine to have it ready for 2021-22.