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.

Missing targets

Waiting time targets for new and expectant mums were scrapped from new national guidance when it was published two weeks ago.

HSJ revealed that while a draft copy of the perinatal mental health care pathways guidance published by NHS England did have waiting times, the final publication did not.

Campaigners were naturally disappointed, but this is not the first time a row has erupted over introducing new targets in the sector.

Last year’s children and young people’s green paper seemed to promise that a “key proposal” would be a new four week access target. But the paper only pledged to pilot a new target.

Lord Crisp told HSJ he was “disappointed” with the lack of urgency in implementing his recommendation of a new four hour waiting target for acute mental health patients.

It is clear why many feel new targets are an esstential step towards parity of esteem. While it is one thing to talk about prioritising mental health equally with physical health, this can only be demonstrated by action.

The Mental Health Forward View is a clear commitment to improving access and treatment for mental health patients. However, some feel that parity will only be achieved if mental health patients can expect to be treated with the same promptness as acute patients.

Avoiding perverse incentives

HSJ understands that a number of targets have been put before NHS England, including a four hour referral to admission target for mental health inpatients and a four hour emergency community target.

The worry among many leaders is that introducing new targets will lead to perverse incentives and undo much of the good work achieved already through the Mental Health Forward View.

A four hour target to find an inpatient a bed could lead to more patients being sent out of area which would be completely counter intuitive when so much time and effort has been put into trying to eliminate unnecessary out of area placements.

However, the new early intervention in psychosis and eating disorder waiting time targets are being phased in, with providers being given until 2020-21 to meet the national standards.

So there is no reason why new waiting times targets for other areas of mental health could not be phased in as well. This could allow leaders to monitor whether the spirit of rule was being adhered to, or just the letter.

Hoisted on your own petard

But the debate around introducing new targets is complex and ultimately comes back to cash and workforce.

HSJ understands that NHS England is sympathetic to the idea of introducing new targets, but is taking a hard line that it will accept no new targets without new resources to support them.

This is a pragmatic position because introducing a new target with no new staff or investment to actually hit it risks burdening already overstretched staff with yet more pressure.

NHS England would also be hoisted with its own petard by introducing a target it knew it had no chance of hitting.

But this excuse does not hold much water when perinatal services are due to receive an extra £365m of extra funding by 2020-21

So it begs the question, exactly what new resources are needed to introduce a new target for mental health?