HSJ’s fortnightly briefing covering safety, quality, performance and finances in the mental health sector.
While NHS England continues to ponder the future of the government’s flagship four-hour accident and emergency target, let me point you towards a few targets for mental health which never even made it off the ground.
All the way back in 2016, during the infancy of its Five Year Forward View for Mental Health, some readers may remember NHSE promised to publish a suite of new pathways for the sector, including a set of recommended waiting times.
Two of those pathways appear to have reached near final drafts in 2017 and were planned for publication in November that year, according to material seen by HSJ, but never saw the light of day.
One sets out emergency and urgent mental health care standards for blue light services, and the other for adult and older people’s community services.
Within both pathways, the key standards included:
- Blue light services (such as the police, ambulance) should receive a response from an urgent and emergency mental health professional within one hour of being contacted;
- After an emergency mental health professional in the community is contacted, the next steps for the person should be agreed within one hour;
- Within four hours, a patient who has been urgently referred should have had an assessment and an emergency care plan should be in place; and
- A person should be seen no later than the day of referral.
The blue light pathway goes as far as to recommend some quite sensible pathways for non-mental health professionals, and guidance for the much-neglected approved mental health professions.
These standards are described as the “minimum recommended benchmarks”.
Untested targets and money matters
Three years after these documents were finished, we now have a set of different targets which are being piloted by a handful of areas for emergency mental healthcare.
The work that went into the unpublished pathways will have fed into this, but the current targets being tested are slightly different.
Rather than one hour, the stipulated response time is now “within hours” for emergency referrals and “24 hours” for urgent referrals.
Questions remain over why those two 2016 pathways and waiting standards were never published.
NHSE did not confirm the reason when asked by HSJ but did say the work was now four years old and has been superseded by the new mental health waiting times which are being tested as part of the clinical review of standards.
A sound theory could be there was simply not enough funding under the 5YFV to meet the targets.
Funding under the long-term plan for crisis services is set to increase considerably, but anecdotal evidence suggests many services are a long way from a 24-hour response, let alone one hour.
While one side of the camp argues the 2017 targets were untested and overly optimistic, to others the new standards represent watered-down ambitions.
Mental Health Matters is written by HSJ’s mental health correspondent Rebecca Thomas. Tell her what you think, or suggest issues she could cover, by emailing her in confidence at email@example.com or by sending a direct message on Twitter.