This is HSJ’s fortnightly briefing covering quality, performance and finances in the mental health sector. Feedback and comments are welcome - email me in confidence.

Cake mix

With the long term plan for the NHS in development, and mental health a declared priority, the sector is wondering what it will get from this latest policy intervention.

I wrote in June about some of the prospects for the plan.

Much is still possible and could go into the cake mix, but we have been given a few new tantalising tasters to get our teeth into.

The government set out £1.5bn plans to improve children and young people’s mental health services last month. The assumption is that much of this funding will come from the new cash promised by prime minister Theresa May, with the new mental health support teams requiring £1.3bn cumulatively by 2027-28.

If that’s the only growth available for mental health it will be pretty meagre. Yet as one of many competing calls for new or expanded services on the single £20bn growth pot, it is no small sum. And these only come into play after decisions on what must be coughed up to deal with existing commitments, budget shortfalls and strains.

It will mean not all mental health priorities get funded. Some would argue that even one or two new expansions backed with new money means the glass is half full, not half empty.

A question of priorities

If there are new funded schemes in mental health on top of CYP, what will they be?

Nothing has been decided, but we can have a good guess based on the rhetoric deployed by national leaders so far.

The Healthcare Safety Investigation Branch earlier this year recommended that NHS England tackle the problems young people face transferring from child and adolescent mental health services to adult provision.

I understand NHS England is very keen to address this issue and leaders at NHS Improvement have also spoken privately of focusing on this.

Leaders across the health system have highlighted both strengthening crisis care, and support for people with serious mental illnesses.

This gives us essentially a top three – or four, if you include agreeing to fund and implement the CYP green paper.

Whither the workforce?

An even greater question remains: even if the sector gets new cash for new priorities, where will the workforce come from?

No senior leader in the sector has spoken to me with confidence about the Health Education England workforce plan – due in November alongside the NHS long term plan – cracking this. Many expect it to suggest more doctors and more nurses, as if simply wishful thinking will fill degree courses.

One option is creating new roles, going beyond the 8,000 new mental health practitioners trained through a new course proposed in the CYP green paper.

Some think psychology graduates will prove crucial to growing the workforce, and that providing alternative qualifications for them to enter the sector is pivotal. This would provide a massive pool of potential staff, but still relies on creating the qualifications and competency frameworks for the roles – and establishing confidence that this is the sensible path forwards.

NHS England and NHS Improvement national clinical director Professor Tim Kendall is in favour of new grade psychology workers, telling MPs that if new roles can be created for talking therapies and CYP, then why not for others?

It remains to be seen whether concrete proposals will be hammered out by the time the long term plan is published in November.

It’s important this is done right – not cobbled together on the back of a cigarette packet – but equally, the absence of a plan would be a failure to address the sector’s biggest risk.