HSJ’s fortnightly briefing covering safety, quality, performance and finances in the mental health sector. Mental Health Matters is now written by HSJ’s new mental health correspondent, Rebecca Thomas. Tell her what you think, or about issues she could write about, by emailing her in confidence at firstname.lastname@example.org; or by sending a direct message on Twitter.
Last week, the chancellor gave us a sneak preview of the NHS’s long term plan. In his Budget announcements, Philip Hammond revealed at least £2bn of the NHS’s promised funding boost will go towards increasing spend on mental health by 2023-24, including £250m earmarked for crisis services.
Alongside this came a familiar commitment to achieve “parity of esteem” between physical and mental health services.
The promise of parity has been batted around many times before. Last year, prime minister Theresa May pointed to the increase in mental health investment as an example of progress towards this oath.
There is no doubt that increased spending in mental health is a win, but this does not amount to parity if spending on acute services is going up at a higher rate. This latest commitment to actually increase mental health’s slice of the pie does have potential to bring us much further towards meeting the promise.
However, as always, the devil is in the detail. Many voices, including The Royal College of Psychiatrists, have said if spending only increases by £2bn, money for mental health services would in fact go down as a proportion of total spend in 2023-24.
Calculations from the royal college show the figure the sector really needs is around £2.6bn and, in a report last week, the Institute for Public Policy Research claimed the NHS would need to spend at least £4bn more in 2023-24 to achieve real parity.
Whether it’s £4bn, £2.6bn, or somewhere in between, the price of parity is likely to be significantly greater than £2bn.
With this in mind, it is worth remembering the chancellor’s clever wording of “at least £2bn”— it is something NHS England’s national director for mental health Claire Murdoch has since highlighted multiple times on Twitter.
While it is not a good idea to base one’s assumptions on semantics or Twitter, considering the national focus on mental health, it’s safe to assume those doing the bidding for the sector’s piece of the £20.5bn will be asking for more.
A crisis warning
In light of last week’s focus on crisis services, a recent report from Norfolk and Suffolk Foundation Trust’s council of governors is worthy of mention.
According to the governors, crisis services operated across five sites by NSFT are “disjointed” and vary in quality across each location.
This is partly due to poor commissioning and partly because the trust “has not clearly defined” the services it wants to provide.
Governors claim conflicts of demand between the crisis and mental health liaison teams in some areas mean patients are referred to the crisis service just to free up acute beds.
The report said: “There are a number of examples where the mental health liaison teams actively assert pressure on the [crisis resolution and home treatment] teams to accept referrals mainly to ‘unblock’ beds within the acute hospital…On occasion this way of working just moves the pressure.”
The document added: “Similarly, as the trust’s teams are separately managed, and are mostly embedded in the emergency department, they reflect the culture of the target driven acute trust, sometimes at the detriment of the service being run within crisis and home treatment.”
Obviously, these pitfalls could be unique to NSFT. However, they should stand as a warning that, while money for crisis services is very welcome, there needs to be a close eye on implementation.
Keeping people well
A big question the NHS long term plan will need to answer is how much investment it wants to put upstream in services which go towards preventing mental health problems.
Readers may want to take a look at the president of The Royal College of Psychiatrists’s recent reaction to the Treasury’s crisis funding announcement. Writing for The Guardian last week, Wendy Burn welcomed the focus on crisis services in accident and emergency, but also asked: “Why should people with mental illness be able to access care only when they feel they have nowhere left to turn?”
She makes a good point. It is vital we have good crisis services, but the long term plan must also not shy away from spending money on the things which keep people well and out of crisis in the first place.
According to the new health and social care secretary, prevention is set to be central to the long term plan. The boss has even promised a green paper on the topic next year. However, as history has shown us, actually getting money into prevention areas can be difficult for policy makers. As welcome as green papers are, they provide no guarantees.
The fruits of prevention can often take longer to grow and benefit from, which makes it a more difficult bid for those working on the mental health’s long term plan to make.
Not to mention a lot of prevention measures in mental health do not just sit within the NHS budget. So, even if NHS spending on mental health increases, if spending on council support services, housing, education, and welfare remain stagnant, can we fully address the determinants of poor mental health and prevent crisis in the first place?