- HSJ analysis finds 47 of 207 CCGs are spending less than £8,250 per patient with first episode psychosis
- This is despite NHS England estimating this is the amount needed to provide NICE concordant care
- It has led to calls to strengthen oversight of CCGs to make sure those falling behind are investigated
Nearly a quarter of clinical commissioning groups are spending less than the estimated sum needed to provide proper care to seriously ill mental health patients, according to a new analysis by HSJ.
HSJ’s investigation found that 47 CCGs were spending less than £8,250 per patient with a first episode of psychosis in 2017-18. This is the sum NHS England has set in guidance as its estimate of the cost of providing National Institute for Health and Care Excellence concordant care, as required by national standards.
As part of the Mental Health Forward View implementation plan, half of the patients experiencing a first episode of psychosis should be treated with a NICE concordant care package within two weeks of referral.
There was substantial variation in the spend per head – the lowest being £1,182 at North Essex CCG, while the highest £88,250 at South East Staffordshire and Seisdon Peninsula.
Rethink Mental Illness said Early Intervention in Psychosis was a postcode lottery for patients trying to access psychosis treatment.
The charity’s head of health influencing Lucy Schonegevel said the new investment in EIP has produced “excellent” results but more needed to be done to help struggling CCGs improve.
She added: “Waiting time data reveals a postcode lottery when it comes to accessing EIP treatment within two weeks. When this happens, it is the patient that loses out every single time.
“We’d like to urge all commissioners to look at the big picture, and to see the very real economic and human benefits of providing interventions at the earliest opportunity.
“We are calling for oversight to be strengthened to ensure those CCGs falling behind are investigated and supported to improve.”
Only 11 CCGs were missing the national EIP waiting target, which was introduced in April 2016. But by 2020-21, NHS England has pledged that 60 per cent of first episode of psychosis patients will be treated within two weeks.
HSJ understands that while nationally the target is being hit, leaders are worried many services are not providing NICE concordant care.
But an NHS England spokeswoman stressed there was no mandated minimum spend on early intervention in psychosis treatment.
She added: “There is no mandated spend per episode of EIP treatment nor should there be.
“The NHS in England is investing an extra £70m in Early Intervention in Psychosis services, and now treats more than 12,000 people with a first episode of psychosis each year, with more than three quarters of patients seen within two weeks, far exceeding the waiting time standard.”
HSJ worked out the average spend per patient based on the total EIP spend reported in NHS England’s 2017-18 mental health dashboard. This was then compared with the total number of complete EIP pathways for 2017-18 to get an average spend per patient.
The CCGs spending the lowest amount per EIP patient
|CCG Name||Total completed pathways 2017-18||EIP spend (£k)||Cost per patient||% <2 weeks|
|NHS NORTH EAST ESSEX CCG||77||91||£1,182||93.5%|
|NHS WEST ESSEX CCG||46||66||£1,435||91.3%|
|NHS ST HELENS CCG||59||93||£1,576||81.4%|
|NHS KNOWSLEY CCG||47||75||£1,596||80.9%|
|NHS HALTON CCG||40||98||£2,450||82.5%|
|NHS MID ESSEX CCG||31||77||£2,484||74.2%|
|NHS WEST KENT CCG||41||103||£2,512||92.7%|
|NHS HASTINGS AND ROTHER CCG||39||107||£2,744||100.0%|
|NHS HEYWOOD, MIDDLETON AND ROCHDALE CCG||89||257||£2,888||15.7%|
*Cambridge and Peterborough CCG is, according to NHS England’s figures, the organisation with lowest spend per patient at £863, but it told HSJ the figure published in the NHS England mental health dashboard was wrong and it had actually spent £2.2m. This would make its average spend around £11,000 per patient.
*Update 5pm 8 October: NHS West London CCG has told HSJ its published spend figure for EIP (£59,000) is incorrect, and its indicative 2017-18 spend on this service was in fact £940,000. The new figure means it is no longer one of the “CCGs spending the lowest amount per EIP patient”, so it has been removed from the list.
West Essex CCG said EIP services were included in the block contract it operates with its provider. A spokesman added: “The provision consistently meets the EIP access target of 53 per cent of people with first episode psychosis to be on a NICE concordant package of care within two weeks of referral.”
St Helens CCG said its EIP service “consistently delivers safe and effective care and meets the NICE target for EIP”. Mental health commissioner Paulin McGrath added: “The CCG has invested £1.183m in 2016-17 to support the service in delivering care to NICE standards and is working with the service provider to consider options paper for further investment to ensure future resilience and sustainability.”
NHS England data
- Mental health
- National Institute for Health and Care Excellence (NICE)
- NHS Cambridgeshire and Peterborough CCG
- NHS England (Commissioning Board)
- NHS Halton CCG
- NHS Hastings and Rother CCG
- NHS Heywood, Middleton and Rochdale CCG
- NHS Knowsley CCG
- NHS Mid Essex CCG
- NHS North East Essex CCG
- NHS St Helens CCG
- NHS West Essex CCG
- NHS West Kent CCG
- NHS West London (K&C & QPP) CCG
- Quality and performance