Mental Health Matters: Assessing the long-term plan

Money matters

The long-awaited long-term plan was published last week. For mental health, we had some strong promises around money and access standards, but the ambitions around learning disabilities and autism felt underwhelming.

The pledge to increase real terms mental health spending by at least £2.3bn after five years has landed well with the sector.

But to meet the parallel pledge – for mental health spending to rise faster than the overall NHS budget – then the “at least” part of that sentence is going to be important.

The planning guidance confirms that additional mental health cash will flow into CCGs’ allocations from 2019-20. But as we don’t know what the final 2018-19 spend on mental health services is going to be, it’s not yet clear what the baseline will be.

However, if we take the average increase over the last two years, the figure for 2018-19 should be around £12.5bn. Taking this as the baseline, raising mental health spend by £2.3bn after five years would represent an increase of 3.42 per cent – which is virtually neck and neck with total NHS growth (see graph below).

The graph shows the cash increases needed to meet an overall real terms NHS funding uplift of £20.5bn, and the mental health uplift of £2.3bn, based on 2018-19 prices. 

Community shift

The nod towards community mental health teams was a welcome feature of the long-term plan and with it came two key pledges.

In an attempt to recognise the needs of those with severe mental health problems, NHS England said it would improve these patients’ access to community services through “new integrated models of care”.

Leaders won’t set much store on the promises of new care models until some actual detail is given on the “what” and the “when”. Although, a recent blog from the national director for primary care suggests that emerging primary care network models will play an important role.

The other main pledge, to introduce an access target for community mental health teams, is far more tangible and could be a game changer.

Introducing an access target for community care sends a strong signal that the services which keep people well should be prioritised. If implemented correctly, this could help finally shift the rhetoric within mental health from reaction to prevention.

That being said, data showing a 20 per cent cut by some trusts in their community health teams since 2012-13 suggests NHS England has a big funding hole to fill before any target can realistically be imposed on providers.

Good intentions

The learning disability and autism chapter of the long-term plan offered a list of good intentions, but failed to give any real detail on progression from the last national plan that was published for the sector.

When NHS England published guidance for the transforming care programme in 2015, it promised to reduce inpatient provision by 35 to 50 per cent and commission new intensive community and crisis support services to keep patients out of hospital.

These were laudable intentions, but as an HSJ investigation last year showed, they have largely failed to deliver results.

NHS England has now promised that at least 50 per cent of inpatient units will be closed and investment in seven day intensive community, crisis and forensic support services will be increased by 2023-24.

It is the lack of detail on the second point which raises the risk of repeating past failures.

Promises made in 2015 did not stick, and so to ensure plans for the next five years go beyond just signalling good intentions, some clear directions on local funding with targets to hold commissioners to account will need to be produced.