Mental health services in England can enhance care and save hundreds of millions of pounds a year through measures including cutting unnecessary hospital bed use and out-of-area placements, research has found.
However, such productivity improvements could be put at risk by the government’s reforms to the NHS and a lack of joint working, the report by think-tank the King’s Fund and charity the Centre for Mental Health said.
The study examined how mental health, which accounts for about 10% of the NHS’s £100bn annual budget in England, could contribute to the government’s target of making £20bn in annual efficiency savings by 2015.
Report author Chris Naylor, senior researcher at the King’s Fund, said it would be “challenging” for mental health to achieve a £2bn a year productivity gain, in line with its share of the budget, but said it could get a “substantial way there” by taking the measures outlined in the report.
The report estimated up to £200m a year could be saved by cutting unnecessary use of acute psychiatric beds given the current variations in admission rates and average lengths of stay on inpatient wards between mental health trusts with similar populations. This would require improvements to crisis resolution and home treatment (CRHT) teams, which have been set up to support people who are in crisis at home, but have been found to be under-performing in some areas.
Up to half of the 10,000 out-of-area placements in psychiatric hospitals could be avoided, saving £65m a year, through investment in local residential services and supported acommodation, the research found.
The report also suggested that more than £300m a year could be saved for the NHS by improving mental health support for older people with dementia in general hospitals, facilitating earlier discharge, through mental health liaison teams in hospitals and specialist older people’s CRHT teams.
Other areas set out for savings include reforming secure services – the biggest slice of mental health expenditure at almost £1bn a year – by reducing unnecessary admissions, increasing workforce productivity by reducing sickness absence and providing effective employment support to clients.
However, the report warned that the abolition of PCTs by 2013 and their replacement as health commissioners by new GP consortia could detract from efforts to improve mental health productivity. It also highlighted a survey by the charity Rethink that found most GPs did not feel equipped to commission mental health services.
Naylor said consortia would need support to commission mental health, including from councils and regional officials from the new national NHS commissioning board, adding: “GP consortia on their own will really struggle to meet these challenges.” Other issues raised by the report included the fact that in some of its examples of improved productivity, spending by one body would result in savings in other organisations’ budgets. Naylor said tackling this would require pooled budgets, but warned: “Pooling budgets can be a fiendishly complicated process on the ground.”
Mind welcomed the document but raised concerns about the impact of NHS efforts to make efficiency savings. “We welcome new and innovative thinking about the delivery of mental health services but we know that many people currently struggle to access the help, treatment and support that they need,” said Alison Cobb, senior policy and campaigns officer at the charity. “It is vital that any efficiency savings do not come at the expense of the quality of care received by service users and that people are still able to have timely access to responsive services.”
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