Civil service cuts put mental health strategy at risk


The government has admitted it risks undermining its plans to help one million people recover from mental health problems by 2014 because of massive cuts in civil service expertise.

At the heart of today’s mental health strategy are plans to expand access to talking therapies to all who need them by 2014-15, including children, older people and those with severe mental health problems, building on the work of the existing Improving Access to Psychological Therapies (IAPT) programme.

But 11 of the 14 staff delivering IAPT will leave the Department of Health at the end of March, a government source told Community Care, as part of widespread cuts to DH support schemes to implement policy, which includes the closure of the National Mental Health Development Unit.

In an impact assessment on its plans to roll out talking therapies, the DH admitted that the cuts could put the delivery of its plans at risk.

“Without a well-functioning central team and regional teams to support implementation and data validation locally, there is a danger of the talking therapies roll out stalling or not making the progress intended,” it said. 

“Also, there is a danger of specific care models for older people, children and young people, those with long-term conditions or medically unexplained symptoms and those with severe mental illness not being developed or piloted, or best practice not being disseminated across the country.”

“The departing staff will take policy and process knowledge with them,” said the government source, in reference to the cuts to IAPT and other DH programmes. “There are no handover plans in place to assure continuity of programmes and the pressure on existing staff is leading many to leave via the voluntary exit (redundancy) scheme.”

Responsibility for the talking therapies programme will pass from the DH to the NHS Commissioning Board from 2012-13, but the DH confirmed support for local delivery would remain “limited”.

Andy Bell, deputy chief executive of the Centre for Mental Health, said it would have been preferable to have retained as much continuity as possible in a “challenging landscape”.

He said: “The IAPT programme has been well run and it’s had very good quality of support and we will need to see what arrangements will be put in place to make sure its [quality is] continued and it’s vital that this massive development of the project is done well and to a high quality.”

The cuts reflect the DH’s focus on making local organisations more responsible for policy delivery.

It has earmarked £400m towards the talking therapy programme’s expansion up to 2015, which it anticipates will produce £700m of savings to the public sector in healthcare, tax and welfare gains.

However while this funding has been allowed for in primary care trust funding allocations, the final spend is subject to local discretion.

A DH spokesperson said: “We are clear that at a time when the NHS budget is under pressure, we need to find efficiencies so that we can invest in frontline services.

“We are working with the Royal College of GPs and the Royal College of Psychiatrists to produce robust guidance for commissioners on mental health services. so they have the expertise to commission good mental health services.

“A central policy team within the Department of Health will continue to oversee roll-out of our talking therapies programme.”

A four-year plan on delivering the talking therapies expansion, also revealed today, said this “small team” would be responsible for supporting training and commissioning, and setting outcomes for and benchmarking services.

Shadow care services minister Emily Thornberry said she was unclear how the government intended to deliver the outcomes when it was “shaking” the NHS “really hard and cutting local authority funding.

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