Doubts over therapy pledge mars mental health strategy aims

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The sacking of government adviser Professor David Richards for speaking out over the government’s mental health strategy has exposed gaps in the high ambitions set out by ministers when they launched the mental health strategy last week.

Mental healthcare would finally be put on a par with physical healthcare; one million people would recover from mental health problems by 2014; and £700m of public sector savings would be released over the same period.

The basis of these claims was a single pledge: to roll out talking therapies to all who need them, be they adults of working age, older people or children, or those with common problems such as depression or more severe conditions such as schizophrenia.

The pledge would be backed by £400m from 2011 to 2015, increasing the investment pumped in by Labour for its Improving Access to Psychological Therapies (IAPT) programme, which reached £173m in 2010-11.

“Be in no doubt,” said care services minister Paul Burstow. “The momentum and the political will is there. This is a deep commitment for me, and for the government.”

However, the pledge was not all it seemed, as Professor Richards set out in a letter to The Guardian today, explaining the reasons behind his sacking.

The £400m was money already allocated to the NHS in the 2010 comprehensive spending review.

Like other government funding commitments to specific programmes, it was not ring-fenced, and it will be up to primary care trusts – and new GP consortia from 2013 – to choose whether to spend the money on talking therapies.

Although £400m is just 0.4% of the annual NHS budget and 4% of annual spend on mental health in England, ensuring it flows into talking therapy services will not be easy when the NHS needs to find £20bn of savings from 2011-15.

Over this period the NHS budget will decline slightly in real terms, while mental health services are already facing rising demand. Inpatient numbers in mental health wards rose for the first time since 2005 last year, latest figures show.

And this issue has been recognised by the DH.

In its impact assessment on the plan, it said: “There is a risk that the NHS will not allocate the expected amount on talking therapies, as the allocation is likely to be subsumed into the general PCT allocation and funds could be diverted to other priority areas.”

From 2013, this will be an issue for GP consortia when they take over PCTs’ commissioning responsibilities.

The money was not the only problem recognised by the DH.

Community Care also learned that 11 of the 14 members of the central IAPT were leaving the Department of Health next month under the DH’s plans to radically scale back its role in supporting policy implementation – part of the government’s “localist” philosophy.

But the impact assessment warned: “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.

“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.”

Of the cuts to IAPT and other DH programmes, a government source said: “The departing staff will take policy and process knowledge with them. 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 in 2012, but the DH confirmed support for local delivery would remain “limited”, from a “small team”. Its tasks will include supporting training and commissioning, and setting outcomes for and benchmarking services.

There will be mechanisms to drive process. The 2011-12 NHS operating framework, which sets priorities for next year, calls on PCTs to roll out talking therapies. The NHS Commissioning Board will hold GP consortia to account for delivery against a new NHS outcomes framework, which will include indicators related to talking therapies.

Meanwhile, a system of payment-by-results will be introduced for providers of talking therapy services.

Whether this will outweigh the lack of ring-fenced funding and a well-staffed central team to drive the implementation of policy will determine whether the government’s grand ambitions come to fruition.

● More on the mental health strategy

 

Other key pledges from the strategy

● DH to part-fund anti-stigma Time to Change campaign after the current funding runs out in 2012.

● Six recovery pilots will be launched to trial services to help people overcome mental illness.

● GP consortia to receive advice and support in commissioning mental health from the DH, Royal College of GPs and Royal College of Psychiatrists.

 

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