Today NHS England has committed to investing £1bn a year extra in mental health services by 2020-21 so it can deliver the mental health taskforce’s recommendations. So where’s the money coming from and what will it be spent on?
Where will the £1bn come from?
There’s no extra money from the Treasury so this will have to be found from within the NHS’s spending review settlement.
George Osborne agreed to increase NHS England’s budget by £8bn above inflation by 2020-21, with almost £4bn of that rise being frontloaded in 2016-17. In return the chancellor demanded the NHS deliver £22bn in efficiency savings by 2021.
The spending review did earmark £600m for mental health in the NHS settlement but that won’t be enough to cover today’s commitments. NHS providers and commissioners will be nervous about the prospect of more being promised from the £8bn, particularly as there are already signs the health service will struggle to find the £22bn efficiency savings the chancellor expects.
Is it new money?
NHS England says yes. This is because the £1bn promised by 2020-21 will be additional compared to what services received in 2015-16. However, the £1bn actually contains a lot of previously announced mental health funding pledges, some of which were only ever going to come into force from next year anyway. There’s a fair amount of announcement recycling going on here.
For example, the £1bn pledged today apparently includes some of the money from spending priorities totalling £940m announced by the prime minister last month. That announcement of £940m included the £600m for mental health announced by Osborne in the spending review.
So is the £1bn effectively just a repackaging of old announcements? NHS England says no. It claims the £940m promised by the prime minister covers the total expected spending on a few priority areas over five years whereas the £1bn a year in 2020-21 is the total cost of delivering the taskforce recommendations (which include, but are not limited to, the Cameron priorities) for one year only.
Untangling the claims is tricky as NHS England won’t provide a breakdown for what will be spent when. Ironically a lack of transparency on mental health spending is one of the problems flagged by the taskforce report.
NHS England refused to answer a series of questions on the funding but did provide this statement: “The mental health taskforce proposals need an extra £1 billion a year to be spent on new mental health services annually by 2020, and that’s precisely what we’re committing to today.
“Only the most bizarre mangling of that fact would claim this isn’t ‘new’ money when it patently is new funding for mental health over and above what is being spent today, and money that is for the first time being earmarked for mental health from future funding growth. On any definition this is genuinely new investment in mental health.”
What will it pay for in 2020-21?
According to the taskforce’s plan, the money will see:
- 600,000 more people each year accessing talking therapies
- Mental health liaison services in every acute hospital A&E
- 24/7 community-based mental health crisis response available in every area, including “adequately resourced” crisis teams
- At least 30,000 more women each year accessing perinatal mental health services
- At least 60% of people experiencing psychosis getting a NICE-approved care package within two weeks of referral
- A doubling of individual placement and support programmes for people with mental health conditions who are out of work
- At least 280,000 more people living with severe mental illness having their physical health needs met by increasing access to physical care assessments
- More specialist community provision and ‘step down’ services for forensic mental health patients
- The national roll out of liaison and diversion schemes across England
- All areas with a multi-agency suicide prevention plan in place by 2017
How was the £1bn figure reached?
Apparently the taskforce used the best available evidence to cost these proposals and concluded that £1bn a year extra would be needed in 2020-21. NHS England has not provided a breakdown of how much each proposal will cost or how the funding will be phased in (i.e. whether it all arrives in 2020-21 or some arrives earlier) but it’s likely to be introduced in stages.
The £1bn a year estimate is also based on an expectation that any efficiencies found when delivering the reforms are reinvested in services. However, NHS England says the £1bn figure does not include the efficiencies and is genuine investment. It also says the efficiencies identified by taskforce will be separate to the £22bn efficiencies identified in the wider NHS.
How will the funding get to services?
NHS England anticipates the majority of the £1bn funding commitments will be delivered through clinical commissioning groups (CCGs).
In the past the government has used the annual NHS planning guidance to set out what it expects from CCGs in terms of mental health spending. The planning guidance for 2016-17 to 2020-21 says “commissioners must continue to increase investment in mental health services each year at a level which at least matches their overall expenditure increase”.
This system has been criticised as being too easy for CCGs to ignore or game. So, for example, the guidance says mental health spending must increase, so CCGs rebadge more spending as ‘mental health’ rather than actually increasing funding for frontline services.
Another problem is NHS England has historically relied on CCG planned spending to monitor this. So if CCGs indicate they plan to increase mental health spending then NHS England (and ministers) often go on to claim spending has increased. Without audits of actual spend it is impossible to know whether the planned spending levels were delivered or where the money went.
The taskforce recognises this as an issue and says by 2020-21 CCGs should be required to publish data to provide transparency about mental health spending.
There used to be a national survey of spending on mental health services. The government axed it in 2013, a year after it showed the first real terms decrease in spending in a decade.