Community teams at a north London mental health trust should have their caseloads cut by at least 10% and staffing reduced to help plug a £15m funding deficit for services, according to a review.
The proposal is part of a ‘difficult and controversial’ cost cutting package set out in a review of services in Barnet, Enfield and Haringey that was carried out by consultancy group Mental Health Strategies at the request of local NHS commissioners. The review found that services at Barnet, Enfield and Haringey NHS mental health trust were “unsustainable” at current levels without significant further investment by commissioners or the introduction of cost cutting measures.
The impact of bed pressures
In January, the CQC censured Barnet, Enfield and Haringey NHS mental health trust after inspectors found that a lack of available mental health beds at St Ann’s hospital had seen patients admitted to seclusion rooms, in one case for five days, months after the trust had assured the regulator that the practice had stopped.
The most significant pressure facing the mental health trust’s services was the overspend of £5.8m on adult acute admissions in 2013-14. This included £1.6m spent by the trust on external placements, including the cost of discharging patients to Bed and Breakfast accommodation to free-up beds, a practice revealed by Health Service Journal in April.
The pressure to free-up beds had been compounded by delays accessing housing and social care for patients ready for discharge, the report found. The number of bed days lost by the trust to these ‘delayed transfers of care’ rose 29% in 2013-14 at an estimated cost of £2.2m.
The review of services proposes a recovery package to plug the estimated £15m recurrent cash gap facing services. The recommendations include:
- The trust saves up to £1.3m per year by cutting community team caseloads by at least 10% and “reducing the teams’ size accordingly”. The intention should be to discharge people with long-term stable needs and reduce referrals of “relatively less severe needs”, the report says. This should be linked to improved peer support and primary care provision.
- Commissioners should ‘halt or withdraw’ from any commitments involving new expenditure on mental health. These include plans to improve dementia assessments as identifying more cases “could produce additional costs”.
- NHS services should hold ‘robust’ negotiations with local authorities to cut the numbers and lengths of delayed transfers of care to save £2.2m.
- The trust should save £3m to £4m through a consolidation of its buildings.
- A proportion of the cost of the trust’s acute overspill should be diverted into expanding home treatment teams. This money should be ring-fenced to respond to “cases at genuine risk of admission”, the report states.
Responding to the report, a Barnet CCG spokesperson said that a group including representatives from local CCGs, local authorities and the mental health trust had been set up to consider the viability of the savings proposals.
“The CCG in Barnet is very clear that there is no intention to cut services, rather, we are reviewing the way in which the services are delivered in line with our vision to improve access to mental health care in community settings, so that patients get the right care, in the right place, at the right time,” the spokesperson said.
Commissioners had invested an extra £1.5m for 2014-15 to take account of “increased acute activity”, the spokesperson added. “Barnet CCG operates within a financially challenged health economy, and it is important that levels of funding should increase to match need. Despite this challenge and the many other health priorities that are competing for funding, Barnet CCG has managed to increase its funding of mental health services to meet some of the pressures identified in the report,” he said.
A spokesperson for Barnet, Enfield and Haringey NHS mental health trust said the trust would be considering the report’s recommendations, including the review of community team caseloads.
“The local CCGs did increase their funding for the mental health trust’s services slightly this year, but the position is that the trust still bears most of the financial risk around increases in the numbers of patients the trust is caring for, which is causing the trust major financial problems this year, as it did last year. This is not sustainable in the long term,” the spokesperson said.
“The mental health trust is currently under pressure from increased numbers of patients, without the corresponding increases in its funding. It has already made major cost reductions over the last five years, but is unable to keep doing this while still providing safe, high quality care for patients.”