NHS England has accepted a five-year blueprint to address the growing crisis in mental health services and pledged to increase investment by an extra £1bn a year by 2020.
The Mental Health Five Year Forward View, published today, delivers a scathing verdict on the state of care. It points to rising suicides, long waiting lists and problems accessing beds for acutely unwell patients. It also raises concerns over staff shortages and significant gaps in support for new mothers with mental health conditions.
There has been “no improvement” in race inequalities relating to mental health care since a national policy initiative finished in 2010, the report adds.
The review criticises NHS commissioners for years of “chronic underinvestment” in services and says a lack of transparency has masked a growing inequality between spending on mental and physical health.
“The human cost is unacceptable and the financial cost to government and society is unsustainable,” it warns.
The report was commissioned by NHS England and produced by the mental health taskforce, led by Paul Farmer, the chief executive of mental health charity Mind.
The report sets out 58 recommendations to improve services and says the changes will require £1bn a year in additional investment by 2020-21. It says the funding should be on top of an existing government commitment to spend an extra £280m annually in children’s mental health provision. The report claims the funding will see:
- 600,000 more people a year accessing talking therapies
- 280,000 more people with severe mental health problems having their physical health needs met each year
- 70,000 more children a year receiving high-quality mental health care
- 30,000 more women each year getting perinatal mental health care
- 29,000 more people with mental health conditions accessing employment support
- More than 60% of people experiencing first episode psychosis get early intervention services
- 24/7 community-based crisis services available in every area, including “adequately resourced” crisis teams
- Liaison psychiatry services available in every A&E department
- An end to the practice of sending patients out of area for beds
The review is light on social care-specific recommendations but does call for an expansion of the Think Ahead fast-track training scheme for mental health social workers and for social work to be considered routinely in mental health workforce planning.
Responding to the report, NHS England committed to investing the extra £1bn a year by April 2020 and promised more transparency on mental health spending.
Pledge of £1bn investment
The £1bn a year extra promised by NHS England by 2020-21 will have to be found from within the NHS’s spending review settlement. The government agreed to increase NHS England’s budget by £8bn above inflation by 2020-21.
The £1bn a year for mental health also includes spending commitments outlined by David Cameron last month. The prime minister announced £290m for perinatal mental health care, £400m in 24/7 crisis services and £250m for liaison psychiatry services, would be spent over the next five years.
The Department of Health confirmed to Health Service Journal that Cameron’s announcement included no new money but instead outlined priority areas to spend previously announced funds, including £600m promised for mental health in the spending review.
NHS England said today’s £1bn goes further and is the total estimated cost of implementing the taskforce changes in full for one year only, whereas the £940m announced by the prime minister covered the total cost of funding the three priority areas over five years.
Services will want to know how and when the funding will be made available to them given the severe strain on budgets.
Research by Community Care found NHS mental health trusts saw their budgets cut by 8% in real-terms over the last parliament. Local authority spending on mental health fell by 13.2% in real-terms between 2010 and 2014.
The NHS is required to deliver £22bn of efficiency savings by 2020, while local government leaders have predicted a widening funding gap for social care in coming years.
Aspirations vs affordability
NHS and social care professionals told Community Care they backed the aspirations of the NHS taskforce plan but had concerns over its affordability.
One said local authority cuts were a “huge danger” to the strategy as many mental health community services, such as crisis teams, were joint NHS and council funded. Several raised fears that the pressure on commissioners to address the deficit in the NHS acute sector risked mental health reform quickly dropping down the list of funding priorities.
Farmer acknowledged the pressure on both systems but insisted the five-year strategy was realistic and deliverable: “We’ve been really encouraged by NHS England’s commitment on this. There’s no doubt it is going to need a lot of focus on the delivery over the next couple of years but I think the recommendations are achievable.
“For people with mental health problems I think the most important recommendations will be around levels of access. For the system, the commitments around data transparency and reform of payment and workforce approaches will be fundamental. Those are the elements that have been missing and contributed significantly to mental health being the poor relation of the NHS for some time.”
Simon Stevens, the chief executive of NHS England, said: “Putting mental and physical health on an equal footing will require major improvements in seven day mental health crisis care, a large increase in psychological treatments, and a more integrated approach to how services are delivered. That’s what today’s taskforce report calls for, and it’s what the NHS is now committed to pursuing.”
Health secretary Jeremy Hunt said: “We will work across government and with the NHS to make the recommendations in this landmark report a reality, so that we truly deliver equality between mental and physical health.”
Stephen Dalton, chief executive of the Mental Health Network, said: “This important report will be widely supported by mental health service providers – all of which have been straining to provide care with shrinking resources.
“The government has promised better support for mental health services and its response to this taskforce will be an important test of its commitment. The government needs to do more to ensure NHS England’s vital funding for mental health trusts reaches front line services.”
Sean Duggan, chief executive of the Centre for Mental Health, said: “We know that the NHS faces an unprecedented financial challenge in the next five years.
“Local councils face even bigger pressures, putting public health and social care under threat despite their important roles in promoting and protecting mental health. But the changes the taskforce is calling for could help public services improve the help they offer and make more equitable and effective use of scarce resources.”