Analysis

Influential MPs say government’s planned improvements in mental health care may not be achievable

A recent report from the Public Accounts Committee (PAC) was scathing in its assessment of whether the government would be able to achieve urgently needed improvements in mental health services.
Getting the balance right

A recent report from the Public Accounts Committee (PAC) was scathing in its assessment of whether the government would be able to achieve urgently needed improvements in mental health services.

The Mental Health Taskforce, launched by NHS England, published a report earlier this year making a series of recommendations for improving outcomes in mental health by 2020-21.

The PAC stated that NHS England and the Department of Health (DH) have a laudable ambition to improve mental health services but, given the current pressures on the NHS budget, we are sceptical whether this is affordable, or achievable without compromising other services.

They added that achieving parity between mental and physical health is a task for the entire government.

Working together

The Mental Health Care Crisis Concordat, a

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A recent report from the Public Accounts Committee (PAC) was scathing in its assessment of whether the government would be able to achieve urgently needed improvements in mental health services.


Getting the balance right for improving outcomes in mental health. Picture: Getty Images

The Mental Health Taskforce, launched by NHS England, published a report earlier this year making a series of recommendations for improving outcomes in mental health by 2020-21.

The PAC stated that NHS England and the Department of Health (DH) have a ‘laudable ambition to improve mental health services but, given the current pressures on the NHS budget, we are sceptical whether this is affordable, or achievable without compromising other services’.

They added that achieving parity between mental and physical health is a task for the entire government.

Working together

The Mental Health Care Crisis Concordat, a national agreement between services and agencies involved in the care and support of people in crisis, was established two years ago setting out how organisations can work better together.

Although the PAC report says the concordat has been beneficial, it concludes that structures are not in place to enable joined-up working to support mental well-being across government in areas such as prisons, housing, employment and schools.

It added that it is difficult for people to access the support they need due to mental health services often being ‘complex, variable and difficult to navigate’ and emphasised the lack of information about the mental health workforce.

The report highlighted a Health Education England (HEE) estimate that implementing access and waiting time standards will require the number of mental health nurses to rise by 7%, from 39,000 in 2014 to 42,000 by 2020.

£105 billion

The amount that mental health problems cost the economy each year

As large numbers of nurses leave the NHS every year, the numbers joining the register are not increasing the total number employed in the NHS, according to the report.

Strategy in place

HEE is producing a workforce strategy for mental health, but PAC chair Meg Hillier says that if the government is serious about achieving its aims, it must also ‘plan to secure skilled staff in sufficient numbers’.

Responding to the report, RCN professional lead for mental health nursing Ian Hulatt says that equal care for mental health patients seems like a ‘far off dream’.

‘Mental health issues are affecting more people, and it is unacceptable that only a quarter are receiving the care they need. Mental health is just as important as physical health and needs to be treated as such – as one so often impacts on the other.

‘This report highlights some of the serious failures in workforce planning that have led us to have many plans for services without the staff numbers to back them up.’

£11.8 billion

Estimated spend by NHS England during 2014-15 on mental health services, equating to about 12% of total healthcare spending

Committee campaign

Health spokesperson for the Liberal Democrats, Norman Lamb has campaigned extensively on mental health issues and is chairing a committee on mental health for the West Midlands Combined Authority.

‘One aspects we are looking at is how money is spent and how it could be spent more effectively,’ Mr Lamb says.

‘Too much resource is spent on containment and not enough on prevention. In the West Midlands we are assessing how we can effectively keep people in employment when they fall out of work due to mental ill health.

‘The government needs to recognise spending money out of one silo can make savings in another. An example could be the prison service, where people could get diverted into treatment rather than recycling them through the courts and back into reoffending.

‘There is certainly a big workforce issue, and I think we need to be innovative and smarter about how we use the existing workforce sometimes, such as giving training to staff who aren’t perhaps specialists in mental health but could offer extra support.’

52%

Of mental health trusts said that they had received a real terms increase in funding in 2015-16

The PAC report also targeted commissioners and providers of services, stating that current structures, practices and payment mechanisms do not incentivise them to deliver high-quality mental health services.

Cautious about change

Phil Moore, chair of the Mental Health Commissioners Network and deputy chair of NHS Kingston Clinical Commissioning Group, says commissioners, who are spending public money, are cautious about change.

‘The truth is that most commissioners and providers do want to deliver good services, but they don’t want high risk change, they want change with a relative amount of security and with the element of risk shared between commissioners and providers.

‘The baseline we need to start from is the Five Year Forward view, which we need to develop locally. What we don’t want to do is take away the ability of commissioners to interpret national aspirations in light of their local priorities.

'Mental health has always been the poor relative, but what we need to do is try and reverse that trend, not only with money, but access to services and making integrated decisions about physical and mental health.’

Read the PAC report here

The Department of Health response

The DH claims that the majority of PAC recommendations are already being addressed. It has reiterated that it has 'high-level' partnerships across the home office, departments of justice, education and work and pensions.

A mental health services dataset has been established to enable access to evidence-based care and outcomes across mental health and transparent information on waiting times.

The DH is also working with NHS England and NHS Improvement to create better commissioning arrangements and incentives by moving away from unaccountable block commissioning contracts to payment mechanisms that are outcomes-focused to promote recovery.

A DH spokesperson said: ‘As the PAC has recognised, we have made important progress in the way we think about and treat mental illness in this country, introducing the first mental health waiting times in the history of the NHS. We are determined to accelerate progress further working across government, and are backing the NHS’s plan to revolutionise mental health care with an additional £1 billion invested every year by 2020 – helping 1 million more people with mental illness to access high-quality care.’

Case study

In the north east of England a project called RESPOND has been developed between Northumberland Tyne and Wear NHS Foundation Trust, North East Ambulance Service, Northumbria Police, Newcastle City Council and service users who are experts by experience.

The project presents frontline staff with a range of real-life scenarios with constant input and support from a mental health professional, paramedic, psychiatric doctor, emergency services crisis nurse and an expert by experience.

Following two successful pilots in Newcastle, the training is to be rolled out from the Scottish borders to areas of Yorkshire over the next six months.

Mental health nurse Claire Andre, who works for the trust as a clinical police liaison lead, has been involved in setting up the RESPOND project: ‘It is about bringing all the agencies together to learn from one another.

‘The aim is to improve the response to someone who is in crisis and better understand each other’s roles and avoid conflict. For example, if someone is detained and goes to a place of safety, often a nurse will be in the suite when they arrive with a police officer, the officer may want to leave immediately and the nurse may want the police officer to stay.

'It may actually be both their jobs to stay, but it is about understanding what the other person can do.’

She says that staff from the various agencies took on each other’s roles during the training pilots, which take place in specialist simulation suites.

‘You do need money to develop services and we couldn’t have done this without financial input from the vanguard, but it is also important for everyone to be able to problem solve together to improve services.’

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