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Mental health funding gap widens further

King’s Fund report reveals lack of parity

Jo Carlowe

Tuesday, 16 January 2018

The gap between spending on NHS acute hospitals and NHS mental health providers widened last year.

A new report Funding and staffing of NHS mental health providers: still waiting for parity from The King’s Fund, published today, shows that income for mental health trusts rose by less than 2.5% in 2016/17 compared to over 6% for acute and specialist trusts, continuing a trend of a growing gap between spending on mental health and acute trusts.

Since 2012/13, funding for mental health trusts has increased by just 5.6% compared to an increase of 16.8% in funding for acute hospitals. Some 84% of mental health trusts, which provide the great majority of mental health services, received an increase in funding last year; a significant increase on previous years. But funding for acute and specialist hospitals has continued to grow more quickly as national leaders have given priority to reducing financial deficits and improving performance in A&E.

The squeeze on NHS mental health providers funding, together with a lack of available staff, has put huge pressure on the workforce and left mental health trusts struggling to staff services safely, warns the report.

Moreover, the number of mental health nurses has fallen 13% since 2009, while one in 10 of all posts in specialist mental health services are currently vacant.

Analysis of Care Quality Commission inspection reports for all fifty-four mental health trusts identified an increased risk to patient safety as a result of problems with staffing in more than half of trusts. This included an increased risk of suicide and self-harm on inpatient wards, delays in treatment and reduced access to care and bed closures. Examples drawn from a review of board papers of a small number of trusts also highlighted difficulties staffing services on a day-to-day basis, a reliance on bank and agency staff and ‘substitution’ of staff, for example health care assistants stepping in for registered nurses.

Helen Gilburt, report author and fellow in Health Policy at The King’s Fund, said: “The NHS is in the very difficult position of trying to deliver parity of esteem at the same time as it is under huge pressure to reduce deficits and improve performance in acute hospitals.

“While the great majority of local clinical commissioning groups have met their commitments to raise spending on mental health, the overall spending gap between mental health trusts and acute and specialise trusts has widened because national funding has focused on relieving pressure on acute hospitals. Unless funding grows more quickly, mental health providers may end up implementing improvements to some services at the expense of others. Despite the commitment of national leaders, the funding gap between mental health and acute NHS services is continuing to widen, while growing staff shortages are affecting the quality and safety of care.

“As long as this is the case, the government’s mission to tackle the burning injustices faced by people with mental health problems will remain out of reach.”

Commenting on today’s report, Catherine Gamble, Royal College of Nursing and professional lead for Mental Health, said: "This report is very worrying, but sadly not surprising. Parity of esteem between mental and physical health will never be achieved unless there are enough mental health nurses to support recovery and care properly for people with mental health problems.

“Staffing problems at some mental health trusts are so serious that the safety of patients is being compromised. The Royal College of Nursing revealed last year that there are now 5,000 fewer mental health nurses than in 2010 - one of the greatest reductions in specialist nursing.

"Mental health nurses struggle daily to meet the needs of patients, families and carers in a highly-complex and undervalued role. This cannot be allowed to continue.”

Mental health charity, Mind, also described the findings as ‘worrying.’ Its chief executive Paul Farmer, said: “This report highlights the crucial importance of funding and staffing in transforming mental health services. While spending on mental health trusts isn’t the full picture, it is a worrying indication of the enormous challenge faced. After years of underfunding and neglect, and at a time of increasing demand as more and more people seek help, we need to see continued momentum around improving mental health services.

The Five Year Forward View for Mental Health, launched in 2016, came with a commitment by the NHS to spend £1 billion more on mental health services by 2020-21. Evidence suggests that it is materialising but we know there are concerns about how it is reaching the frontline. Local commissioners are now required to report their spending on mental health so transparency around funding should improve – it’s up to the rest of us to use this data to hold the system to account and make sure the money gets where it needs to be.

“This report also reiterates the huge challenges around workforce planning. Mental health services are heavily reliant on their staff, who do a fantastic job and can make all the difference to the experience of people under their care. But huge gaps in the workforce will take years to fill, which puts enormous pressure on the current workforce and means that two-thirds of people with mental health problems get no help or support at all.

"Mental health has been under-resourced for too long, with dire consequences for people with mental health problems. If people don’t get the help they need, when they need it, they are likely to become more unwell and need more intensive – and expensive – support further down the line. The five-year plan is the opportunity to get this right, to start building the kind of NHS mental health services that will carry us into the future and make sure everyone with a mental health problem gets the help and support they need.”

Professor Wendy Burn, President of the Royal College of Psychiatrists said: “Despite the increase in funding in mental health services, mental health trusts are still lagging desperately behind those acute trusts providing care for physical health problems.

“The Government last year committed to prioritising mental health in the NHS, but as good as that sounds, this isn’t happening on the ground. Patients with mental illness continue to bear the brunt of an underfunded sector experiencing unprecedented demand with limited supply. Prioritisation of mental health is about getting the right care, at the right time, in the right place. That can’t happen if funding is growing at three times the rate for acute hospitals as mental health trusts.

“We are calling on the Government to hold CCGs to account, individually, for meeting the Mental Health Investment Standard (MHIS). Sanctions should be imposed on those failing to meet the MHIS, without valid cause. The standard is one of few tools available to monitor even distribution of mental health spend across England and is therefore vital for transparency.”

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