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Three quarters of CCGs miss child mental health target

Huge variation across England in CCGs’ performance, planning and funding for CAMHS

Louise Prime

Wednesday, 22 March 2017

Nearly three quarters of clinical commissioning groups are failing to meet NHS England’s benchmark for improving child and young people’s mental health services (CAMHS), a report based on official figures has revealed this morning. The Education Policy Institute (EPI) also found that fewer than a third of CCGs had a fully funded plan to improve crisis care, and more than one in ten had no agreed plan or funding to improve crisis care from its current level. Furthermore, and in direct contravention of government policy, children have spent a large and increasing number of nights on adult wards. The EPI found evidence of a ‘postcode lottery’ across England in all these areas.

The Institute analysed data from NHS England’s Mental Health Five Year Forward View Dashboard in compiling today’s report.* It said:

  • On assessing overall performance of children and young people’s mental health services, it found 73.2% of CCGs failed to meet NHS England’s own benchmark for improving services.
  • In order to meet NHS England’s standard for crisis care performance, CCGs must have an agreed plan to develop better local services. But across England, just 31.6% of CCGs had a fully funded plan to improve crisis care, and 10.5% of CCGs had no agreed plan or funding set out.
  • Government policy states that no one under 18 should be treated on an adult ward – but between July and September 2016, children spent a total of 2,654 nights on an adult ward, a rise of more than a third compared with the previous quarter (although it is not yet possible to establish whether this results from fluctuation or a longer trend).
  • There is wide variation between CCGs’ planned spending per head – with those in the top quarter spending over £52 per capita, compared with those in the bottom quarter spending just £23 or less, which the EPI said “suggests there is a postcode lottery in children and young people’s mental health care”.

The EPI made several policy recommendations to tackle the wide variation that it found across England in overall CCG performance, crisis care performance, the problem of children on adult wards and CCGs’ spending per head. These are that NHS England should continue to scrutinise local CCG improvement plans over the five-year transformation period; the government should set an expectation that every CCG has a clear and funded plan to improve crisis care; a clear strategy to reduce the number of children being treated in adult wards should be implemented; and the government should set an expectation that every area increases investment in line with their share of the £1.4 billion additional funding announced in 2015.

NHS Providers said the report’s findings paint a worrying picture about support for the mental health services for children in England, and seem to be evidence of a postcode lottery in care. Its director of policy and strategy Saffron Cordery said: “It is disappointing that despite repeated commitments to ensure parity between mental and physical health, the funding needed for mental health services is not getting through to the frontline. This undermines the ability to invest in and meet the benchmark of improvement set by NHS England. Without promised investment it is very difficult to fix the ‘postcode lottery’ of services available to patients in different areas.

“Two thirds of mental health trusts when surveyed by NHS Providers late last year did not believe their CCG would meet parity of esteem commitments. Effective commissioning is critical to the provision of high quality services for all. The promised transparency of CCG investment needs to clearly demonstrate this funding is not lost to competing priorities.”

* Frith E. The performance of the NHS in England in transforming children’s mental health services. Education Policy Institute, March 2017.

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