The new NHS Providers’ Report on the State of the NHS Provider Sector has found that core mental health services are deteriorating, despite the commitment from Government and NHS system leaders to address long-standing inequalities in care for people with mental health conditions. The report states that rapidly rising demand is overwhelming core mental health services; extra funding is not reaching the NHS trust frontline; trusts are facing major workforce shortages; and mental health does not feature strongly enough in Sustainability and Transformation Partnership (STP) Plans.
Seven key areas of concern have emerged from their analysis:
- Rising demand outstripping capacity – There are two underlying reasons for these increases: increasing public focus on mental health uncovering unmet demand, and broader societal pressures, such as rising unemployment, leading to a greater need for services. Demand for mental health services is rising at a rate that matches and in many cases exceeds the available capacity. This is the case for services for adults, as well as children and young people. Bed occupancy rates for inpatient units are now regularly exceeding 100% in many trusts.
- Funding not getting through to the frontline – The level of financial investment in core mental health services – against a backdrop of rising demand and costs – is failing to keep up with rapidly rising demand. The survey indicates that the extra money intended for mental health at a national level is still not getting through to NHS mental health trusts operating frontline services. Eight in 10 respondents from mental health trusts are ‘worried’ or ‘very worried’ about whether the national commitment to increase investment in mental health and transparency on CCG spending will result in adequate investment in their trust to meet the ambitions set out in the NHS Mandate for 2017/18.
- Persistent gaps in the mental health workforce – The survey shows that mental health trusts are struggling to find enough staff with the right skills to deliver existing services to the right quality, let alone being able to find new staff to extend services to new users or create new services. Across all staff roles in all specialties, less than a third of chairs and chief executives were ‘very confident’ or ‘confident’ that national workforce planning will deliver appropriate numbers of staff. Respondents generally had higher levels of confidence for recruiting psychologists and therapists and other allied health professionals than for nurses and psychiatrists.
- Deteriorating access to and quality of some mental health services – The speed at which service users are able to access treatments, and the quality of their experience once using them, is being hampered by rapidly rising levels of demand and the capacity of mental health trusts to meet this demand. Resourcing pressures are resulting in higher thresholds for referrals into mental health services from GPs, and there is also a direct correlation between timely treatment and outcomes, particularly for conditions such as psychosis or those related to drug and alcohol misuse.
- Insufficient support for liaison between mental health and other NHS services – One of the key issues in mental health care is the need for effective liaison between mental health and other NHS services, particularly acute care. Liaison psychiatry features heavily in the Five year forward view for mental health, which states that “by 2020/21 no acute hospital should be without all-age mental health liaison services in emergency departments and inpatient wards, and at least 50% of acute hospitals should be meeting the ‘core 24’ service standard as a minimum”.
- Lack of priority for mental health in sustainability and transformation partnerships – The NHS is changing and moving to new ways of providing care. It is using sustainability and transformation partnerships (STPs) – a key part of the new NHS landscape – to plan for this transformation. If mental health services are to flourish and we are to realise the new ambition, then it is vital that mental health is at the centre of the STP process.
- Fractured commissioning leading to uncoordinated care for service users – The challenges facing mental health services are being compounded by the fractured nature of commissioning arrangements in mental health, with the 2012 Health and Social Care Act resulting in a split between NHS England (for specialist commissioning), local CCGs and councils which in turn leads to uncoordinated care. This means patients are often treated in expensive, inappropriate care settings, or it means that patients are unable to access a service at all. In particular, a number of those wider services supporting mental health service users, such as substance misuse or public health more generally, are now commissioned by local authorities which has introduced delays and inefficiencies into the coordination of care. It has also meant lower levels of investment as local authority funding pressures have increased.
The report suggests that Providers need:
- Realism about demand and what’s needed to meet it,recognisingthat increased focus on mental health and current societal pressures will generate more demand
- Better ways to guarantee that mental health funding reaches the NHS mental health trust frontline
- A robust workforce strategy and,critically, support at local level to make it happen. We need to ensure that we match the ambition to expand services with a realistic view of how quickly we can grow the workforce to deliver this
- STPs to give enhanced mental health service delivery greater priority in their plans, processes and thinking
- Commissioning to be overhauled to support the delivery of more coherent care and to maintain the level of nancial investment in both core and new priority mental health services.