The NHS long term plan, and the previous five year forward view for mental health, have set out ambitious plans and increased investment to improve the quality, volume, and accessibility of mental healthcare in England.
This is welcome and significant progress, and follows a decade of campaigning to dismantle the stigma surrounding mental ill health and bring about equity between the treatment of mental and physical health.
However, a survey of frontline mental health leaders by NHS Providers makes clear that the sector faces significant challenges which are driving a substantial “care deficit” across mental health services.
The demand challenge
Demand for services is outstripping supply. According to recent NHS statistics, over 50,000 more people were in contact with secondary mental health, learning disability and autism services last November, and there were over 35,000 more new referrals. Mental health trusts leaders have told us that they are struggling to meet current demand for community services and that there is a lack of mental health beds in their trust or local area. Many said that maintaining the quality of services over the next two years is a major concern.
While increased awareness has played a role in rising demand, a number of the contributory factors are socioeconomic. Mental health trust leaders are seeing greater social isolation, deprivation, and homelessness increasingly driving demand for mental health services, and changing the nature of the support that trusts need to provide. This trend has only been exacerbated by cuts to wider prevention and early intervention services funded by local authorities that can help prevent people becoming more unwell.
The rise in demand for mental health services is happening at a time when the sector is facing significant capacity and financial pressures. Mental health trusts are contending with an enduring workforce shortage that is undermining the frontline’s ability to staff services efficiently and effectively. The vast majority of mental health trust leaders do not feel that they currently have the right staff in the right place and many are deeply concerned about the numbers and skills of staff in two years time. The long term plan’s ambitions cannot be delivered while workforce pressures remain across services, and while gaps in the mental health workforce continue to grow. A national workforce plan, with appropriate focus on the mental health workforce, needs to be published as soon as possible, and must be coupled with adequate funding for education and training budgets.
The way that trusts are paid to deliver the majority of their services (through inflexible block contracts that do not reflect changes in demand once agreed), and earmarked funding not reaching the frontline services have been two contributing factors to the pressure faced by the sector.
The additional money that the long term plan commits to is hugely welcome given the financial pressures that trusts are facing. However, NHS England has since confirmed that funding for mental health will only rise as a share of the NHS budget by 0.5%. This rise falls far short of the amount needed to close the gap with funding for physical healthcare and raises questions over how much of the long term plan can be delivered—and how fast—as a result. Providers need a detailed implementation plan that sets out exactly what commitments from the plan will be delivered and when, with priorities for each year matched against the funding and staff available.
Mental health trusts need to see tighter monitoring and enforcing of the mechanisms that guarantee mental health funding reaches frontline services, as well as fostering less fragmented and burdensome approaches to commissioning.
Despite the clear challenges facing the sector, system working provides an opportunity to further pursue equity of treatment for people with mental illness. Mental health trusts now have the opportunity to plan with health and care partners across their systems to work out how, together, they respond to the needs of their local populations in the decades to come. It is clear that mental health leaders are receptive to the challenge of working in a more integrated way, and are thinking positively about how changes to commissioning and greater system working will help them be more efficient and strategic.
What trusts need from the long term plan
As we move towards implementation of the NHS long term plan there are a number of priorities and challenges that both mental health providers and the national bodies will need to consider.
First of all, mental health trusts, with the support of the national bodies, will continue to focus on reducing the number of out of area placements and addressing inpatient capacity problems, although national bodies need to recognise the sustained demand for inpatient services. Secondly, providers’ capital investment needs must be met so that urgent improvements can be made to estates.
National bodies also need to continue to promote careers in mental health and retain the current financial incentives to recruit mental health professionals. Last but not least, mental health trusts will be working hard to make further progress on data collection and data quality to give a better understanding of mental health activity, access, and outcomes which can consequently enable better commissioning.
To overcome the demand for services that is currently facing mental health services in the longer term there needs to be greater realism about demand and what is needed to meet it, as well as better demand and capacity planning with input from trusts, commissioners, and the national bodies.
Despite the impressive progress in improving mental health awareness, developing national policy and enhancing the delivery of services, we must be clear sighted about the significant challenges that remain for mental health trusts. It is vital we overcome these challenges if the ambitions for supporting people’s mental health and wellbeing over the next decade are to be realised.
Ella Fuller is a senior policy officer at NHS Providers
Competing interests: None declared