Mental Health Matters: The patients left bottom of the pile

Pursuing easy wins

A senior coroner has called out the NHS commissioning system - claiming it is “biased” against “chronic incurable conditions” and in particular autism spectrum disorder.

The warning comes in response to the death of 15-year-old, Max Kohler, who was diagnosed with ASD and attention deficit syndrome.

According to a preventing future deaths report from a coroner in north London, sent to health and social care secretary Matt Hancock and NHS England medical director Stephen Powis, Max “took his own life whilst suffering from [ASD]”.

Multiple accusations are levelled by the coroner, including: “There is a relative paucity of [NHS] services for conditions which are chronic and difficult to treat and cure, compared to illnesses which respond to short term therapies, and so show easily auditable improvements in health.”

This paucity, the coroner claimed, reflects the tendency for clinical commissioning groups to prioritise services for “relatively easily treatable conditions” over the “expensive and resource rich treatment” for patients with ASD – resulting in ASD services being left “bottom of the pile.”

The report says services are even worse for adults with ASD, which rings true with what some in the sector have told HSJ. There is currently no requirement for CCGs to commission adult ASD assessment services, meaning patients in some areas may be left to languish once they hit 18.

Other concerns from the coroner included; a lack of support and education available for parents and carers; and a “severe” shortage of inpatient psychiatric beds for children and adolescents in the NHS.

The failures highlighted by the coroner come just as NHS England has told CCGs it intends to extend the national transforming care programme beyond March this year.

While most will welcome this, the step has been taken without any real evaluation published into how effective the programme has been so far.

Thanks to some recent CCG board papers we now know that nationally the NHS has only managed to close 18 per cent of inpatient LD and autism beds – against a target of between 35 and 50 per cent by March 2019.

However, no official information on the performance and existence of community or crisis services for this patient cohort has been made public by NHS England. The national commissioner also continues to decline HSJ requests for it to publish its TCP ratings, which show progress in each area.

While we cannot confirm the failure of the programme without a proper evaluation, the coroner that looked at Max’s case clearly feels commissioners’ focus on learning disability and autism services has been superseded by services which produce easier wins.

Capital gains

Last week HSJ revealed a third of mental health trusts did not submit bids for capital funding in any of the four sustainability and transformation partnership allocation waves.

Beyond this bizarre finding, mental health didn’t fare too badly, getting around 13 per cent of the total amount awarded to all trusts – roughly matching the sector’s percentage of the NHS budget.

Click here to see a run-down of almost all the bids accepted and rejected for the mental health sector, alongside their STP’s most recent planned spend - according to the quarter two mental health dashboard.