Mental Health Matters: The C word

For those who missed the meeting of mental health minds at the HSJ summit last week, here are a few of the issues which seemed to interest the good and great.

Capital question

Investment is always a concern within mental health, but during the summit the outlook largely appeared positive – until someone raised the issue of capital funding.

During one particular session, a question around the barriers to accessing capital funding prompted other tales of woe from those working in mental health trusts.

The lack of capital investment is a well-know gripe , but having senior provider leaders admit to being “embarrassed” by their estate brings the issue sharply into focus.

One plea came from a delegate distressed because their trust still operates dormitory wards, which, if the capital was available, should’ve closed a long time ago.

The Care Quality Commission highlighted the existence of these wards as a problem back in 2016-17, but it seems little has been done to address the issue.

Whispers that the elimination of dormitory wards was due to be a feature of the long-term plan evidentially didn’t bear fruit. One may wonder whether this was due to the capital commitments that would be required to meet this ambition.

NHS England has made it pretty clear it will lobby for some capital for mental health in the upcoming spending review, while Sir Simon Wessely’s review of the Mental Health Act has called for a multiyear settlement.

So far, no figures have been thrown out, but the sum will have to be significant to address the years of capital neglect.

Provider purse strings

Should providers be holding the purse strings for mental health services? It was a question which came up a few times over the two days.

One trust chief said the answer was a resounding yes. While it is unlikely this will happen for general mental health services, specialised commissioning is well on its way to becoming provider owned.

So far, £640m of the £1.9bn specialised commissioning budget has been devolved to provider collaboratives. Success in devolving the remaining £1.2bn will depend on maturity of relationships between providers in these collaboratives, so should be treated with caution.

Just one squabble could easily undo the agreements and see devolved commissioning descend into a Game of Thrones like saga.

Areas already holding the budget seem to be faring well, though. One provider, which holds the budget for inpatient CAMHs, has been able to direct more of that budget to prevention services.

Dashboard delving

In other news, NHS England has published its mental health dashboard for quarter one of 2018-19, although much of the data newly included – such as out of area placements - has already been published in one form or another.

It reveals plans for a 0.1 per cent increase in mental health spend this year, giving us a 2018-19 baseline of £12.15bn for the long-term plan promises.

It isn’t yet clear how the £2.3bn funding will be phased in, and while many in the sector might want it all and want it now, what use would a major increase in funding for 2020-21 be without the workforce to spend it on? As recent history has shown it will take some years for the staff to filter through.

As always, it’s useful to take note of the Ts & Cs and readers may find it interesting to look at the footnotes on the new dashboard. These make very clear the £2.3bn increase for mental health does not apply to learning disabilities or dementia.

Talking about the numbers, it looks like 100 per cent of CCGs are on track to meet the mental health investment standard. According to the footnotes, CCGs planned mental health increase for 2018-19 was 3.8 per cent compared to a 3 per cent increase in overall allocations.

With another three quarters of spending data yet to be published, we will wait to see if the plans become a reality.