Independent think tank, the King’s Fund, published its latest report - ‘Mental health under pressure’ - as the news that 40% of mental health trusts will face budget cuts begins to sink in.
The report concedes that it’s difficult to provide a definitive assessment of the state of mental health services but sheds important light on the pressures and challenges facing mental health care on a daily basis. This is something that we, as providers of mental health care to millions of people across London and beyond, welcome.
The last two decades have seen major advancements in mental health services and treatments. Collaborative work between providers, services users, carers and colleagues from the third sector has led to innovative services which save both money and lives.
But progress is slow. The issue now, as then, is ensuring that there is adequate financial support to fund these major advances in treatment and care. We know from experience that mental health services – during times of financial strain – are cut harder and faster than other NHS services and that we take longer to recover.
Greater investment in mental health makes economic sense. The average 500-bed general hospital could wipe up to £25million per year off its costs base for treating acute physical health conditions if it invested in treating those mental health issues which so often accompany conditions such as diabetes and heart disease. Early interventions for children and young people saves £8 for every £1 invested in supporting the parents or carers of children with behavioural disorders.
Our record of financial management is good. In London, our trusts have dug deep to deliver more care when budgets are flat (or, worse, reduced) and have so far, managed to largely avoid falling into deficit. Government commitments on extra funds for targeted mental health services are, of course, very welcome. However, when set against a backdrop of disinvestment in mental health over previous years, it’s unlikely to plug the gap left by increasing demand for core services.
Commissioning partners are feeling the strain. While some London commissioners have passed on the full allocation of mental health spend to trusts, others have had to apportion part of that spend to other areas and others have said the money needs to be siphoned off altogether to reduce bigger pressures elsewhere, typically at acute hospitals and in A&E departments.
For those of us on the front line of mental health, this is wholly unacceptable. It is a sign of a civilised society that when people become mentally unwell, there is equal treatment and equal funding for the right mental health services and care as if they were experiencing a physical issue. The NHS must not be run on the basis of robbing Peter to pay Paul.
Longer rounds of contract setting for mental health – of five years or more – would offer providers and commissioners alike the scope to properly map and plan innovative co-commissioned services which will meet the long term needs of our health economies. Offering opportunities for transformations to take root and deliver positive impacts on both people’s health and the NHS’ bottom line. This will avoid the sort of knee-jerk commissioning or expensive service change the King’s Fund fears in its report.
But the pounds only make up part of the picture: as the King’s Fund report rightly points out – there must be a measure to ensure the need for financial savings does not overtake the need for evidence-based treatments and robust health infrastructure with patient safety at its core.
We are working across London to build a network of comprehensive care delivered by our 10 member trusts, third sector colleagues and of course, local authority-led community and social care services to reduce the unacceptable levels of variations in care.
While recognising that the best services are those commissioned locally, in close partnership between providers, CCGs, service users and staff, we are calling for a set of national standards and principles that no service is able to deviate from. Whether that’s access to a bed in a crisis, waiting time targets or access to early invention services – mental health providers must adhere to a set of non-negotiable commitments to our patients.
Each member of the Cavendish Square Group believes that our services have the ability to change lives and save lives. Every instance of poor patient experience motivates us to do better. We’re wholly committed to driving forward the mental health agenda in London – we demand parity, where to date it has only been promised. We welcome and echo the King’s Fund’s call for stable funding to allow us to achieve that.