This piece is joint-authored by the ten chief executives who make up the Cavendish Square Group. It originally appeared in the Guardian Society on the 18 November 2015.
The NHS is facing the greatest financial challenge in its history. Figures for the first three months of the financial year reveal an accumulated deficit of almost £1bn. The independent health think tank, the Nuffield Trust, says deficits have now become the ‘new normal’ in the NHS with four out of five trusts now in the red. The figures for the second quarter of the financial year are feared to be significantly worse.
The position for acute hospital trusts is particularly challenging, as they account for 98% of the total NHS deficit. Despite an excellent record of financial management, deficits are growing in London’s mental health trusts due to increasing demand, an ageing population but the same resources.
In 2014/15, the percentage of health expenditure that London’s health commissioners spent on mental health was 12%. In 2015/16 it fell to 11% - a transfer of funding from mental health to acute trusts. Nationally, mental ill health currently accounts for over 25% of the total disease burden but mental health services receive less than half that amount of NHS funding and the proportion of the budget that goes to mental health is falling.
The Cavendish Square Group was set up in 2015 by the ten NHS Mental Health Trusts in London to speak up for mental healthcare in the capital. It is seriously concerned that health commissioners in London will again raid mental health budgets to address the ever growing deficits in the acute hospital sector.
It cannot be right that we run the NHS on the basis of robbing Peter to pay Paul and it simply cannot go on. We must increase spending on mental health services and we must do it now.
Such an approach is particularly reckless given that the best way to tackle the growing NHS deficit is to deliver more services in the community. This is particularly true for patients who have both mental health and physical health problems. The cost of caring for people with combined mental health and physical health problems is over £13bn a year. Increased investment in community and primary mental health services could dramatically reduce this cost and cut the NHS deficit.
The imminent report by NHS England’s Mental Health Taskforce will set out a new five-year national strategy for mental health. Over 20,000 people with experience in the mental health field including service users, families, carers and clinicians have fed their views into the taskforce. It is essential that the strategy is now properly funded with investment directed into frontline mental health services, if we are to realise the parity of esteem all the main political parties committed themselves to before the election. It is time for the government to deliver on these promises. There must be no back sliding.
The case for protecting and increasing mental health budgets is compelling. We owe it to people living with mental health problems to ensure they get services that are as good as the services delivered to people with physical ill health. And investing properly in mental health services is one of the most effective ways of increasing productivity, cutting costs and reducing the wider NHS deficit.
The ten London mental health trusts have taken big strides to reduce the number of mental health beds and to move services into the community. This is what people want and what they need. So we can help the acute sector to learn from our experiences.
We need greater stability through longer mental health service contracts and budgeting. The annual budgetary cycle precludes consistent, London-wide agreement on longer term quality improvements in favour of extended wrangling over contract values, before the entire process starts up all over again. It is expensive, inefficient and destabilising. Five-year service contracts would encourage more collaborative working between CCGs and providers and lead to long term stability.
We need a healthcare payment system that incentivises primary care, acute care and mental health care providers to get people better quicker and keep people healthier for longer. Funding arrangements in the physical health sector incentivise providers to treat more people rather than to keep them well so they don’t need treatment. By contrast, mental health providers receive block payments and are simply asked to do what they can within their allocated budget.
We also need a single, unified regulatory system that ends the conflict between the Care Quality Commission’s edict that trusts need to employ more staff and Monitor’s insistence that trusts need to spend less money on staffing. We can’t do both.
With concerted action England could have mental health services that prevent physical ill-health and keep people at home, but we need to move rapidly. Time is running out.