One of London’s largest mental health trusts, East London Foundation Trust, is attempting to cut spending by £29m – and putting the quality of services at risk, with the potential loss of up to 365 jobs, including adult and child and adolescent services, according to the largest union in the Trust, Unite.
The cutback comes as a result of NHS England pressure on North East London Integrated Care System to deliver no more than a £35m deficit for 2024/25. NELICS ended last financial year £48m in the red, and is already £59m in deficit by month 3 – £32m worse than the planned position – and compelled by NHS England to bring in management consultants to help drive through the necessary cuts to get back on track.
North East London faces the toughest savings target of £289m: but ICB Board papers show all five London ICSs face similar targets for savings in 2024/25, totalling £1.23 billion, with North Central London the lowest target at £206m.
Pressures
ELFT is one of the hardest hit mental health trusts in London, up against a series of pressures which are largely outside the Trust’s control:
- High bank and agency usage arising from vacancies
- Staffing cost pressures linked to the increase in the number of patients with complex needs requiring enhanced levels of observation and 1-to-1 staffing.
- High agency usage in primary care services
- Slippage on Financial Viability delivery (savings measures)
- Expenditure pressures across Home Treatment Teams
- And largest of all a massively higher than planned usage of private sector beds, costing more than ten times the estimate of £400,000 as at month 3. The trust had already spent 74% of its annual income to cover costs of private beds, with nine months still to go.
However ELFT’s situation is not unique. All of the other nine mental health trusts covering the capital and some surrounding areas are up against similar problems, and probably many if not most mental health trusts around the country will be telling a similar tale.
Darzi report
The desperate level of under-resourcing of mental health services is a major theme running through Lord Darzi’s recent report commissioned by the Labour government. Darzi stops short of making any proposals on what should be done, but the report consistently exposes the gaps that have been opened up by 14 years of austerity funding of the NHS since Tory-led governments took over in 2010:
“But it is our mental health that appears to have deteriorated most significantly in the past decade. The prevalence of depression has shot up from 5.8 per cent in 2012 to 13.2 per cent a decade later in 2022. But the rise in need for mental health services is not evenly distributed in the population. For adults, mental health referrals have been increasing at a rate of 3.3 per cent a year. But for children and young people, the rate of referrals has increased by 11.7 per cent a year from around 40,000 a month in 2016 to almost 120,000 a month in 2024.” (p23)
“In 2016, around 2.6 million people were in contact with mental health services; by 2024, this had increased to 3.6 million people.” (p32)
“Some 343,000 referrals for children and young people under the age of 18 are waiting for mental health services, including around 109,000 referrals waiting for more than a year (equivalent to the population of Maidstone). For any person, a year wait is far too long. But for young people who are going through profound life changes, this is particularly concerning.” (p33)
Darzi is also clear on the broken promises to fix mental health. He notes:
“In 2011, the Coalition Government published its mental health strategy, ‘No health without mental health’, in which it stated “we are clear that we expect parity of esteem between mental and physical health services”. Yet in the year of publication, the number of mental health nurses fell and would continue to fall for each of the following five years.” (p80)
And Darzi notes the way this awkward fact has been largely overlooked:
“The 2023 National Audit Office report Progress in improving mental health services in England omits this vital context by only examining what had happened from 2016-17 to 2022-23.”
Now as the financial pressure is cranked up on ICBs and trusts, mental health is once again being pushed back down, and as Unite is arguing in ELFT, managers who have spent years building services up are being forced to help cut them back down again, and watch more demoralised staff leave the NHS while demand for services keeps on rising.
No consultation
Unite is angry that ELFT managers are evading any consultation with staff, with the public or with local politicians by announcing the cuts in a succession of relatively small packages which alone would not interest the news media or politicians: but already the schemes on the table would cut 61 jobs, with far more still to come. These plans together amount to a significant change in the access to and quality of services, and should have been put to consultation.
The apparently random, piecemeal way these announcements have been made calls into question whether there is any overall plan in place, kept under wraps, or whether the Trust directors themselves lack any overview of the cutbacks and their potential knock-on impact.
This is worsened by the way ELFT has imposed an inappropriate across the board 4 percent-plus cut in all departments, which has an especially damaging impact in the services for some of the most vulnerable service users.
Unite is seeking to ignite a fightback in defence of mental health against these cuts, in line with Unite leader Sharon Graham’s recent TUC speech arguing that the Labour government can and should choose an alternative path rather than continue with the failed policy of austerity.
The Lowdown will follow this fight, but we invite health workers or campaigners who are aware of cuts planned in mental health services elsewhere to get in touch with details to we can assemble a fuller assessment.
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