Lord Simon Stevens, the previous chief executive of NHS England, has tabled amendments to the health and care bill currently making its way through Parliament, which would force the government to be clear on the level of funding it is providing for mental health services.
The amendments would require NHS England’s annual report to disclose whether “in that year NHS revenue expenditure on mental health services increased as a proportion of total NHS revenue expenditure” and that each NHS integrated care board (part of each ICS), “state whether, and to what extent, in that year the integrated care board’s revenue expenditure on mental health services increased as a proportion of its total revenue expenditure.”
A third amendment under which the government “must ensure that revenue expenditure on mental health services increases as a proportion of total NHS revenue expenditure” has been withdrawn.
These amendments were welcomed by the mental health charity MIND, with Paul Farmer, Chief Executive, noting:
“If the UK Government is serious about ‘levelling up’ and treating mental and physical health equally, they must accept this amendment, which would make sure they were accountable for increasing mental health spending in line with need.”
However, although the amendments are welcome, mental health services are struggling right now. Services that had been subject to years of underfunding prior to the pandemic and that struggled to provide sufficient services are now faced with a massive rise in need due to the pandemic.
Back in November 2021 Claire Murdoch, Senior Responsible Officer for Mental Health, reported to the board of NHS England and NHS Improvement that between 180,000 and 200,000 calls per month were being received by covid-19 response crisis lines in the first quarter of 2021-22 more than 6,000 each day, plus there had been a 74% increase in referrals to crisis services ‘post-pandemic’. The report to the board also highlighted that services were seeing only 40% of children and just under 50% of adults with mental health problems.
If the government is serious about addressing the need for mental health services, including the increase in need due to the pandemic, an expansion of services and an increase in funding is needed, according to Farmer:
“The pandemic has taken its toll on the mental health of a nation, and as a result our mental health services are under even more pressure. There are currently 1.5 million people on a waiting list for treatment and a further eight million who would benefit from treatment can’t get on the list. While physical health services are stretched too, mental health services have been disproportionately affected and were lagging behind even before the pandemic.”
Organisations are trying to budget for services over 2022-23 at the moment, but without extra funding promises then services will begin to be cut. Planning guidance released on Christmas Eve for the coming financial year failed to provide any extra funding for mental health services on top of that already planned for this period.
The NHSE said it would “[maintain] continued growth in mental health investment to transform and expand community health services and improve access”, and that “delivery of the Mental Health Investment Standard (MHIS) remains a mandatory minimum requirement”.
The additional funding for the NHS announced back in September is unlikely to benefit mental health services, with most of it earmarked for clearing the backlog of elective surgery. There was no matched funding for mental health services. To tackle winter pressures mental health services have been allocated seasonal funding of around £50m to tackle bed occupancy rates and boost emergency care.
At the time of the funding announcement, NHS Providers, which represents the NHS trusts, warned that without an adequate increase in funding any progress that has been made in improving mental health services over the past few months to help those who actually reached the waiting lists will be lost and there would be no prospect of reaching the 8 million who had failed to even reach the waiting lists.
No extra funding could mean that despite claims from the Health Secretary Sajid Javid that he wants to maintain the “parity of esteem” funding policy of recent years, the overall share spent on mental health could go down in 2022-23. If Lord Stevens amendments are included in the bill, then this reduction would have to be made clear in NHS England and ICS reports.
Services for eating disorders is a good example of what mental health services are having to deal with. Recent data from NHS Digital earlier this month for England showed a sharp rise in admissions for eating disorders, up 41% in a year. The provisional data for April to October 2021 shows there were 4,238 hospital admissions for children aged 17 and under, up 41% from 3,005 in the same period the year before. The 2021 figure is also a 69% rise on the pre-pandemic year of 2019.
Dr Agnes Ayton, the chair of the eating disorders faculty at the Royal College of Psychiatrists, said: “The hidden epidemic of eating disorders has surged during the pandemic, with many community services now overstretched and unable to treat the sheer number of people needing help. We are at the point where we cannot afford to let this go on any longer.”
Dr Ayton noted that it was a matter of urgency that money reaches the frontline services and that a workforce plan tackles the shortages of staff in eating disorder services.
The lack of staff in mental health services was highlighted by the December publication of the Royal College of Psychiatrists’ official 2021 census which reveals consultant vacancies are up by more than a third (35%) since 2017 with nearly one in 10 posts going unfilled.
The Dean of the college Professor Subodh Dave told the HSJ that the current situation impacts “very adversely” on achieving NHS long-term plan goals for mental health services adding that one in four (24%) of the country’s 7,782 consultant posts are not substantive (permanent) and are currently dominated by locums, typically on shorter-term contracts. The census covered findings from 84 NHS organisations and eight independent providers.
The college has called for an amendment of the Health and Care Bill to include a duty for the secretary of state to report independently verified workforce numbers every two years and it also asks for the reporting of projected supply for the following five, 10 and 20 years, and future workforce numbers based on the projected health and care needs of the population.
An amendment has been proposed by Conservative peer, Baroness Cumberlege, supported by Lord Stevens, Liberal Democrat and Labour peers, which would require the Government to publish independently verified assessments every two years of current and future workforce numbers required to deliver care to the population in England, taking account of the economic projections made by the Office for Budget Responsibility, projected demographic changes, the prevalence of different health conditions and the likely impact of technology. This has yet to be voted on.
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