Shocking new findings from NHS Providers’ latest survey of frontline mental health trust leaders include the fact that fewer than 10% of trusts reported that they currently have the right staff in the right place to deliver services.

A massive 95% of people responding to the survey, which was conducted last November,  do not believe overall investment will meet current and future demand.  The most recent increases only raise the share of NHS funding spent on mental health by 0.5%; this rise is not adequate to close the care deficit: and too little of the new money that is available is reaching the front line of service delivery.

“This raises questions about how much of the NHS long term plan can be delivered and how fast.”

More than two thirds of mental health leaders said they are worried about maintaining the quality of services over the next two years.

 

Community CAMHS services failing

An overwhelming majority (81%) of trust leaders said they are not able to meet current demand for community CAMHS and more than half (58%) said the same for adult community mental health services; more than half (56%) could not meet demand for crisis resolution teams.

In relation to overall community provision, 85% either disagreed or strongly disagreed with the statement that there are adequate mental health community services to meet local needs.

37% of trust leaders said they had to change or close services such as alcohol and substance misuse services, homelessness services and some inpatient services as a result of financial pressures, while more than half (55%) said they had changed or closed similar services or withdrawn mental health primary care provision due to commissioning issues.

A small number of trusts across the country felt that the amount of time people are waiting to access services such as psychiatric liaison, community CAMHS and inpatient CAMHS is decreasing. However, far more trusts Told NHS Providers that waiting times were increasing:

*58% reported an increase in waiting times for community CAMHS and community adult mental health services

*44% had seen an increase in waiting times for crisis resolution home treatment.

* And 41% increased waits to access inpatient adult mental health services

There have been large numbers of ‘out of area placements’ (OAPs) for lack of local capacity, with 70% reporting OAPs in acute inpatient treatment, 63% in CAMHS tier 4 patients and 58% for rehabilitation patients.

There is significant unmet need for a number of mental health conditions – particularly community services for adults and children, gender identity services and crisis home treatment teams.

Despite all of the government and NHS England rhetoric in the NHS Long Term Plan, and the Five year forward view for mental health before it on “parity of esteem” and improving resources, and a decade of campaigning to dismantle the stigma of mental ill health and achieve equity between the treatment of mental and physical health, NHS commissioning decisions are still resulting  in services being cut or reduced.

Nearly two thirds of trust leaders are ‘very concerned’ about the numbers and skills of staff in two years time. And an indication of the impact of austerity cuts on NHS services is the fact that too much current staff capacity is being diverted to support service users with a greater number of non-clinical issues “such as negotiating the benefits system”.

“Demand for services is outstripping supply and socio-economic factors are contributing to this. 92% of trusts tell us that changes to universal credit and benefits are increasing demand for services, as are loneliness, homelessness and wider deprivation.

“Cuts to services funded by local authorities also mean that preventative approaches and early intervention services are less available. Mental health leaders pointed to rising demand during winter but it is clear that these pressures on services are a year-round phenomenon.”

NHS Providers argues that to redress these issues:

“national policy must focus on increased support for both mental health and public health. There also needs to be greater realism about the levels of demand and what is needed to meet them, as well as better planning with inputs from trusts, commissioners and the national bodies.”

Not surprisingly, action on workforce is identified as “a top priority”, with calls for a national plan, with appropriate focus on the mental health workforce, coupled with “adequate funding from the comprehensive spending review that meets the plan’s education and training budgetary requirements.”

Of the external factors driving increased dependence on mental health services,

* 92% said changes to benefits/universal credit – with 63% saying the impact was high, making it the most significant factor

* 98% said financial hardship

* 97% said housing

* 97% said loneliness and isolation

* 91% said cuts to local services.

The fragmented health care system entrenched by the 2012 Health and Social Care Act is clearly seen by many mental health leaders as an obstacle to progress.  When asked what changes would most alleviate the pressures on services, trust leaders said called for ending block contracts, but also:

* “delegating commissioning to providers” and

* “reducing tendering activity”

Other suggested changes were “investing in core services beds and community mental health teams, assertive outreach, crisis care, CAMHS”; “incentives to increase the workforce” and “capital for investment in estates”.

Just over a third (36%) of trust leaders said they were satisfied or very satisfied with how mental health had been prioritised within their STP/ICS/ local system and 32% said they were neither satisfied nor dissatisfied.

Recent NHS statistics on mental health performance further illustrate the demand challenge for mental health trusts. In November 2018 (NHS England, 2019d):

* The number of people in contact with NHS funded secondary mental health, learning disabilities and autism services increased by 4.1% to 1,310,985 (51,496 more people) compared to the average number of people contacting per month in the past year.

* Of these individuals, 78% were in contact with adult mental health services, 17% were in contact with children and young people’s mental health services and 8% were in contact with learning disability and autism mental health services.

* The number of new NHS funded secondary mental health, learning disabilities and autism services referrals increased by 12.4% to 320,349 (35,343 more people) compared to the average number of new referrals per month between in the past year.

 

John Lister
Author

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