Funding diverted to acute hospitals over mental health providers

While funding to mental health trusts has increased, it is not at the same pace as funding for acute hospitals, warns King’s Fund

Published on 24th January 2018

The spending gap between NHS acute hospitals and NHS mental health providers got wider last year, the King’s Fund has warned.

The spending gap between NHS acute hospitals and NHS mental health providers got wider last year, the King’s Fund has warned.

While 84 per cent of mental health trusts received an increase in funding last year, funding for acute and specialist hospitals has continued to grow even more quickly, says the report.

Helen Gilburt, lead author and Fellow in Health Policy at The King’s Fund, said: “The NHS is in the very difficult position of trying to deliver parity of esteem at the same time as it is under huge pressure to reduce deficits and improve performance in acute hospitals.

“While the great majority of local clinical commissioning groups have met their commitments to raise spending on mental health, the overall spending gap between mental health trusts and acute and specialist trusts has widened because national funding has focused on relieving pressure on acute hospitals,” she added.

The report highlights that income for mental health trusts rose by less than 2.5 per cent in 2016/17 compared to more than 6 per cent for acute and specialist trusts, continuing a trend of a growing spending gap between mental health and acute trusts. Since 2012/13, funding for mental health trusts has increased by just 5.6 per cent compared to an increase of 16.8 per cent for acute hospitals.

This, combined with staff shortages, has placed enormous pressure on the workforce and left mental health trusts struggling to staff services safely. The number of mental health nurses has fallen 13 per cent since 2009, while one in 10 of all posts in specialist mental health services are currently vacant.

Analysis of Care Quality Commission inspection reports for all 54 mental health trusts identified an increased risk to patient safety as a result of problems with staffing in more than half of trusts. This included:

  • An increased risk of suicide
  • An increased risk of self-harm on inpatient wards,
  • Delays in treatment,
  • Reduced access to care
  • Bed closures.

Examples drawn from a review of board papers of a small number of trusts also highlighted difficulties staffing services on a day-to-day basis, a reliance on bank and agency staff and ‘substitution’ of staff, for example health care assistants stepping in for registered nurses.

The report concludes that providing treatment and care in mental health relies on a good workforce which requires two things: for a trained workforce to be available and for employers to have the money to pay them.

NHS mental health trusts are struggling to staff existing services on a day-to-day basis and, while actions to implement routine safe staffing levels are evolving, the lack of available staff, particularly nursing staff, at a national level continues to undermine this. Growth in income for mental health trusts did rise in 2016/17. However, despite the implementation of the Mental Health Investment Standard many trusts continue to see reductions in their income, which places constraints on staffing secondary mental health services.

The priority being given by national leaders to expanding the mental health workforce is not yet being matched by a priority to ensure there is sufficient growth of income among NHS mental health providers to support this, nor to matching the growth in funding available to acute providers, the report warns.

A vicious circle exists between the availability of trained staff and investment to support that workforce. The workforce plan to support the Forward View for Mental Health will further stretch this with 21,000 new posts to be created by 2021, 11,000 of which are ‘traditional’ regulated professions, such as nurses, occupational therapists and doctors; it requires providers to pull every lever to deliver.

While the emphasis remains on allocating funding to support financial sustainability and improve performance in acute hospitals, the gap between growth in funding for NHS mental health providers and that for NHS acute providers will continue. Commissioners, providers and boards alike also need to be honest about where their priorities lie and what impact this will have on care.

At its core, the commitment to parity of esteem is for people with mental health problems to receive the same quality, safety and effectiveness of care that people with physical health problems can expect. Any change that is achieved at the expense of this commitment will ultimately fail to deliver parity, the report concludes.

Helen Gilburt added: “Unless funding grows more quickly, mental health providers may end up implementing improvements to some services at the expense of others. Despite the commitment of national leaders, the funding gap between mental health and acute NHS services is continuing to widen, while growing staff shortages are affecting the quality and safety of care.

“As long as this is the case, the government’s aim to tackle the burning injustices faced by people with mental health problems will remain out of reach,” she concluded.

Karin Orman from the Royal College of Occupational Therapists says: “The RCOT recognises the importance and growing need for mental health services and believes in parity with general physical health. The current focus of our flagship Improving Lives, Saving Money campaign is focused on mental health services to reflect this growing need. Our intelligence gathering is driven by the understanding that resources in the NHS are under continuous and growing pressure and it is our aim to pinpoint and raise awareness of areas of best practice that both improve lives and save money to tackle this pressure.

“In May we will be releasing our latest report outlining how occupational therapy should be redeployed into primary care to offer early intervention, teaching self-management techniques, resilience training and balancing daily and weekly routines with activities (occupations) that support mental wellbeing.  Currently, services are focused on managing crisis (perhaps an underlying reason why the Kings Fund has compared mental health with acute services?) and are predominantly reactive. Not offering support and advice at an early stage inevitably pushes people into crisis. Early intervention is key to being able to address many mental health issues and bring mental health into equal parity of esteem with physical health as laid out in the NHS’ Five Year Forward View,” she concluded.

The King’s Fund’s new report is available here.



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