No end in sight to mental health postcode lottery

It’s no surprise to find that spending on mental health services by clinical commissioning groups (CCGs) varies markedly and service users face a postcode lottery. Neither is the fact that there is no end in sight to that sorry situation.

The results of Luciana Berger, Labour’s shadow public health minister’s, Freedom of Information (FoI) requests to England’s 211 GP-led local NHS CCGs, published last week, have been met with dismay, but little surprise.

Of the 142 (67%) CCGs that responded to Berger’s FoI, 72 reported that they spent less than 10% of their budget on mental health services, despite research showing that it accounts for 23% of the burden of disease.

Time for a bit of ‘naming and shaming’: Surrey Health CCG spent the least on mental health; only £7 million – 6.55% – of its £107 million budget. Solihull and Northern, Eastern and Western Devon CCGs only spent fractionally more of their budgets on mental health. Others performed better, and we don’t know what a third are doing because they didn’t respond to the request. 

Nevertheless, the evidence is mounting that a postcode lottery exists. In June, a survey by the Royal College of Psychiatrists’ Psychiatric Trainees' Committee found that 70% of respondents said they had experienced difficulty finding an appropriate bed for a patient on at least one occasion. 

When CCGs were set up to replace primary care trusts two years ago, one of the main fears was the development of a postcode lottery for what can still be seen as ‘niche’ services such as mental health. Critics said that there was a risk that some services could be prioritised over others and that if there wasn’t a doctor with an interest in mental health on the CCG, then those services could be side-lined in favour of other health areas. Two years on, it seems that this fear has, at least in part, been realised.

Inevitably, this is having an adverse impact on patient care. As Professor Sir Simon Wessely, president of the Royal College of Psychiatrists, noted: “in the past two years we have seen a doubling in the number of mental health patients being forced to seek emergency treatment away from their local area - from 1,301 people in 2011-12 to 3,024 in 2013-14, including patients being sent 300 miles from Devon to Yorkshire. This is a direct result of not enough money being made available locally for mental health beds.”

In a debate in the House of Lords last week, Parliamentary Under-Secretary of State, Department of Health, Earl Howe put the blame for not commissioning enough mental health inpatient beds firmly on local clinical commissioners.

But what can be done? Clinical commissioners are under financial pressure: demand for health services is rising, and funding is not keeping pace – while the government may bang on about protected health spending, it doesn’t mean there is enough to cope – and the funding gap is only going to increase. 

Smarter commissioning can go some of the way to addressing the problems created by funding pressures, including an emphasis on preventative services to stop people going on to need inpatient care, as well as taking into account prevalence rates in the local area when commissioning. More money in the central health budget would not go amiss either.

But that is easy to write, and of course the reality is much more complicated. For instance, health funding won’t change before the election next year, and probably not before the next spending review in 2016.

Health is said to be one of the big battlegrounds for the upcoming election debates – and mental health should be at the top of the agenda, with all of the major parties needing to find a solution to this postcode lottery. Being able to access mental health care when you need it should not depend on where you happen to live.