NHS England’s new plan to improve mental health services admits to current failings and sets out how to they should be rectified. But will it make the step change in mental health services that everyone wants? Editor Dan Parton offers his thoughts on the Five Year Forward View.
When Prime Minister David Cameron spoke about how “we haven't as a country focused enough on mental health” at the launch of the NHS England Five Year Forward View for Mental Health recently, you could almost hear the service users and professionals who work with them shout back collectively “We know!”
It is a cliché that mental health is the Cinderella of health services, but that is for good reason: it still lags way behind the provision – and funding – given to physical health services. But the new Five Year Forward View for Mental Health strategy from NHS England aims to change that, outlining wide-ranging reforms to NHS mental health services over the next 5 years.
Refreshingly, the Forward View admits that the previous strategy, 2011’s ‘No health without mental health’ failed in its remit, saying that outcomes have worsened in recent years.
So, what will make this new strategy any different? The initial signs are promising. Firstly, it recognises that this is the beginning of a 10-year journey to transform services – there are no illusions that there are any quick fixes – which gives a welcome dose of realism that has perhaps been absent in previous strategies.
The strategy aims to provide a 7-day NHS service – now, where have we heard that recently? Sarcasm aside, the specific aims related to this are generally much needed, such as additional investment in Crisis Resolution and Home Treatment Teams and the development of a similar care model for children, eliminating out-of-area placements for acute care as quickly as possible, and ensuring all hospitals have all-age mental health liaison services in emergency departments and inpatient wards.
Elsewhere, there are pledges to ensure that 30,000 more women access perinatal mental health services, 280,000 people with severe mental health problems will have their physical health needs met and 600,000 more adults with anxiety and depression will have access evidence-based psychological therapies.
All these objectives – and the many others listed in the full document – are much-needed and, if they are realised, will make great improvements to mental health services in England and improve outcomes for hundreds of thousands of people experiencing mental ill health.
Crucially, the strategy is backed up with funding, to the tune of £1 billion over the next five years. This is said to be in addition to the £1 billion announced last year that will be spent on improving perinatal mental services and services for people with eating disorders, among others.
The new investment is desperately needed. The BBC reported on February 14 – the day before the report came out – that funding for NHS mental health care in England fell by 2% from 2013/14 to 2014/15.
The figures, garnered through a Freedom of Information request, also showed that of the 53 out of 59 mental health trusts in England that responded, 29 said their budget had been cut this year.
Overall, the budget for mental health trusts in the year to April 2016 was projected to increase by just 0.3% – compared to a 2.6% rise in hospital trusts’ operating budgets.
The extra £1 billion will be found from existing NHS budgets – although quite where is unclear, given that the NHS as a whole has a funding gap running into billions. As ever with these sorts of documents, the devil is in the detail – or lack of it – and where, how and when the money appears will be interesting to see. I have a concern there may be an element of ‘robbing Peter to pay Paul’ in this – will other services have funding cuts to accommodate increases for mental health?
There is also the question of whether the funds promised are enough to realise the ambitious plans laid out. Instinct says they aren’t, but I doubt there will be any more money forthcoming, so the point is a little moot – the NHS will have to work with what it has got.
I do have other concerns. For instance, this is an NHS-focused strategy, and while there is plenty in it that will impact on, and be delivered by, social work and social care services, it isn’t as complete a strategy as perhaps people would like.
Another interesting point is that the Five Year View seems to completely ignore ‘Old Problems, New Solutions’, the report by the Commission on Acute Adult Psychiatric Care, chaired by Lord Nigel Crisp, which was published less than a week before.
Why these reports seem to have been operating separately is unclear – and where the Crisp Commission report sits in the wider plans for mental health care is similarly unclarified. But surely some bodies will have had representation on both exercises? It also leaves questions about the implementation of Crisp’s recommendations going forward and how – or if – they will work with the reform of NHS services.
But perhaps the biggest concern is that we have been here before with such strategies: the aforementioned ‘No health without mental health’, for instance, but there are others, depending on how long your memory is.
They are generally launched with much hoopla and promises for how things will be different and that [insert name of strategy] will make a sea-change in the way services are provided etc etc. Then, 4-5 years down the line, the same problems are still there, more or less, and a new strategy from government comes along that they claim will make a sea-change in the way services are provided… you get the idea.
Will this one be any different? Only time will tell. While the soundbites from the Prime Minister were high on rhetoric, the document behind it has put forward some necessarily ambitious and specific goals, which, as mentioned, will make a substantial, positive difference to the lives of service users – if they are realised. Whether the strategy will bring about the goal of parity of esteem with physical health is unlikely, but the gap will be a lot smaller.
We now await the implementation programme, which should reveal much of how the reforms will be delivered – and give a good indication of whether it is realistic to assume the goals will be met. Hopefully, that will be released very soon and commissioners, providers and frontline workers can get on with the business of making it happen. We have waited long enough.