The government’s commitment to parity of esteem for mental and physical health services is being undermined by a failure to ensure funding increases reach the frontline, according to a survey.
In fact, only half of providers report receiving funding increases in the past year, the survey by the NHS Providers and the Healthcare Financial Management Association (HFMA) revealed.
The HFMA surveyed finance directors in mental health trusts and chief finance officers in clinical commissioning groups (CCGs) to understand how the parity of esteem commitment is being implemented locally. More than half (55%) of England’s mental health trusts responded, along with 10% of CCGs.
The report, Funding mental health at local level: unpicking the variation, revealed that only 52% of providers reported that they had received a real terms increase in funding of their services in 2015/16.
Many providers don’t expect this situation to change this year: only 25% of providers said they were confident that their commissioners were going to increase the value of their contracts for 2016/17.
In addition, there is a lack of alignment between commissioners and providers over what it means to implement parity of esteem – there is confusion over what services should be covered, and how much investment should be made.
Also, more than 90% of providers and 60% of commissioners were not confident that the £1 billion additional investment recommended by the Mental Health Taskforce and supported by NHS England will be sufficient to meet the challenges faced by mental health services.
NHS Providers and HFMA argue in the report that the policy and funding framework in place for mental health does not support providers and commissioners to invest in mental health services and to make required service improvements and transformation. This is compounded by a lack of clear guidance on what constitutes mental health services.
Saffron Cordery, director of policy and strategy at NHS Providers, said: “Much has been said at the national level to improve the disparity between mental and physical health, but this report highlights that the necessary investment is not reaching frontline NHS trusts. These are the very organisations that are facing increasing levels of demand and pressure on their resources, whilst needing to provide the most essential urgent and long term care, treatment and support to service users.
“A majority of providers are not confident that the investment announced to support the Mental Health Taskforce will be enough to address the challenges they are facing. There is now an urgent need to develop a costed implementation plan by August 2016 to ensure that we are fully investing and supporting NHS providers to make the service improvements they need and want to undertake for the benefit of patients and service users.”
Paul Briddock, director of policy at the HFMA, added: “To improve the disparity between mental and physical health provision, providers and commissioners need to work collaboratively and towards the same goal. Today’s report shows that we are not quite where we would like to be and there are still challenges ahead in order to get this right. It is important that commissioners are open and transparent about where the extra funding is being distributed, what it is being spent on and the impact it is intended to have. We feel this approach will give concerned providers the reassurance they need that the right financial investment will reach the front line, and the patients it needs to at a local level.”
The report calls for greater clarity and transparency from the government and leaders of the arms-length bodies in several key areas, including how much is being spent on mental health services; how much is being made available for mental health services, and in which areas and explicit alignment about what it means to meet parity of esteem commitments.
It also calls for better enforcement and support for local organisations to help counter the significant local variation highlighted in the survey about how the rules are being interpreted and responded to. Where organisations are struggling to invest in line with the guidance, support should be required to ensure that challenges are addressed.
Rebecca Cotton, director of mental health policy at the Mental Health Network, echoed the report’s call: “We urgently need resources for mental health services to reach the people who need it most. We must have greater transparency, both to explain delays in funding and to ensure vital money isn’t being diverted into other priority areas. The government have committed to achieving parity of esteem for mental health services and we now need the rhetoric to be realised.
“This report shows an urgent need for better data on how and where mental health funding is being allocated for the benefit of people with mental health problems.”