The Department of Health and NHS England are starting to make progress with the actions needed to implement access and waiting time standards for people with mental health conditions, but much remains to be done, according to a report by spending watchdog the National Audit Office (NAO).
But the NAO added that the full cost of implementing the new access and waiting time standards and meeting longer-term ambitions for better services is not well understood and meeting them will be a very significant challenge. For instance, the Department estimated that achieving the commitments made in the first three areas – Improving Access to Psychological Therapies (IAPT), early intervention in psychosis and liaison psychiatry services – could be £160 million a year more than the estimated £663 million that clinical commissioning groups (CCGs) spent on these services in 2014-15. Subsequent indicative analysis suggests that the cost of improving access further could be substantially higher, although there is considerable uncertainty around these estimates.
The Department and NHS England have committed to improve mental health services. In October 2014, the Department and NHS England set a first set of standards for the access to mental health services that people should expect and how long they should have to wait for treatment.
To this end, the Department and NHS England have made available £120 million of additional funding over 2014-15 and 2015-16. However, most of the cost of implementing the new access and waiting time standards will be met from CCGs’ existing budgets, at a time when the NHS is under increasing financial pressure.
But the NAO’s report found that full information does not exist to measure how far the NHS is from meeting the access and waiting time standards. Nationally, the access and waiting times for IAPT are being met but performance varies substantially across different areas. A survey of acute hospitals in July 2015 indicated that 7% had the level of service NHS England considers will be beneficial to patients – at least a core liaison psychiatry service operating 24 hours a day, seven days a week. Complete information is not yet available to measure performance for early intervention in psychosis.
The Department and NHS England are making progress, particularly in setting priorities and national leadership, but significant risks to implementing the access and waiting times programme remain. The strongest areas are the clear objectives and strong leadership, and a governance framework is being developed. The greatest challenges for the future are collecting data to show whether the standards are being met, building the mental health workforce and reinforcing incentives for providers.
“The Department of Health has recognised that mental health has been treated as a poor relation relative to other health needs for many years,” said Amyas Morse, head of the NAO. “This recognition, the goal of ‘parity of esteem’ and the setting of new standards for access and waiting times are all bold and impressive steps forward. It is important that these steps are supported by implementation in a reasonable timescale if they are not to be a cause for disillusionment, and this looks challenging in current conditions.”
Focus on making a difference
Stephen Dalton, chief executive of the Mental Health Network, welcomed the NAO’s report. “We must urgently move on from describing the problem to actually making a difference,” he said. “Behind the headlines lie widespread problems in access to mental health services, affecting some of the most vulnerable people in our society including children.
“It's time national leaders stopped making promises that things will improve and focused on getting resources to the frontline. The government rightly talks about the need for the NHS to be the most transparent healthcare system in the world. It is a scandal that there is no accountable and transparent system for understanding where the government’s promised funding for mental health services has gone.”
Max Davie, mental health lead for the Royal College of Paediatrics and Child Health, added: “With 1 in 10 children and young people currently experiencing a mental health problem, it is absolutely vital that we make significant improvement to our mental health provision, so it is pleasing to see that some progress is being made in better setting our mental health priorities.
“But it is vital that we focus on making early interventions into these problems, freeing up resources for the health service later down the line, and more importantly, saving years of additional suffering for the patient. We need everyone including parents to be aware of the risks of mental health so they are well placed to make that all important early intervention.
“If we can combine strong preventative actions alongside better quality of mental health care for children, we have a far greater chance of curbing issues with mental health in both children and in adults.”