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Working or Wasted: Mental Health Funding documentary Working or Wasted: Mental Health Funding documentary

Working or Wasted: Mental Health Funding documentary - PowerPoint Presentation

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Uploaded On 2018-10-22

Working or Wasted: Mental Health Funding documentary - PPT Presentation

Data analysis and questions to be asked Matt Joy NHS Report 201617 One Year On Indications are that some good progress is being made Mental Health Five Year Forward View Dashboard NHS Providers themselves paint a less rosy picture ID: 693307

mental health nhs services health mental services nhs funding care additional billion people england spend year providers commissioning ccgs

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Slide1

Working or Wasted:Mental Health Funding documentaryData analysis and questions to be asked

Matt JoySlide2

NHS Report : 2016/17 - “One Year On”

Indications are that some good progress is being madeSlide3

Mental Health Five Year Forward View DashboardSlide4

NHS Providers themselves paint a less rosy pictureSlide5

NHS Provider document: headlines (July 2017)Slide6

NHS Providers : 7 key areas of concern

Rising demand outstripping capacity

Funding not getting through to the frontline

Persistent gaps in the mental health workforce

Deteriorating access to and quality of some mental health services

Insufficient support for liaison between mental health and other NHS services

Lack of priority for mental health in sustainability and transformation partnershipsFractured commissioning leading to uncoordinated care for service users

These seven key issues point to a

growing gap between the government’s welcome ambition for the care of people with mental health needs and the reality of the core services these service users are receiving on the frontline. In some cases, the reality is that core mental health service provision by mental health trusts is actually getting worse, not improving

. Unless action is taken to address these areas of concern, then the government’s overall ambitions for transforming mental health care will not be met. Slide7

Parity of Esteem

Parity of esteem

 is the principle by which mental health must be given equal priority to physical health. It was enshrined in law by the Health and Social Care Act 2012

Despite this, as funds for mental health is not ring-fenced, it appears that the additional funding destined for this area is not reaching its intended target

Mental health trusts largely have to operate on block contracts which, unlike the acute sector, do not account for rising demand.

At the same time, these trusts are having to make very significant annual cost improvement plan (CIP) savings often in the range of 4-6% per year. This is putting huge pressure on core frontline services. There is also a lack of transparency in how funding is allocated from clinical commissioning groups (CCGs) to NHS mental health trusts, with CCGs also facing inevitable pressure to use any ‘new’ funding to prop up core services whose funding has been cut or is static.Slide8

Initial thoughts

Seems that there has been some progress, in terms of people receiving treatment

However even NHS Providers confirm that, if anything, the situation is getting worse

Demand is outstripping available resource

Additional funding seems to be insufficientAdditional funding that was promised is not reaching the front line

Funding not ring-fencedFunding not necessarily being wasted, but it is potentially being allocated to other areasDoubts that the NHS “ambition“ to achieve genuine parity of esteem by 2020 is possible

Slide9

Q1 Spend vs. increases in treatment

What is the increase in spend on mental health in 2016/7 over 2015/6 – as a percentage of the 2015/6 spend?

NHS state that there was an increase in people receiving treatment of 120,000 over 2015/6 – again, what is this as a percentage of the 2015/6 figure

How do the two percentages compare; for example:

If there is an additional 5% spend and an additional 10% increase in treatments, how is this achieved?

If the percentages were reversed, why is this? (i.e. money not getting to the front line)Over 90% of providers and 60% of commissioners were not confident that the £1 billion additional investment recommended by the Mental Health Taskforce supported by NHS England will be sufficient to meet the challenges faced by mental health services

What additional funding, if any, is planned to meet this additional demand?Slide10

NHS / CCG funding structure

What is primary care?

Primary care is the first point of contact for most people

and is delivered by a wide range of independent contractors, including GPs, dentists, pharmacists and optometrists, as well as NHS walk-in centres and the NHS 111 telephone service.

NHS England is responsible for purchasing

primary care services and some specialised services, including military health care, at a national level, ensuring the provision of specialised care for the small groups of individuals who require it. In 2014-15, the Department gave a total of £97.4 billion to NHS England for all NHS services. The estimated £11.7 billion spending on mental health services represents 12% of this total.

NHS England directly commissioned around £3.7 billion of mental health services, including secure and other specialised services, primary care and services for those in prison or custody or in the armed forces.

What is secondary care?

Clinical commissioning groups (CCGs) commission most of the hospital and community NHS services in the local areas they are responsible for. They also co-commission GP services with NHS England as a result of the 

NHS Five Year Forward View

 objectives.

Services that CCGs commission include:

planned hospital care

rehabilitative care

urgent and emergency care

 – including out-of-hours and NHS 111

most 

community health services

mental health services

 and learning disability services

some 

GP services

Clinical commissioning groups (CCGs) and local authorities commission local provision for people in the community, who constitute the majority of those with mental health conditions; this also allows for the provision of support beyond that of health services.

Clinical commissioning groups estimated that they would spend £7.9 billion on mental health servicesSlide11

Mental Health Spend: “fractured commissioning”

Mental Health Funds

NHS England: Primary

Specialist commissioning

Mental Health Trust CCGs: Secondary

Mental health commissioning

NHS Providers

£3.7 billion (32%)

£7.9 billion (68%)

£11.7 billion

But…”mental health trusts provide about 80 per cent of all mental health care”?Slide12

Mental Health spend data (part 1)

Latest figures from 2014-15

Mental health services are paid for by a 

wide range

 of different organisation. When NHS England asked them to estimate how much they planned to spend on mental health services last year, the answer was £11.7 billion.But we don’t know how much of that £11.7 billion was actually spent on mental health. There have been 

discrepancies in the past between planned spending on mental health and what actually happened.Slide13

Mental Health spend data (part 2)

Data from NHS Five Year Forward View document

Poor mental health carries an economic and social cost of £105 billion a year in England.

Analysis commissioned by NHS England found that the

national cost of dedicated mental health support and services across government departments in England totals £34.4 billion each year

, excluding dementia and substance use£19.1 billion of this is made up of government spend, though there is little or no national data available for how up to 67 per cent of mental health funding is used at a local level. Most of the remainder (£14bn) is for the support provided by unpaid carers, plus a relatively small share that is funded through the private and voluntary sectors.

(Data from 2013-14, latest detailed data available)Slide14

Q2 : Is the money getting to the front line

The NHS Providers document states that “Funding [is] not getting through to the frontline”.

Why is this – where IS the funding going?

What plans are in place to address this in the near future?

NHS England had made assurances that almost 90% of plans submitted by CCGs in 2015-6 included mental health funding increases.

However, according to the accounts of 58 mental health trusts in England which provide 80% of all mental health care, income fell and a higher proportion of trusts ended the year in deficit than in previous financial yearsHow can this discrepancy be explained – and again, where IS the funding going

5 clinical commissioning groups (CCGs) in Sefton, Scarborough, the Isle of Wight, St Helens and Walsall are set to reduce spending on mental health by £4.5mHow can this be challenged?Slide15

Q3 : Where is the money going ?

In 2016-17, £119m has been allocated to CCGs, but this has been included in their total baseline allocation.

The report of the Independent Commission on Children and Young People’s Mental Health said the fact that the money was not ring-fenced also created a risk that funding would be diverted to other priorities covered by national targets, such as reducing A&E waiting times.

What proposals, if any, are in place to ensure the funds are ring-fenced & allocated to Mental Health treatment, in order to truly achieve Parity of Esteem Slide16

Mental health trusts & block contracts

Under a block contract a commissioner agrees that a provider is paid a lump sum fee to offer services for a certain patient population for a fixed period

of time.

The commissioning of an unaccountable block contract, which is poorly monitored and defined, means that other providers are not able to offer services to that patient population – even if they can provide a service more suited to local patient demand or that offers better value for money

Mental health providers continue to be paid predominately through block contracts.

These not only fail to reflect increases in demand, which must be met by the provider, but are also More vulnerable to cuts which can impact across the range of services that the contract covers.Slide17

Q4 : Additional funding

With the progress being made on removing the stigma of mental health (a good thing), many more people are expected to receive some kind of treatment

120,000 more people being treated

(Including 21,000 more children and young people)

Additional resources and training is also planned

However, even if we could be sure that the £1 billion additional investment recommended by the Mental Health Taskforce supported by NHS England, is this enough?

Over 90% of providers and 60% of commissioners are not confident that this will be sufficient to meet the challenges faced by mental health services

What additional funding, if any, is planned to meet this additional demand?Slide18

Q5: Resource issues

The NHS report indicates some additional staffing & training is in progress, whilst the NHS Providers document indicates

Rising demand outstripping capacity

Persistent gaps in the mental health workforce

Deteriorating access to and quality of some mental health servicesWhat plans are in place to address this shortfall – is it just a funding issue, or are there other areas that also need to be addressed?

Training issues - again, is it just lack of funding that prevents skill acquisition?Slide19

Q6: Early years intervention, detection, & prevention (part 1)

The ICC report mentioned in Q3 also stated

“It is also important to consider this additional investment in the wider context of funding for the whole system,” the report added. “Children’s mental health services have been historically underfunded. In 2012-13 £704m was spent on CAMHS, the equivalent of about 6% of the total mental health budget, or around 0.7% of the total NHS budget.

“This is in spite of prevalence data showing that one in 10 children and young people experience mental health problems and that 75% of young people experiencing a mental health problem are thought not to access any treatment.”

The report also quoted figures from the Children’s Society showing that

Between 2010-11 and 2015-16, spending by local authorities on early intervention services fell by 31%It is due to fall by 71% by the end of the decade.Slide20

Q6: Early years intervention, detection, & prevention (part 2)

Given the apparent issues around funding of children's mental healthcare, what plans, if any, are in place to ensure that services such as CAMHS receive sufficient (increased) funding?

Taking a “prevention better than cure” approach, what work, if any, is being done with schools etc. to ensure potential issues are identified sooner and appropriate help given at an early stage

Research indicates that as many as 40 percent of those with depression can trace it to a genetic link. What work (if any) is being done with families of depression sufferers (especially where there is a strong indication of an inherited issue)Slide21

Over 72,500 more people with common mental health problems will access psychological therapies compared with the previous year

21,000 more children and young people are expected to access treatment in NHS-commissioned community teams

Over 600 new training places have been made available to continue to increase the number of skilled therapists

556 staff working in children and young people’s services have begun training courses to improve skills in evidence-based treatment

At least 750 more women should receive access to specialist perinatal mental health support and care

New integrated services have been set up so that an additional 6,000 people will receive integrated treatment – with 22 new sites starting in January 2017

The use of police cells as places of safety continued to decline, accounting for only 7% of detentions and having more than halved