If it’s Monday, the prime minister is doing something good and kind, according to the Downing Street grid: last week it was prisons, this week it’s a mental health “revolution”. Announcing £1bn for threadbare mental health services, he launched a report detailing their dire state.
Written by the head of Mind, this hard-hitting report was widely welcomed, as was the £1bn. One in four people suffer mental health problems but three-quarters get no help at all. Suicide rates are rising, as is self-harming, with services so bad that lives are “put on hold or ruined” for lack of care, with mental health patients dying 15 to 20 years earlier than others. Beds are so scarce that 2,000 acutely ill patients a month end up sent far from home.
Prime ministerial attention undoubtedly helps, when the anguish of mental illness is often worse than it is with physical ailments that get priority. Here’s his promise: a million more people will get “high quality” treatment, including 600,000 more getting talking therapy (previously known as IAPT – Improving Access to Psychological Therapies); every A&E will get a mental health liaison team; and every maternity unit will get perinatal psychiatry to catch depression in mothers. There will also be extra help for children and young people with eating disorders, plus more crisis teams to keep people out of hospital.
But “parity of esteem” for mental health has been announced many times by Cameron’s government – more parity of rhetoric than resources: the tariff for mental health was cut below that for physical health. Less than a tenth of NHS funds go to mental illness, and severe cuts since 2010 have left 5,000 fewer mental health nurses and 8% fewer mental-health beds.
Professor Sir Simon Wessely, the president of the Royal College of Psychiatrists, says mental health funding has been cut by 8%, telling of severely ill patients shunted “from Cornwall to Cumbria”. His college commissioned a report from Sir Nigel Crisp, a former head of the NHS, which calls for hard targets – such as a maximum four-hour wait for acute treatment and an end to the “postcode lottery”. But that lottery is at the heart of Cameron’s NHS policy.
What does £1bn buy? As the Health Service Journal reports, this is not new money but part of the £8.4bn George Osborne was forced to promise during the election, faced with unprecedented NHS deficits. Anita Charlesworth, chief economist at the Health Foundation, lays it out with brutal clarity: “That £8bn was the minimum to sustain services. It doesn’t include any money for improving quality, for extra mental health or for a seven-day NHS.” Along with other health economists, she presses the government to say where the money is to come from. “What has to give to provide new and better services, we ask. We get stonewalled.”
She says the NHS’s ability to carry on depends on good social care, but local authority cash is severely cut. “Money could be saved by early prevention – but in the spending review public health funds were cut by 4% every year to 2020, with its ringfence soon removed.”
Luciana Berger, the shadow minister for mental health, travels the country looking for community support for the depressed and ill. “But,” she says, “Sure Start children’s centres, youth services, befriending projects, education psychology in schools and drop-in centres for the vulnerable are all vanishing. DWP work capability tests pile on mental pressure, although the work programme fails to get 93% of mental health patients into jobs.”
Cameron was precise about his new services – but the money is not ringfenced to ensure that’s where it goes. Whenever you hear the prime minister “announcing” things in the NHS, alarm bells should ring. Since the 2012 Health and Social Care Act, how money is spent has been devolved to local CCGs – care commissioning groups, nominally led by GPs. Many are now so strapped for cash, they will use it on contracting for existing services.
Follow the money and take a look at one large mental health trust: Central and North West London. I interviewed Trevor Shipman, its finance director, for the Guardian’s This is the NHS series, finding him facing an £8m shortfall this April, despite making £26m in savings. I asked if he expected his share of this £1bn to help extend his services. Studying the taskforce report, he pointed to recommendation 58, for the health department “to confirm what governance arrangements will be put in place to support the delivery of this strategy”. In other words, will they force it through and report the results? He sees no ringfence or enforcement mechanism.
Will CCGs pay up? “I’ve been told by CCGs in financial trouble that they have been told by NHS England to clear their debts first and worry about mental health later – nothing in writing of course. It’s not CCGs’ fault, as many suffer an unfair funding formula.” He needed £1.3m from his CCGs for urgent care, but got only £900,000 this year. He needs to be paid fully for existing services before adding new ones. Nor is there mention of local authority social care, on which he depends to empty blocked beds. Half his costs for children did come from local government, but those grants were abolished five years ago.
One mental health success has been the Improving Access to Psychological Therapies talking therapy programme, evidence based, tightly costed and until now ringfenced. By getting nearly 5% of its patients back to work, it pays for itself. But those savings to the DWP don’t flow back to mental health. The sheer dogged determination of the economist and campaigner Professor Richard Layard has forced this through, says Charlesworth.
But Shipman says a trust like his has had to deliver it at the expense of acute psychosis services. He must deliver psychosis appointments within two weeks from 1 April. “But how do we get the funds or the staff for that?” Funding is so badly administered from on high that he still has no idea what his budget is from April: “How can I plan for staff?”
He can’t, of course. But then he is obliged to find logic where logic doesn’t exist. For it’s simply self-deceiving to make brave new announcements of fine mental services without new money, safely ringfenced; and they can’t ringfence old money already earmarked for debts everywhere else in the NHS.