At its heart, the government’s commitment to parity of esteem for mental health is about making sure people get the same quality of NHS treatment whether they have a mental illness, physical health problems or both. The NHS has a long history of underfunded mental health services, certainly compared to acute hospital services, and so it’s not surprising that funding is by and large how we now measure progress towards parity.
The government has made a number of financial commitments in recent years, but announcing extra money is the easy bit; actually delivering that funding and getting it to the frontline can be more difficult. While the NHS plans to develop key services such as teams for crisis resolution, home treatment and early intervention in psychosis, this kind of expansion requires significant investment.
With this in mind, there is some positive news. The King’s Fund’s latest analysis suggests that most NHS mental health trusts, which are tasked with delivering many of these improvements, saw an increase in their income last year. Just 16 per cent did not see an increase in their income in 2016/17, a much better position than the previous two years when 40 per cent of mental health trusts did not receive any extra money.
So what’s the problem? Although some areas of mental health spending are increasing, including funding for mental health trusts, the problem is that this growth is too little, especially at a time when demand for services is rising. That demand is driving costs across the NHS, and the threat of growing deficits among NHS acute and specialist providers has led to them being the main priority for extra funding. So while funding for NHS mental health providers has increased, the gap in funding between mental health trusts and acute trusts has widened.
“Since 2010 the number of nursing posts in NHS mental health services has fallen 13 per cent”NHS England has called for an honest conversation with the public about what the NHS should and can provide within a constrained budget. At a point when the NHS is trying to deliver improvements in mental health while dealing with pressures in other parts of the system, this calls for realism about what can be delivered, to whom and at what cost.
A limited budget leads to difficult decisions on the ground about which services can be resourced and how. In mental health, even more so than in other health services, staffing accounts for the vast majority of spending. Since 2010 the number of nursing posts in NHS mental health services has fallen 13 per cent. The current vacancy rate amongst NHS mental health providers is 10 per cent. As one mental health trust board put it in its official papers, the “the trust is losing staff faster than it is able to recruit."
One risk of these financial and workforce pressures is that developing new services may come at the expense of existing ones. We could see a scenario where the NHS meets its ambitions for expanding the services it offers people, but this would be a hollow victory if it compromises the safety and effectiveness of services people rely on at the moment.
With growing national support and awareness for mental health care, it is easy to forget how much further the NHS has to go. The commitment to parity goes beyond simply improving mental health services to taking an equitable approach across the NHS. As the government releases £350m in emergency funding for hospitals to weather the winter, just £18m of which will be spent on mental health, and headlines are dominated by overcrowded A&E departments, it is worth remembering that the government’s own figures show that less than a quarter of children and young people who need mental health care can access it.
Should we welcome the additional support for mental health? Yes. But is this parity? Most certainly not.
“Funding and staffing of NHS mental health providers: still waiting for parity” was published by The King's Fund on 16th January
