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Improving children and young people’s mental health services

The government has started to tackle issues of parity of esteem between physical and mental health services for children and young people, but there is a long way to go to ensure equal access to care, says the National Audit Office (NAO).

In a report published today, the NAO has said that even if current initiatives are delivered as intended, there would remain significant unmet need for mental health services amongst young people. Experience in other sectors suggests that programmes to improve access to mental health services may also uncover previously unidentified further demand.

The government started from a very low base when it developed its strategy for children and young people’s mental health services. The most recent (2004) survey of children’s mental health needs found around 10% of 5 to 16 year olds had a mental health condition. It also estimated that only around a quarter of children and young people requiring support from mental health services can access the services they need.

The government’s current work to improve mental health support for children and young people is an important but modest step towards achieving its longer term aspirations. It includes initiatives to increase the proportion of children and young people who need support accessing NHS-funded mental health services from around 25% to 35%, estimated to be equivalent to treating an additional 70,000 children and young people per year, between 2015-16 and 2020-21. This reflects the Department’s assessment of what is possible within current funding and staffing constraints.

However, the NAO has found significant weaknesses and unreliability in the government’s data which undermines its understanding of its progress and whether additional funding has been spent as intended. In particular, the NHS cannot reliably track progress against one of its key targets to treat an additional 70,000 children and young people. It is encouraging that it has met its interim access rate target for 2017-18, but as this was based on a one-off data collection, it still cannot be confident about how fast access is improving. The NHS is working to improve the data it collects including developing the first comprehensive collection of data on NHS-funded children and young people’s services.

An additional £1.4 billion was committed to children and young people’s mental health services between 2016-17 and 2020-21. Since the government launched its strategy, local health spending on these services has increased. However, NHS England cannot be sure all the additional funding has been spent as intended by clinical commissioning groups, although it has tried to strengthen controls in 2018-19. In reality, it has limited powers to ensure that CCGs increase spending in line with their intentions and it has chosen not to introduce any restrictions on how CCGs spend the additional funding received.

Slow progress on increasing the mental health workforce in England by 40% (4,500 staff) is emerging as a major risk to delivering the government’s ambitions and there are currently no data available to monitor any increase. In March 2018, local areas were only planning to recruit 3,410 NHS staff by 2020-21. This means that to meet the original ambitions a quarter of new posts would need to come from outside the NHS, but local areas have not yet estimated how many non-NHS staff they will need.

New government estimates, expected late 2018, of the number of children and young people with a mental health condition are likely to be higher than previously estimated, which will make it even harder for the government to achieve its long-term ambitions. If prevalence is 50% higher than the previous 2004 estimate, this would mean NHS England would have to treat an additional 186,000 children and young people in order to achieve an access rate of 35% by 2020-21.

The report recommends that the Department, working in conjunction with other departments, should set out the scale of the needs of young people requiring mental health services, building on the new prevalence data when available and identify what work and resources are needed to implement its 2015 strategy, Future in Mind, in full.

“Parity of esteem between physical and mental health services for children and young people is a laudable aim. However, to deliver meaningful change, this must be matched by the necessary planning, resourcing and co-ordination. Despite a welcome start this aim remains far off. Current targets to improve care are modest and even if met would still mean two-thirds of those who need help are not seen. Rising estimates of demand may indicate that the government is even further away than it thought.

Amyas Morse, head of the NAO, 9 October 2018

Notes for Editors

Key facts

49
proposals in Future in Mind, the government's 2015 strategy to improve children and young people's mental health services

10%
proportion of five- to 16-year-olds who have a mental health condition, as estimated by a 2004 national survey

10%
NHS England's target percentage point increase in the proportion of children and young people diagnosable with a mental health condition who access treatment (from 25% to 35%)

30.5%
estimate of the access rate at the end of 2017-18, based on a one-off data collection from clinical commissioning groups, against an interim target of 30%, as published in the Five Year Forward View for Mental Health (Forward View)

70,000
Forward View target for the additional number of children and young people accessing mental health services per year by 2020-21, although no reliable national information is available on progress against this target

4,500  
Stepping Forward to 2020/21 ambition to increase the children and young people’s mental health workforce (full-time equivalent) between 2016 and 2021; this covers NHS and non-NHS staff, although no information is available to measure this

3,410
expected increase in the NHS children and young people's mental health workforce by 2020-21 in England, as reported by local areas in March 2018

£1.0 billion
spent by clinical commissioning groups and NHS England on children and young people's mental health services in 2017-18

£1.4 billion  
additional funding agreed for children and young people's services for 2016-17 to 2020-21

 

  1. The Department of Health & Social Care is responsible for mental health policy, while NHS England is responsible for overseeing the commissioning of NHS-funded services, either directly or through clinical commissioning groups (CCGs), and various other government departments and arm's-length bodies also have a role in funding and delivering these services (see paragraph 3.18 and Figure 17). NHS England and CCGs collectively spent £1 billion on children and young people's services in 2017-18.
  2. The most up-to-date estimates (from 2004) indicate that 10% of five-to 16 year olds have a mental health condition comprising of: conduct disorders (5.8%); anxiety (3.3%); depression (0.9%) and hyperkinetic disorder also known as severe attention deficit hyperactivity disorder (1.5%), although as little as 25% of children and young people with a diagnosable condition actually access treatment.
  3. In 2014 and 2015, the government announced £1.4 billion of transformation funding for children and young people’s mental health services. In March 2015, it set out its vision for children and young people's mental health services in its Future in Mind strategy
  4. Press notices and reports are available from the date of publication on the NAO website. Hard copies can be obtained by using the relevant links on our website.
  5. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Sir Amyas Morse KCB, is an Officer of the House of Commons and leads the NAO, which employs some 785 people. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services. Our work led to audited savings of £741 million in 2017.

Contact

NAO Press Office
+44 (0)20 7798 7400 or email pressoffice@nao.org.uk

PN: 46/18