Mental health services: preparations for improving access
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 the National Audit Office. Today’s report from the spending watchdog is the first in a planned programme of work on mental health.
The Department and NHS England have made a clear commitment to improve mental health services for people who need them. In 2011, the government set an ambition that mental health would be valued as much as physical health. 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.
Improving care for people with mental health problems depends on action by many local organisations working together. However, the full cost of implementing the new access and waiting time standards and meeting longer term ambitions for better services is not well understood. 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 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 made available £120 million of additional funding over the two years 2014-15 and 2015-16. However, most of the cost of implementing the new access and waiting time standards will be met from clinical commissioning groups’ existing budgets, at a time when the NHS is under increasing financial pressure.
Today’s report finds that full information does not exist to measure how far the NHS is from meeting the access and waiting time standards, but it is clear that meeting the standards will be a very significant challenge. Nationally, the access and waiting times for IAPT are already 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. 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.”
Amyas Morse, head of the National Audit Office
Notes for Editors
NHS England’s estimate of spending on mental health in 2014-15
Estimated proportion of NHS England’s total spending that was on mental health in 2014-15
Of people needing mental health services have access to them
Of adults reported, in 2014, being diagnosed with at least one mental illness at some point in their lives
People in England known to be suffering from depression in 2014-15
Up to 3 in 100
People may experience psychosis in their lifetimes
Additional funding the Department of Health and NHS England made available to support implementation of access and waiting time standards for mental health over the two years 2014-15 and 2015-16
Between 7% and 99%
Proportion of patients treated within the six-week target for improved access to psychological therapies in 2014-15, by clinical commissioning group
Of acute hospitals had a liaison psychiatry service operating 24 hours a day, seven days a week, in 2014-15
- Around one in four adults in England is diagnosed with a mental illness at some point in their lives, and may need to use mental health service. Mental health conditions cover a broad range of disorders of varying severity. The most common problems are conditions such as depression, anxiety and panic disorders. In 2014-15, 3.3 million people were known to be suffering from depression. Psychosis is less common but more severe, and may affect up to three in every 100 people during their lives. Other forms of mental illness include eating disorders and personality disorders.
- In 2014-15, the NHS spent an estimated £11.7 billion on mental health services, some 12% of total spending. Mental health services include a range of interventions offered in community, inpatient and primary care settings, which may need to be integrated and multidisciplinary. The Department of Health is ultimately accountable for securing value for money from spending on healthcare, including mental health services. It sets objectives for NHS England through an annual mandate and holds it to account for the outcomes the NHS achieves.
- 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.
- 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 810 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, and our work led to audited savings of £1.15 billion in 2014.