Funding parity of esteem: mind the gap

09 May 2016

The report Funding mental health at local level: unpicking the variation, published today by NHS Providers and the Healthcare Financial Management Association (HFMA) makes for difficult reading. It highlights that despite the rhetoric around increasing funding for mental health services and improving access to essential treatments, the necessary investment is still not reaching many local areas and services.

We found that only a half of mental health trusts in England received the required real terms increase in their services last year, despite commissioners being told to increase investment in line with their overall allocation. Particularly concerning is the finding that NHS England is not necessarily leading by example in the area. It is responsible for setting the rules and for holding local commissioners to account for their spending plans, yet its own specialised commissioning teams are not consistently meeting their parity of esteem commitments towards specialised mental health services.

Supporting patients with mental health conditions in a more timely and comprehensive way is not just necessary for improving services, it also ensures that we are maximising the value of the currently constrained NHS budget

The situation does not look like it will improve this year either. Although we are still concluding the contracting round for 2016/17, providers were even less positive about receiving sufficient additional investment, with only a quarter confident that they would see an increase in-line with the allocation growth for 2016/17.

Identifying the barriers

There are currently too many claims on the additional money given to commissioners. This cannot be used as justification for letting commissioners off the hook for investing in mental health services, not least because they are required to do this by the planning guidance, but also because investment in these services has the potential to alleviate other pressures on their budget. For example, people with mental ill health use more emergency care than people without ill mental health – they have over three times more A&E attendances and almost five times more admissions.

Supporting patients with mental health conditions in a more timely and comprehensive way is not just necessary for improving services, it also ensures that we are maximising the value of the currently constrained NHS budget.

Second, there is not enough information about how services should be prioritised. The government announces funding for certain priorities, for example £1.25bn for children and young people’s mental health services. But this is subsumed into commissioner allocations making it difficult for local organisations to understand how this investment has been passed on to the frontline.

It is ultimately for local organisations to determine funding priorities and investment decisions, but we need to ensure that there is a level playing field and fair access to services across the country.

Third, there is not enough transparency or accountability over how the money is spent. As identified by the National Audit Office (NAO) report in April 2016, NHS England does not currently have reliable data matching expenditure to different mental health disorders. This both makes it difficult to track how money actually reaches frontline services but also undermines the evidence base available about where to prioritise investment.

NHS England does not currently have reliable data matching expenditure to different mental health disorders

When there is such little transparency, it is also difficult to hold organisations to account – commissioners are required to report their total spend on mental health services, but not how much they have spent on different types of treatments and services.

Addressing the barriers

There are no quick fixes, and concerted efforts will be required at local and national level to ensure the necessary investment for mental health reaches frontline services.

Key will be creating an environment in which commissioners and providers work more closely together to determine how and where additional investment is spent. It is simply not sustainable to have a situation in which commissioners report that they have increased their overall spending, yet individual providers have seen no direct investment, despite their services being under intense pressure. This lack of alignment between investment priorities and funding at the local level needs to be addressed. It might be too late for 2016/17, but we need to get this right for 2017/18.