CCGs cutting spending on mental health despite NHS pledges
Exclusive Five areas in England are planning to cut spending on mental health services in 2017/18, despite being told by NHS England to ensure that they increase spending in line with physical health spending.
A Pulse investigation has revealed that CCGs in South Sefton, Scarborough, Isle of Wight, St Helens and Walsall are collectively spending £4.5m less in 2017/18 than they spent on services in 2016/17.
Mental health services in Walsall will be experiencing the largest cut, with the CCG reducing spending by £1.9m – or 3.2% – despite its overall budget increasing by 1.4%.
Freedom of information responses received from 127 CCGs in England reveal that the total CCG spend on mental health increased by 4.15%.
NHS England said in its Five Year Forward View for mental health in February 2016 that CCGs should spend an extra £1bn a year on mental health by 2020/21.
It also requires CCGs to increase their spend on mental health services in line with their budget increases – the so-called ‘parity of esteem’ standard
The think tank The Health Foundation had already found that 46 CCGs are not expected to meet the standard in 2016/17, with another £20.8m needed in mental health funding to meet the parity of esteem commitment.
But Pulse’s investigation reveals that some CCGs are even cutting funding for mental health, with a further 78 unable to provide their budgets for 2017/18.
A Pulse investigation last year revealed that increasing numbers of vulnerable children are being refused vital mental health treatment that is recommended by their GP. Figures obtained from 15 mental health trusts revealed that 60% of GP referrals to child and adolescent mental health services (CAMHS) lead to no treatment and a third are not even assessed.
A Pulse survey last year also revealed the majority of GPs say they have to diagnose child and adolescent mental health disorders ‘above their level of competence’ due to a deterioration in access to specialist services.
Dr Chaand Nagpaul, chair of the BMA’s GP Committee, said: ‘This goes against the pronouncements of Government that mental health will have priority, that we will see more support in the community, the promises we’ve had that there will be greater numbers of mental health workers in primary care. Cutting the mental health budget will have a reverse and damaging effect.
'This will simply result in patients, by default, turning to GPs when they have neither the capacity nor the expertise to deal with many of these patients. This goes against the grain of the pronouncements from NHS England and Government.’
How the CCGs are cutting mental health spending
NHS Walsall CCG
Overall cut: 3.2%
Overall CCG funding uplift: 1.4%
Prof Simon Brake, Chief Officer for NHS Walsall Clinical Commissioning Group, said: ‘Walsall CCG benchmarks nationally as high spending, falling within the upper quartile as an outlier. It has invested significantly more in previous years in mental health services than its CCG peers ahead of the national requirement to make investments in this area.
‘This, combined with lower than average funding growth of only 1.4 per cent compared to a national average uplift of 2.14 per cent has resulted in the CCG working closely with its local mental health providers to develop a transformation programme which meets national trajectories for moving care closer to home and improves quality of provision and outcomes whilst at the same time working within available financial resources.’
NHS South Sefton CCG
Overall cut: 2%
Overall CCG funding uplift: 1.5%
A spokesperson from NHS South Sefton CCG said: ‘Importantly, it is difficult to compare us to other CCGs when simply looking at reported spend in mental health, as this does not fully reflect our local position and agreements to ensure investment in these services meets expected requirements.
‘We have assurance from our main mental health providers for adults and children’s services that they will be able to deliver the ‘must do’s’ set out in the five year forward view for mental health within the budget allocations for 2017-2018 and 2018-2019.
‘This agreement is set out in our block contract as part of the North Mersey Local Delivery System ‘Acting as One’ agreement, which brings us together with all trusts and commissioners in the area.
‘Additionally, it should be noted that we were allocated a 1.5% increase in our budget for 2017-2018 and 2018-2019, which is more than half a percent lower than the national average. Whilst the figures show that mental health services will receive 2.5% less directly from us this year, they do not reflect further one off investments which are yet to be allocated in the new financial year.
‘Our £1m investment in the financial year 2015-2016 in state of the art facilities shows our commitment to mental health services, and it means that our proportionate investment over the last 3 years exceeds the levels of growth received by the CCG.’
NHS Scarborough and Ryedale CCG
Overall cut: 2%
Overall CCG funding uplift: 2%
‘The raw data does not take account of the collaborative approach NHS Scarborough and Ryedale Clinical Commissioning Group (CCG) is taking to mental health, particularly in services for young people and additional investment from partner agencies.
‘Through a joint approach from the NHS and local authority colleagues across North Yorkshire, we’ve been able to invest in a schools mental health and wellbeing service which will support schools to develop a whole school approach to positive mental health by delivering training to school staff and key partners, followed up by expert professional consultation, coaching and mentoring to education staff on the use of brief interventions and targeted group work.’
NHS Isle of Wight CCG
Overall cut: 0.5%
Overall CCG funding uplift: 0.5%
No response received.
NHS St Helens CCG
Overall cut: 2%
Overall CCG funding uplift: 2%
‘The CCG recognises that parity of esteem requires the CCG to invest in mental health proportionate to the percentage of growth funding received.
‘For 2017-18 St Helens CCG has invested in mental health services up to the STP growth assumptions of 1.93%
‘During 2016-17 it was identified that through historic funding issues St Helens CCG had cross subsidised mental health activity attributable to other neighbouring CCG’s. There was therefore an agreed re-basing of the St Helens CCG share of the mental health contract value with our main mental health provider resulting in a reduction in funding from St Helens CCG of £500k but with neighbouring commissioners correctly adding the same sum to their contracts. The net impact on overall mental health commissioning spend with the provider was therefore neutral and there was no impact on the level of service provided to patients.
‘A further issue is that the CCG had funded some non-recurrent corporate IT costs for its main mental health provider in 2016-17 which are not planned for in 2017-18, again this has no impact on the level of mental health services provided to patients in St Helens but does impact on year to year expenditure comparisons.’