In 2013 the government made a commitment to achieving parity of esteem between physical and mental health. That commitment was followed by a pledge of £1.25 billion for child and adolescent mental health, a national strategy for adult mental health and an investment of £1 billion to support its delivery.
Parity of esteem means equal access to effective care and treatment, equal efforts to improve the quality of care, equal status within health care education and practice, equally high aspirations for service users and equal status in the measurement of health outcomes. Achieving parity requires action at multiple levels. Fundamental to this is ensuring adequate funding and staffing to provide safe and effective care and to deliver the vital improvements outlined in the The five year forward view for mental health [Forward View for Mental Health].
This briefing considers the current situation based on:
- an analysis of the annual financial accounts of NHS mental health, acute and specialist provider trusts
- an analysis of the national workforce data
- a review of the Care Quality Commission (CQC) inspection reports for each of the 54 NHS mental health trusts
- a review of the board papers of eight mental health trusts covering a six-month period from January 2016; the trusts were selected to include the four with the greatest increases in staffing over this time and four with the greatest decreases and to include trusts from each of the NHS England regions.
Like other spending in health, the greatest proportion of funding for mental health care is allocated to NHS England. Much of this in turn is allocated to local clinical commissioning groups (CCGs) and via NHS England’s national programmes to fund the provision of mental health care. Introduction of the Mental Health Investment Standard in 2015/16 requires CCGs to increase investment in mental health services in line with their overall increase in allocation each year. In 2016/17, 85 per cent of CCGs met this commitment.
Several different organisations provide mental health care, including the private and third sectors, and spending from CCGs covers all of these. However, the NHS accounts for more than 80 per cent of secondary mental health care provision, most provided by mental health trusts. Some mental health trusts may receive additional income from other commissioners to provide mental health care such as NHS England for specialist services, or local authorities eg, for drug and alcohol services. Finally, a number of mental health trusts also provide community health services such as district nursing for which they receive additional income. This is not dissimilar to the income of acute and specialist provider trusts, who also provide community health services. Given the key role of mental health trusts in providing mental health care and that many of the commitments to improving mental health care outlined in the Forward View for Mental Health relate to services provided by NHS mental health trusts, their income provides an important marker of their ability to deliver that care.