Hospital Dr News

Funding gap widens between mental and physical health despite parity of esteem pledge

The gap between spending on NHS acute hospitals and NHS mental health providers widened further last year, according to a new report from The King’s Fund.

The report shows that 84% of mental health trusts, which provide the great majority of mental health services, received an increase in funding last year; a significant increase on previous years.

But funding for acute and specialist hospitals has continued to grow more quickly as national leaders have given priority to reducing financial deficits and improving performance in A&E.

As a result, income for mental health trusts rose by less than 2.5% in 2016/17 compared to over 6% for acute and specialist trusts, continuing a trend of a growing gap between spending on mental health and acute trusts.

Since 2012/13, funding for mental health trusts has increased by just 5.6% compared to an increase of 16.8% in funding for acute hospitals.

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.

But, the squeeze on NHS mental health providers funding, together with a lack of available staff, has put huge pressure on the workforce and left mental health trusts struggling to staff services safely.

The number of mental health nurses has fallen 13% since 2009, while one in 10 of all posts in specialist mental health services are currently vacant.

Analysis of Care Quality Commission inspection reports for all 54 mental health trusts identified an increased risk to patient safety as a result of problems with staffing in more than half of trusts. This included an increased risk of suicide and self-harm on inpatient wards, delays in treatment and reduced access to care and bed closures.

Examples drawn from a review of board papers of a small number of trusts also highlighted difficulties staffing services on a day-to-day basis, a reliance on bank and agency staff and ‘substitution’ of staff, for example health care assistants stepping in for registered nurses.

Helen Gilburt, report author and Fellow in Health Policy at The King’s Fund, said: “The NHS is in the very difficult position of trying to deliver parity of esteem at the same time as it is under huge pressure to reduce deficits and improve performance in acute hospitals.

“While the great majority of local clinical commissioning groups have met their commitments to raise spending on mental health, the overall spending gap between mental health trusts and acute and specialise trusts has widened because national funding has focused on relieving pressure on acute hospitals.

“Unless funding grows more quickly, mental health providers may end up implementing improvements to some services at the expense of others. Despite the commitment of national leaders, the funding gap between mental health and acute NHS services is continuing to widen, while growing staff shortages are affecting the quality and safety of care.”

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