Growing gap between governmental ambitions for mental health and reality on frontline

NHS Providers has warned that the prime minister’s welcome commitment to tackling long-standing injustices faced by people with mental health problems is being undermined.

Its report, The State of the NHS Provider Sector, concludes that the impact of rapidly rising demand, workforce shortages and the failure of funding to get through to the frontline means core mental health services are being overwhelmed.

The findings are based – in part – on the largest regular survey of NHS trust chairs and chief executives, which drew responses from nearly two thirds of trusts that provide mental health services and more than half of all NHS trusts in England.

The report sets out how the provider sector is performing, the challenges trusts are facing, and the support they need as we face another five years of constrained funding and rapidly rising demand. Alongside the survey it presents other published data, together with extensive analysis and commentary.

The centrepiece of the report is mental health – a critical area of care for the NHS and other public services, as well as being a growing concern for wider society. The report acknowledges the strong and welcome commitment from the top of government to address long-standing inequalities in care for people with mental health needs. This is starting to enable better service provision in the targeted areas. However trust leaders say the position of core mental health services is deteriorating.

Findings from a survey of NHS mental health trust chairs and chief executives show:

  • More than 70% expect demand to increase this year – leaders say this is overwhelming core mental health services and outstripping their capacity to provide effective care to service users
  • Fewer than one in three is confident they have enough staff to deliver existing services let alone extending or creating new services. In particular, trusts are struggling to recruit enough mental health nurses and psychiatrists
  • Just one in 10 say their local trust is managing demand and planning for unmet need for key mental health services, including those for children and young people
  • A large majority (80%) say extra money intended for mental health at a national level is still not getting through to NHS mental health trusts operating frontline services
  • The pressures on services are affecting the speed and quality of care for some people with mental health needs
  • Mental health services are not being given enough priority in planning for the future, in sustainability and transformation partnerships, with only 11% of respondents confident that their local STP will lead to improvements in access and quality of services.

The report goes on to call for:

  • Realism about rising demand and what is needed to meet it, recognising that increased focus on mental health and current societal pressures will generate more demand
  • Ways to guarantee that mental health funding reaches frontline services provided by NHS trusts
  • A robust workforce strategy combined with support at local level to make it happen.

Director of policy and strategy at NHS Providers, Saffron Cordery, said: “These concerns point to a growing gap between the government’s welcome ambition for the care of people with mental health needs and the reality of services they are receiving on the front line.

“In some cases, core mental health service provision by mental health trusts is actually getting worse.

“NHS mental health trust leaders from up and down the country have told us how concerned they are about the future sustainability of services. Over 70% of mental health leaders told us that they expect demand for services overall to grow. When we look at child and adolescent mental health services (CAMHS) and mental health crisis care that figure was 90%.

“Having the right staff, with the right skills in the right place is the only way to improve mental health services on the ground. But mental health trust leaders are struggling to find sufficient staff to deliver their current services, let alone find new staff to extend, transform or innovate services. And too often trust leaders report that any extra funding is just used to fill existing gaps or to manage current demand, not improve service quality or access.  Unless action is taken to address these areas of concern then the government’s ambitions for transforming mental health care will not be met.

”We need to develop ways to ensure that money committed for mental health gets through to the NHS front line and is spent effectively on quality services. Second – we must be realistic in the way we respond to growing demand, recognising that societal pressures are increasing the need for mental health services. And third – worries over staffing gaps revealed in the survey once again underline the urgency for a proper comprehensive workforce strategy.”

The report also assesses the four wider themes addressed in the inaugural The State of the NHS Provider Sector report last November: quality and patient access, finance, workforce and transformation. Here too, it combines analysis and commentary, published data and the views of trust leaders drawn from a survey:

  • Fewer than two out of three chairs and chief executives (61%) were confident their trusts were able to provide high quality care- slightly down compared with the previous report
  • A quarter expected their finances to improve over the next six months. A third expected them to deteriorate
  • Well over half (57%) were worried about their ability to maintain the right numbers of staff to deliver high quality care
  • The survey confirmed concerns about the pace of service transformation. Almost two thirds (62%) were worried that this was not happening quickly enough

The report goes on to call for:

  • A smaller number of priorities with a realistic delivery trajectory for each, bearing in mind the widening gap between what the NHS is being asked to deliver and the money available
  • More capacity in health and social care to manage next winter safely. There is a clear risk that as pressures continue to grow, the difficulties encountered last winter will be more severe and extensive next time round. NHS Providers has called for a funding injection of £350 million, committed by the end of July at the latest.
  • Clarity on the status of EU nationals working in the NHS and an immigration system that allows the NHS to recruit the staff it needs.

Helen Gilburt, Fellow in Health Policy at The King’s Fund, said: “This report yet again raises concerns around how good intentions on mental health are often not translating into better services on the ground. The NHS is under severe financial pressure, but sacrificing funding for mental health to relieve other parts of the system is at odds with the commitment to parity of esteem between mental and physical health.

“Mental health services must be at the heart of ambitions to transform the NHS to make sure it can meet future need. NHS organisations must be held to account if they fail to meet commitments to ensure funding reaches the frontline. It is also vital that sustainability and transformation plans have a sufficient focus on mental health.

“Without this, it is difficult to see how the political rhetoric around parity of esteem for mental health will be matched by the kind of high-quality mental health services that people need.”

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