Practitioners want clarity on mental health investment

Commissioners and providers of mental health services have called for greater clarity on how mental health investment should be measured.

The NHS long-term plan has promised to increase investment in mental health services faster than the NHS budget overall for each of the next five years, with funding for children and young people’s services growing even faster than total mental health spending.

This builds – some argue minimally – on the existing mental health investment standard (MHIS) that requires clinical commissioning groups to invest in mental health services at a faster rate than their overall programme growth. Providers have complained that they haven’t seen this increase, with commissioners complying with the investment standard by increased spending on continuing healthcare for mental health and related prescribing and spending with non-NHS providers such as charities or community groups.

New surveys of commissioners and providers by the HFMA and NHS Clinical Commissioners show these concerns continue. While 85% of CCG respondents were confident of hitting the MHIS spending target, 88% of providers had low or no confidence that they would receive this same increase in their own funding. One provider commented that the standard was being achieved by investment in areas not covered by the Five-year forward view. And one CCG respondent acknowledged that high demand in mental health continuing healthcare had affected investment elsewhere.

Despite the pessimism from providers, nearly three-quarters of the commissioners taking part in the survey were confident that investment in the sector was being used to meet the targets specified in Implementing the five-year forward view for mental health.

Both commissioners and providers agreed that more guidance was needed about what should and shouldn’t be included in spending counting towards the investment standard.

There were also concerns that outcomes were not part of the measurement process and that spending on prevention was not acknowledged, despite it being essential to good population mental health.

The contradictory nature of the way the measure works was also highlighted. Increased spending on continuing healthcare may help a CCG meet the necessary levels of investment, but is contrary to other initiatives looking to contain continuing healthcare spending.

And respondents pointed out that the MHIS did not recognise historic levels of under-investment in some areas. While increasing the proportion of overall spend on mental health was welcomed, a metric that looked at spend per head of population was suggested as a more equitable approach.

Phil Moore (pictured) from NHS Clinical Commissioners’ Mental Health Commissioners Network said the disparity in confidence between CCGs and providers in meeting the MHIS was worth exploring further. However, he said that CCGs must continue investing in primary and community mental health as well as acute mental health providers – investing in the third sector was a clear commitment in the long-term plan.‘Mental health commissioners welcome the clear steer from NHS England that the money intended for mental health will now be monitored and validated, though there are concerns about the cost of such audits,’ said Dr Moore. ‘It means we need to build a consensus on where mental health money is being spent and where more needs to be done.’

Survey results: www.hfma.org.uk/publications