News / Providers report parity of esteem funding gap

09 May 2016 Steve Brown

Planning guidance for 2015/16 – repeated in guidance for 2016/17 – required ‘each clinical commissioning group’s spending on mental health services to increase in real terms and grow by at least as much as each CCG’s allocation increase’.

However, in a survey undertaken by the HFMA in conjunction with NHS Providers, only half of the 32 mental health trusts taking part (55% of all trusts) said they had received an increase in funding that met these requirements.

This was despite more than two-thirds of these lead CCGs signing up to the principle of parity of esteem. All CCGs taking part in the survey (representing 10% of all CCGs) said they had signed up to parity of esteem and had increased real-term investment in mental health services in line with the planning guidance requirement.

The report highlighted a ‘disjoint’ about whether the investment requirement is being met. It said that part of the problem was ‘what organisations badge as mental health spend’.

Some respondents said that commissioners were investing in areas not provided by secondary care trusts, such as primary care, drugs, the mental health component of continuing healthcare and out-of-area services.

‘This means that commissioners might report that they have increased their spend on mental health services, while some providers will have seen no direct investment or even, in some cases, disinvestment,’ the report added.

NHS Providers and the HFMA said it was ‘concerning that investment priorities and funding are not currently aligned at a local level’. They also highlighted tension created by different rules – the increased investment requirement sat alongside a starting point for contract discussions of a 1.6% reduction in contract prices, in line with the national tariff adjustment.

The survey also found that only a quarter of provider respondents (at the time of the survey) were confident their commissioners were going to increase investment in mental health services in line with allocation growth in 2016/17.

Paul Briddock, HFMA director of policy, said commissioners and providers needed to work collaboratively. ‘The report shows that we are not quite where we would like to be. It is important that commissioners are open and transparent about where the extra funding is being distributed, what it is being spent on and the impact it is intended to have,’ he said.

‘This will give concerned providers the reassurance they need that the right financial investment will reach the front line, and the patients it needs to at a local level.’

This report can be accessed in our publications.

Access standards challenge

The Department of Health and NHS England are making progress in supporting mental health access and waiting time standards, but much remains to be done, according to the National Audit Office. Access standards were set in October 2014 as part of plans to achieve parity of esteem between physical and mental health. However, an NAO report said that the full cost of implementing the standards and meeting longer term ambitions was ‘not well understood’. It said there was not yet enough information to measure how far the NHS is from meeting the standards. NAO leader Amyas Morse described the recognition that mental health had been treated as a ‘poor relation’, the goal of parity of esteem and setting access standards as ‘bold and impressive steps forward’. ‘It is important these steps are supported by implementation in a reasonable timescale if they are not to be a cause for disillusionment,’ he said. ‘And this looks challenging in current conditions.’

Online view

Writing in a blog on NHS Providers’ policy adviser Philippa Hentsch (right) said it was worrying that ‘despite the rhetoric around increasing funding … the necessary investment is still not reaching many local areas and services’. She added that the ‘lack of alignment between investment priorities and funding at the local level needs to be addressed’.

Access standards challenge

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