Mental health goals may not be met, audit office warns

Waiting-time targets were scheduled to start in April, but NAO report says officials do not yet have a grip on how much the policy will cost.

government pledge to bring mental health services up to the standards of those for physical ailments will struggle to be met, the government’s official spending watchdog has concluded.

The National Audit Office has examined the Department of Health’s strategy for bringing a “parity of esteem” to ensure that patients do not have to wait longer for mental health therapies. New waiting time targets for those seeking help with mental illnesses were supposed to be introduced at the start of this month.

Although it is five years since the government first drew up the ambition, a report by auditors has found that the DH does not yet have a grip on how much the policy will cost.

The report found the department and NHS England have made available £120m of additional funding over the two years 2014-15 and 2015-16.

However, most of the cost of implementing the new access and waiting time standards will be met from clinical commissioning groups’ existing budgets – at a time when the NHS is under increasing financial pressure.

The findings have emerged as more people are seeking mental health treatment from the NHS. Official figures show that the number of people in contact with NHS mental health services has increased by more than a third.

Meg Hillier, the chair of the public accounts committee, said the findings were disappointing for millions of people struggling with their mental health.

“The government has committed to putting mental and physical health on an equal footing. The NAO reports that the cost of improving access is not yet clear, but the NHS is still expected to meet most of the costs from existing budgets. This risks piling pressure on to NHS commissioners and providers who are already under significant financial strain,” she said.

Auditors examined the full cost of implementing the new access and waiting time standards and concluded that it was “not well understood” by DH officials.

They found that commitments made to improve access to psychological therapies, early intervention in psychosis and liaison psychiatry services could be £160m a year more than the estimated £663m that clinical commissioning groups spent on these services in 2014-15.

Sir Amyas Morse, head of the NAO, said the goal of “parity of esteem” and the setting of new standards for access and waiting times are all impressive steps forward.

“It is important that these steps are supported by implementation in a reasonable timescale if they are not to be a cause for disillusionment, and this looks challenging in current conditions,” he said.

Figures from the NHS’s health and social care information centre, released in January, showed that the number of qualified nurses working in psychiatry dropped by 10.8% from 41,320 in 2010 to 36,870 in 2015.

Luciana Berger MP, Labour’s mental health spokeswoman, said the report shows a lack of progress in implementing mental health waiting time targets.

“The new standards were meant to come into effect at the beginning of this month, but there are not enough staff on the frontline to deliver what is required and there isn’t the right information available to assess if the government is meeting its target or not,” she said.

A DH spokesperson said it aimed to publish a five year plan for mental health data by the end of this year. “We are well aware of the challenge ahead – our ambitious goals for mental health are backed by an additional £1bn funding by 2020,” he said.

“We have made big improvements in mental health data, publishing more statistics than ever before and launching the first national survey of children and young people’s mental health since 2004.”

In a further development, a new study suggests that weekend admissions to psychiatric hospitals are not associated with a higher risk of death.

Patients admitted to a psychiatric hospital at a weekend are not at greater risk of dying in hospital compared with patients admitted during the week, according to new research from King’s College London.

Researchers examined data concerning more than 45,000 admissions to a psychiatric hospital in south London – 7,300 of which were at the weekend. They then compared the data to look at trends concerning in-patient mortality, the duration of hospital stay and a patient’s risk of readmission.

Being admitted at the weekend meant patients were more likely to have shorter stays in hospital and to be readmitted at a later date, but it was not associated with an increased risk of dying in hospital.

“This is an important consideration if mental health care services are to be implemented across a seven-day week,” the authors wrote.


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