Mental health trusts have less money to spend on patient care in real terms than they did in 2012, official figures analysed by the Royal College of Psychiatrists show.
The College is calling for mental health trusts to be given more money and for better ways of tracking where mental health money is being spent.It fears some of that money is failing to reach the frontline.
Mental health trusts’ income is lower in England now than it was in 2011-12 once inflation is taken into account, according to the latest available figures.
This is despite the Government’s assertion that mental health spending is at “record” levels. It comes as demand for services soars, with some trusts saying a lack of funds has forced them to cut services.
The picture across the UK is similar, with mental health spending in Wales, Scotland and Northern Ireland all lower now than it was in recent years.
Professor Wendy Burn, the College’s president, said: “It is totally unacceptable that when more and more people are coming forward with mental health problems, trusts are receiving less investment than they did, in some cases, seven years ago.
“Patients with mental illness continue to bear the brunt of an underfunded sector experiencing unprecedented demand with limited supply.
“Prioritisation of mental health is about getting the right care, at the right time, in the right place. This can’t happen when trusts continue to receive inadequate investment.”
For England, the College looked at the trusts’ annual reports and data on their spending published by regulators. For Scotland, it looked at data published by the health arm of the Scottish government; for Wales, Welsh government data; and for Northern Ireland, data provided by its department of health. All the data was adjusted for inflation.
- 62% of mental health trusts (34 out of 55) at the end of 2016-17 reported lower income than the amount for 2011-12
- Only one trust saw their income rise all five financial years
- Nine mental health trusts saw their income fall all five years, including three in Yorkshire and Humber
Rest of the UK:
- In Scotland, there was less money spent by health boards on mental health in 2016-17 compared to 2009-10 in real terms
- In Northern Ireland, mental health investment by the Health and Social Care Commissioning Board in real terms is down on where it was two years ago
- In Wales, mental health investment in real terms is lower than it was in 2010-11
The situation is at odds with recent claims by both the Prime Minister Theresa May and Health and Social Care Secretary Jeremy Hunt that mental health funding is at “record” levels.
Similarly, Mr Hunt has referred publicly to the extra £575 million spent by commissioners (Clinical Commissioning Groups) in 2016-17 compared with the previous financial year.
But it is up to the CCGs to pass this money on to mental health trusts and other providers and the College’s figures reveal that mental health trusts’ income is still lower than it was in 2012.
Part of the reason why the funding situation is so opaque is because the 2012 Health and Social Care Act changed the way mental health services are funded.
Mental health trusts are now only part of the picture – mental health funding is also distributed through GPs, local councils, private providers and the voluntary sector.
The picture is further confused by the fact some mental health trusts also provide community health services such as district nursing and sexual health. As the King’s Fund think-tank has pointed out, given the key role mental health trusts have in providing mental health services their income provides an important marker of their ability to deliver that care.
For example, as of September last year 89.5% of all NHS psychiatrists are employed by a mental health trust, according to NHS Digital.
While spending by commissioners in monitored by NHS England’s mental health statistics ‘Dashboard’, there is no regular publication of high-quality data for those other organisations.
The College is calling for comprehensive spending data to be published regularly by all providers of publicly-funded mental health services.
The total amount of income that mental health trusts received in 2016-17 was £11.829 billion, £105 million lower than in 2011-12 at today’s prices.
Of those trusts, only one trust (Tavistock and Portland NHS Foundation Trust) saw its income rise in each of those five financial years (2012-13, 2013-14, 2014-15, 2015-16 and 2016-17).
Nine trusts – Black Country Partnership NHS Foundation Trust, Coventry and Warwickshire Partnership NHS Trust, Leeds and York Partnership NHS Foundation Trust, Norfolk and Suffolk NHS Foundation Trust, North West Boroughs Partnership NHS Foundation Trust, Rotherham, Doncaster and South Humber NHS Foundation Trust, Solent NHS Trust, South West Yorkshire Partnership NHS Foundation Trust and Worcestershire Health and Care NHS Trust – all saw their income fall for five years in a row over that period.
For example, Black Country Partnership saw their income fall from £118,429,000 in 2011-12 to £101,400,000 in 2016-17, a fall of 14.38%.
In 2016-17, health boards spent £936,606,000 on mental health compared with £996,732,000 in 2009-10 in real terms, a fall of 6%. (These figures are for net spend).
According to Welsh government programme budget data, the amount spent on mental health care fell from £699,830,000 in 2010-11 to £697,940,000 in 2015-16 at today’s prices, a fall of 0.3%.
According to figures supplied by NI’s department of health, mental health spending fell from £262,330,000 in 2014-15 to £259,000,000 in 2016-17 at today’s prices, a fall of 1.3%.
England case studies
Cornwall Partnership NHS Foundation Trust had three years of real-term income cuts in a row (in 2013-14, 2014-15 and 2015-16). A new contract for community services won in 2016-17 saw them move into the black overall for the period the College analysed, but medical director Dr Ellen Wilkinson said she had seen first-hand the damaging effects of underfunding. She said her trust had made savings each year but that as it got harder to make the savings required it would be forced to take money out of funding doctors, nurses and crucial clinical resources.
Historic underfunding has set many services up for failure, she said. In one instance, money was given to commissioners for children and young people’s mental health services, but then subsumed into paying off overall debt, she added.
“There is no doubt that demand on mental health services is going up, and there is a real danger that because of well-known pressures people are reluctant to come forward when they need it the most,” she said.
“We’re also finding that smaller support services which help supplement and complement mainstream NHS services are being cut. Services like domestic violence support, befriending or services to help families with problems just aren’t getting the same funding in the current climate.”
The medical director from a Midlands mental health trust, which also had its income squeezed, painted an equally bleak picture.
The medical director, who wanted to remain anonymous, said doctors’ case-loads had gone up at the same time as public expectation about the services had risen and the trust was having to cut services.
Five years ago, they had a liaison-psychiatry service seven days a week and now cuts have brought that down to weekdays only.
“Our doctors are seeing more patients and yet resources are more scarce. How are we supposed to cope with this mental health crisis in that kind of environment?” the medical director said.