By Lucy Phillips
22 April 2010
Significant cuts to frontline mental health services look inevitable as providers have been judged a soft target for NHS efficiency savings, Public Finance has learnt.
Concern arose after the foundation trust watchdog Monitor revised its funding forecasts for the NHS bodies it oversees, asking mental health providers to plan for cuts of up to 5% every year until 2015 from next month. This was up from original ‘downside’ assumptions of 4%–4.5% made before March’s Budget.
The reductions are higher than those suggested for acute services. In a letter to foundation trusts earlier this month, Monitor said the mental health and acute sectors faced ‘a different set of risks’. It said previous recessions had hit mental health funding more than other areas.
But Paul Jenkins, chief executive of mental health charity Rethink, told PF: ‘Historically, mental health services have been a soft touch for cuts. But it’s completely false logic to ratchet that into the future. There’s no greater resilience in mental health services than in acute services... In this case someone has looked unthinkingly at the data.’
He warned that cuts of 5% could lead to the slashing of frontline community services and early inventions for those with illnesses such as schizophrenia and bipolar disorder.
Steve Shrubb, director of the NHS Confederation’s Mental Health Network, said the group’s foundation trust members were unhappy at the retrospective approach taken by Monitor. The regulator had failed to recognise the growing role mental health trusts had in helping acute services make efficiency savings, he said.
‘Monitor have taken a relatively short-sighted view and literally looked at the past two recessions without thinking about what might be different this time.’
But a Monitor spokesman told PF: ‘As the regulator, it would be irresponsible if we failed to ensure the foundation trust sector is prepared for the coming squeeze in public spending.
‘Monitor is not in any way advising that cuts should be made to mental health budgets, but is saying that historically in times of reduced health expenditure, mental health providers have needed to meet greater efficiency requirements.’
Shrubb admitted that mental health budgets were ‘more vulnerable’ to cuts than acute services, primarily because providers were not on a national payment-by-results tariff. ‘It’s easier to lop 5% or 6% off a block contract,’ he said.
The problem was exacerbated by the lack of metrics and data around mental health service outcomes. ‘One can expect mental health trusts are going to be given quite significant efficiency programmes and will have to start looking at what they can and can’t do,’ Shrubb added.
Andy Bell, deputy chief executive of the Sainsbury’s Centre for Mental Health, said 5% year-on-year cuts to services would be ‘enormously challenging’. He added: ‘We have got to make the case for not making unwise cuts. The danger is we make a panic response and cut things on the edges of what is necessary, leading to good services disappearing.’
Bell also called for greater recognition of the savings that good mental health care could bring across to the public purse. He said that only a fifth of those who use mental health services were in paid employment and there needed to be greater emphasis on helping people into work. There was also scope for better, more cost-effective provision for those people with mental illnesses who are in the criminal justice system. ‘If you just look at mental health services alone you are missing a trick,’ he said.
Jenkins agreed: ‘When there’s a lot of pressure on public spending, mental health illness is something crying out for money to be driven into treatment rather than cut out because it will save money elsewhere. More radical thinking is necessary if we are going to pull off dealing with the debt problem and the need for appropriate support and treatment.’
The Royal College of Psychiatrists told PF it was ‘concerned about the pressure on mental health services to do more work for less money’. The college’s president, Professor Dinesh Bhugra, said: ‘Although cuts to services may improve finances in the short term, they can have serious consequences in the long term.’
22 April 2010
Significant cuts to frontline mental health services look inevitable as providers have been judged a soft target for NHS efficiency savings, Public Finance has learnt.
Concern arose after the foundation trust watchdog Monitor revised its funding forecasts for the NHS bodies it oversees, asking mental health providers to plan for cuts of up to 5% every year until 2015 from next month. This was up from original ‘downside’ assumptions of 4%–4.5% made before March’s Budget.
The reductions are higher than those suggested for acute services. In a letter to foundation trusts earlier this month, Monitor said the mental health and acute sectors faced ‘a different set of risks’. It said previous recessions had hit mental health funding more than other areas.
But Paul Jenkins, chief executive of mental health charity Rethink, told PF: ‘Historically, mental health services have been a soft touch for cuts. But it’s completely false logic to ratchet that into the future. There’s no greater resilience in mental health services than in acute services... In this case someone has looked unthinkingly at the data.’
He warned that cuts of 5% could lead to the slashing of frontline community services and early inventions for those with illnesses such as schizophrenia and bipolar disorder.
Steve Shrubb, director of the NHS Confederation’s Mental Health Network, said the group’s foundation trust members were unhappy at the retrospective approach taken by Monitor. The regulator had failed to recognise the growing role mental health trusts had in helping acute services make efficiency savings, he said.
‘Monitor have taken a relatively short-sighted view and literally looked at the past two recessions without thinking about what might be different this time.’
But a Monitor spokesman told PF: ‘As the regulator, it would be irresponsible if we failed to ensure the foundation trust sector is prepared for the coming squeeze in public spending.
‘Monitor is not in any way advising that cuts should be made to mental health budgets, but is saying that historically in times of reduced health expenditure, mental health providers have needed to meet greater efficiency requirements.’
Shrubb admitted that mental health budgets were ‘more vulnerable’ to cuts than acute services, primarily because providers were not on a national payment-by-results tariff. ‘It’s easier to lop 5% or 6% off a block contract,’ he said.
The problem was exacerbated by the lack of metrics and data around mental health service outcomes. ‘One can expect mental health trusts are going to be given quite significant efficiency programmes and will have to start looking at what they can and can’t do,’ Shrubb added.
Andy Bell, deputy chief executive of the Sainsbury’s Centre for Mental Health, said 5% year-on-year cuts to services would be ‘enormously challenging’. He added: ‘We have got to make the case for not making unwise cuts. The danger is we make a panic response and cut things on the edges of what is necessary, leading to good services disappearing.’
Bell also called for greater recognition of the savings that good mental health care could bring across to the public purse. He said that only a fifth of those who use mental health services were in paid employment and there needed to be greater emphasis on helping people into work. There was also scope for better, more cost-effective provision for those people with mental illnesses who are in the criminal justice system. ‘If you just look at mental health services alone you are missing a trick,’ he said.
Jenkins agreed: ‘When there’s a lot of pressure on public spending, mental health illness is something crying out for money to be driven into treatment rather than cut out because it will save money elsewhere. More radical thinking is necessary if we are going to pull off dealing with the debt problem and the need for appropriate support and treatment.’
The Royal College of Psychiatrists told PF it was ‘concerned about the pressure on mental health services to do more work for less money’. The college’s president, Professor Dinesh Bhugra, said: ‘Although cuts to services may improve finances in the short term, they can have serious consequences in the long term.’
