It gives an honest diagnosis of current shortcomings in mental health care in England, and a detailed analysis of how best to target available resources in the future. It follows hot on the heels of last week’s report from the Commission on Acute Adult Psychiatric Care, which gave a similarly frank assessment of the need for improvement.
A particularly encouraging message in the taskforce report is the call for mental health care to be embedded much more deeply within the wider health care system. There are welcome proposals for investment in liaison psychiatry, perinatal mental health services, physical health screening for people with mental health problems, and trialling of other service models that straddle the boundary between mental and physical health. Our forthcoming research and conference on integration of mental and physical health care will provide further evidence on the importance of this and examples of how it can be achieved in practice.
Inevitably, much of the commentary on the taskforce report has centred on one question: is it realistic? My view is that most or all of the recommendations could be achievable if the government and NHS leaders have the will to make this a priority. But it certainly won’t be easy, and one of the most significant challenges will, of course, be the money.
As has been widely remarked, the commitment to increase spending on mental health by £1 billion a year by 2020/21 comes from funding already allocated to the NHS in last year’s Spending Review. In effect, the commitment made by NHS England is that mental health services should expect to receive a proportionate share of the £8 billion pledged by the government in their 2015 election manifesto (the NHS currently spends around £1 in every £8 on mental health).
There are three significant issues that might prevent this commitment from being delivered in practice. First, in 2016/17 (and quite possibly beyond) much of the increase in NHS England’s budget will be needed to stabilise services in the short term and cover rising deficits among NHS providers (predominantly in acute trusts rather than mental health providers). This raises the prospect of most of the new money for transforming mental health services being phased in later in this parliament. It is worth remembering that the £8 billion requested by the NHS was the minimum required, leaving little headroom for investment in new service improvements.
Second, the detail behind the Spending Review settlement reveals that the £8 billion increase in the funding received by NHS England by 2020/21 will be partially paid for by reduced spending elsewhere in the health system, particularly public health, education and training. The recommendations made by the taskforce put significant emphasis on increasing investment in preventing mental illness and promoting mental health, and on placing greater priority on preventing physical ill health among people with mental health problems. There are also important recommendations for professional education and training. It is not clear how much capacity there will be to act on these recommendations in parts of the system that are set to see their budgets fall in real terms over the next four years.
Third, there is the question of whether adequate forms of oversight exist to ensure that the money gets to where it’s needed, and to hold local commissioners to account for achieving the vision that the taskforce describes. It has always been notoriously difficult to track spending on mental health services with any degree of precision, and even harder to measure outcomes. Proposals made by the taskforce for increased transparency in relation to spending by clinical commissioning groups, accompanied by a ‘data revolution’ in mental health, are therefore an indispensable part of the plan.
The last of the 58 recommendations made by the taskforce is that by summer of this year, NHS England, the Department of Health and the Cabinet Office should ‘confirm what governance arrangements will be put in place to support the delivery of this strategy’, including ‘arrangements for reporting publicly on how progress is being made’. If the work of the taskforce is to make it off the shelves and into practice, that final recommendation is arguably the most important one to watch.