Mental health funding squeeze has lengthened waiting times, say NHS finance leads

Eight out of ten NHS trust finance directors say that funding pressures have led to longer waiting times for people who need mental health treatment, according to The King’s Fund’s latest quarterly monitoring report.

New analysis for the report also shows that despite NHS England meeting its commitment to increase its investment in mental health, nearly a quarter of mental health trusts recorded a reduction in income between 2016/17 and 2017/18. An analysis of mental health trusts’ financial accounts carried out for the report found that, while mental health trusts as a whole reported an overall increase in funding, 21 per cent recorded a reduction in income last year, up from 13 per cent the previous year.

The findings are contained in a detailed analysis of the state of mental health services, included in the think tank’s quarterly report for the first time. It shows that key waiting time targets for psychological therapies and services for people experiencing psychosis are being met. But, progress in these areas has not been mirrored by progress in all. Looking across a fuller range of services provided, 80 per cent of trust finance directors surveyed for the report said that financial pressures have led to people waiting longer to get help in the past two years. Even after patients are able to access mental health services, the finance directors said that the pressure to reduce costs has led to shorter courses of treatment and less contact with services.

With the Prime Minister and NHS leaders having identified mental health as a key priority for the forthcoming NHS long-term plan, the analysis illustrates the gap between the rhetoric and reality of previous commitments to give mental health parity of esteem with physical health. Only a quarter of trust finance directors said that mental health services are an essential or high priority in the plans for their local health system, with the remaining three quarters identifying mental health as a moderate or low priority. 

In another symptom of the pressure on mental health services, national data show that in September 2018, 660 patients in acute need were admitted to mental health units outside their local area, with many having to leave family and support networks behind to travel long distances for the care they need. The government has pledged to eliminate this practice by 2020/21.

Analysis of recent NHS performance data found that the whole system is under extreme pressure. 

• The number of emergency admissions to hospital in November increased by 6.3 per cent compared to the same time last year.  
• Despite a national target to halve the number of people waiting a year for routine consultant-led treatment compared to March 2018, by October 2018, over 2,800 people had been waiting more than a year for their treatment to begin. 
• In October 2018, 4.3 million patients were waiting for routine consultant-led care, such as hip and knee replacements, to begin, and 13 per cent waited more than 18 weeks – higher than the target of no more than 8 per cent.  

The report is published ahead of NHS England’s long-term plan, which was recently delayed amidst political turmoil over Brexit and is now expected early in the new year. The plan will set out how the organisation will spend the £20.5 billion funding boost, equivalent to a 3.4 per cent real terms increase a year for the next five years, announced by Theresa May in June this year. In the 2018 Budget, the Chancellor, Phillip Hammond, announced that £2 billion of this money would be spent on improving mental health services.

Siva Anandaciva, Chief Analyst at The King’s Fund and lead author of the report, said:

‘Mental health services urgently need the funding boost promised by the Government. Despite increased investment and a stronger national focus on the sector in recent years services are under huge pressure, making it harder for people to get access to the high-quality care they need. It is clear that the reality for patients is still a long way from the rhetoric of political and service leaders.

‘Across the NHS as a whole, services continue to miss financial and performance targets, with thousands of people waiting too long for treatment and workforce shortages posing a threat to the quality of patient care. The additional money promised by the government is welcome, but it will not be enough for the NHS to do everything that is asked of it. The forthcoming long-term plan will need to be clear about the priorities for overstretched services.’