Mental health trusts have been left with less funding in real terms than they had in 2012 as experts warn patients with mental illness are “bearing the brunt” of government cuts to the sector.
New analysis by the Royal College of Psychiatrists (RCPsych) shows that while the Government states mental health spending is at “record” levels, the income of mental health trusts in England is lower than it was six years ago once inflation is taken into account.
NHS England has disputed claims, saying they “ignore the fundamental fact” that some trusts provide services unrelated to mental health, and that responsibility for funding many of the services provided by the trusts has transferred from the NHS to local government.
But RCPsych said mental health trusts were central to treatment of mental illness in England, with almost 90 per cent of all psychiatrists in the country working in trusts. They urged the fact that some trusts provide community services not directly related to mental health should "not distract" from the figures.
The analysis of figures, based on annual reports and accounts for mental health trusts and the latest set of GDP deflators from the HM Treasury, shows more than half (62 per cent) of trusts reported lower income at the end of 2016-17 than the amount for 2011-12. Only one saw an income rise in all five financial years, while nine trusts saw their income fall in all five years.
The total amount of income that mental health trusts in England received in 2016-17 was £11.829bn. While the figure has risen overall in each of the past two years, it remains £105m lower than in 2011-12 at today’s prices. The picture across the UK was similar, with mental health spending in Wales, Scotland and Northern Ireland all lower now than it was in recent years.
In October 2017, Mr Hunt said the NHS had spent a “record” amount on mental health, and pledged to a “commitment to maintain a healthy flow of investment into mental health services”. He also referred publicly to the extra £575m spent by clinical commissioning groups (CCGs) in 2016-17 compared with the previous financial year.
The RCPsych claimed the funding situation was “opaque” due to the fact that it is now up to the CCGs to pass this money on to mental health trusts and other providers.
The Health and Social Care Act in 2012 changed the way mental health services were funded, with mental health trusts now only part of the picture, as funding is also distributed through GPs, local councils, private providers and the voluntary sector.
While spending by commissioners is monitored by NHS England’s mental health statistics “dashboard”, the RCPsych claims there is no regular publication of high-quality data for those other organisations.
The organisation is now calling for mental health trusts to be given more money and for better ways of tracking where mental health money is being spent, amid fears that some of that money is failing to reach the frontl ine.
Professor Wendy Burn, the president of RCPsych, said it was “totally unacceptable” that when more and more people are coming forward with mental health problems, services are receiving less investment than they did seven years ago.
“Patients with mental illness continue to bear the brunt of an underfunded sector experiencing unprecedented demand with limited supply,” she added.
“Prioritisation of mental health is about getting the right care, at the right time, in the right place. This can’t happen when mental health trusts continue to receive inadequate investment.”
Barbara Keeley MP, Labour’s shadow minister for mental health and social care, said: “This analysis has dealt a hammer blow to Tory claims that they have made mental health an equal priority to physical health.
“Real-terms cuts added to the fragmentation of services have come at a time when demand for mental health services is increasing. Tory ministers must increase investment in mental health services and ring-fence budgets, as Labour pledged to do at the last election, so that funding reaches the front line.“
An NHS England spokesperson disputed the claims, saying: “This sloppy press release contains basic flaws and obvious mistakes.
“Firstly it ignores the fundamental fact that many of the trusts it references provide both mental health and community services entirely unrelated to mental health. So changes in the trusts’ total income tells us nothing about their mental health revenues specifically.
“Secondly, their press release seems to forget that during the period in question, responsibility for funding many of the services these trusts provide, such as sexual health clinics, transferred from the NHS to local government.
“Thirdly, it suppresses the inconvenient truth that NHS mental health investment has been increasing in real terms both last year and this. Indeed even on its own flawed maths, the briefing concedes: ‘the total in 2016-17 was higher than any of the previous four years’”.
Responding to this, a RCPsych spokesman said they had "absolute confidence" that although trust income has gone up since 2014 – in real terms it is still below the levels achieved five years ago.
The added: “As NHS England highlights, mental health finances in England are confusing and it is extremely difficult to track how every penny of tax payers money is being spent. This is a shocking state of affairs which must be remedied so that voters can be confident that money intended for mental health services is being spent on them.
“A particular source of confusion, highlighted by NHS England, is that 29 of the 55 trusts (2016/17) also provide community services such as district nursing and sexual health not directly related to mental health. This should not distract those seeking to ensure that more money goes to front line mental health services from the essential truth here."
The spokesperson urged that trusts "have a primary responsibility for treating mental illnesses" and that the amount of money they have to spend must therefore be a "key indicator" of their ability to fulfil that purpose.
“RCPsych pays tribute to the efforts that NHS England has made – through developments such as the Mental Health dashboard – to improve transparency of mental health spending," the spokesperson added.
“We have and will continue to assist in every way with these vital endeavours and call upon NHS England to publish the update to the dashboard which was due in the autumn of last year.”
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