Most NHS clinical commissioning groups are not achieving key goals for improving children’s mental health services, according to a new report.
The Education Policy Institute found almost three quarters of CCGs did not meet improvement goals set by NHS England.
“The funding needed for mental health services is not getting through to the frontline”
Meanwhile, less than a third had a fully funded plan to improve crisis care and about 10% – 22 CCGs in total – had no agreed plan for crisis care or any funding set out, said the institute in its new report.
The institute also found some vulnerable children were still being treated on adult mental health wards and uncovered wide variations in funding between CCGs, suggesting “a postcode lottery in children’s and young people’s mental health care”.
Its findings are based on an analysis of NHS England’s new Mental Health Five Year Forward View Dashboard, launched last year and designed to track the performance of CCGs.
The dashboard sees CCGs score themselves for overall performance based on answers to questions about key aspects of service improvement, such as workforce planning and spending plans.
Researchers from the Education Policy Institute looked at the latest available data – from the second quarter of 2016-17 covering July to September 2016.
“They need more of the promised – and welcome – government funding as soon as possible”
NHS England’s own benchmark for improving services is a score of five out of six – or 83%. However, 73.2% of CCGs did not hit that target and about a third – 34.6% – were significantly below the threshold, scoring less than 50%.
There were regional variations, with the highest performance seen in the South of England where 42.6% of CCGs met the set standard, compared to London where just 18.8% were on target.
The dashboard assesses progress on crisis care and whether or not plans to improve services are fully developed and funded.
Only 31.6% CCGs were fully compliant with this standard, about 58% were partially compliant and 10.5% were not compliant – meaning they had no agreed plan or finance to improve crisis care from its current level.
Mental health nurse shortage puts strategy ‘at risk’
The dashboard data also revealed 90 children spent a total of 2,654 nights on adult wards between July and September 2016.
This marks a significant increase from the previous quarter when 79 children spent 1,938 days on adult wards, although researchers said it was not clear if this was just a blip or seasonal variation, or an ongoing trend.
When it came to planned spending, there were also wide variations between CCGs with those in the top quarter spending more than £52 per head and those in the bottom quarter spending £23 or less.
Report author Emily Frith, director of mental health at the institute, said it showed the government “still has a long way to go to drive up standards”.
“Our analysis illustrates the need for further national scrutiny of local transformation plans and funding, so that the much vaunted improvements to services are actually delivered,” she said.
The NHS Providers organisation, which represents trusts, said the report painted “a worrying picture about support” for children’s mental health services.
“It is disappointing that, despite repeated commitments to ensure parity between mental and physical health, the funding needed for mental health services is not getting through to the frontline,” said its director of policy and strategy Saffron Cordery.
“This undermines the ability to invest in and meet the benchmark of improvement set by NHS England,” she said. “This lack of investment is leading to a difference in the quality of services accessed by patients in different areas.”
Sean Duggan, chief executive of the NHS Confederation’s Mental Health Network, said the report showed “urgent action” was needed to overcome obstacles standing in the way of progress – not least lack of funding.
“Children’s mental health services are among the frontrunners in modernising care but they face growing pressure, so they need more of the promised – and welcome – government funding as soon as possible,” he said.
“There is clearly unacceptable variation in the quality of services received by children, as well as a major issue surrounding the number of young people being treated in adult wards,” he added.
“We are investing £1.4bn in children and young people’s mental health care”
Department of Health
However, a Department for Health spokesman insisted that plans to improve services were “on track”.
“Every child in crisis should get the support they need — that’s why we are investing £1.4bn in children and young people’s mental health care and are holding CCGs to account for how this is used,” he said.
“We know change won’t happen overnight, but improvements to services are on track – there are a record number of child and adolescent mental health service beds and there will be liaison mental health services in every [accident and emergency department] by 2020.”
The DH said that where CCGs were not meeting investment expectations, NHS England would be working with them to compare plans with projected funding and the expectations of providers.
The department also stressed that the Five-Year Forward View for Mental Health was a five-year programme and, therefore, said “we should not expect immediate results in all areas”.