Mental health services face “significant risks” in meeting new national waiting time targets, in particular due to a lack of understanding of the required number of staff, a report by the national audit body has found.
Problems with data – in particular on nurses – were identified by the National Audit Office in its analysis of how the Department of Health and NHS England were implementing their new requirements.
“It is important that these steps are supported by implementation in a reasonable timescale”
Estimates by local providers of the number of mental health nurses needed to meet the new standards “vary markedly” from forecasts produced by national workforce body Health Education England, noted the report – titled Mental health services: preparations for improving access.
NHS trusts have said they expect demand for mental health nurses to fall over the coming years, but HEE expected the workforce would need to grow by 7%, from 39,000 in 2014 to 42,000 by 2020.
The NAO found plans were still not yet in place to ensure the required number of workers were available to meet one of the standards, which aims to improve early intervention in psychosis, as well as the government’s ambitions for liaison psychiatry services.
In 2014 the government announced it would introduce new waiting targets from April 2016 that ensure 75% of people referred to talking therapies through the Improving Access to Psychological Therapies programme (IAPT) receive treatment within six weeks. In addition, 95% of people should receive treatment through IAPT within 18 weeks.
Meanwhile, more than half of people experiencing a first episode of psychosis should be treated with a care package that complies with National Institute for Health and Care Excellence guidance within two weeks of referral. It also said it would invest £30m in liaison psychiatry in acute hospitals.
“There are not enough staff on the frontline to deliver what is required”
The NAO found that, while figures show the IAPT waiting times were already being met at a national level, performance varied substantially across different geographical areas.
Nationally, in 2014-15, 79% of people entered treatment within six weeks of referral and 96% within 18 weeks. However, 39% of the 211 clinical commissioning groups did not achieve the six-week standard.
Complete information was not yet available to measure performance against the target for early intervention in psychosis, said the NAO.
In assessing the government’s ambition to boost liaison psychiatry services, the body found a survey of acute hospitals in July 2015 indicated only 7% had one operating 24-hours a day, seven-days a week, when NHS England requires 100%.
The DH and NHS England were starting to make progress with the actions needed to implement the standards but much more remained to be done, concluded the report.
NHS workforce planning has ‘serious shortcomings’
“The Department of Health has recognised that mental health has been treated as a poor relation relative to other health needs for many years,” said Amyas Morse, head of the National Audit Office.
“This recognition, the goal of ‘parity of esteem’ and the setting of new standards for access and waiting times are all bold and impressive steps forward,” he said.
“It is important that these steps are supported by implementation in a reasonable timescale if they are not to be a cause for disillusionment, and this looks challenging in current conditions,” he added.
Luciana Berger, shadow minister for mental health and Labour MP for Liverpool Wavertree, said the report “shone a spotlight” on the “startling” lack of progress the government had made so far.
“Shockingly, despite the government promising new funding to deliver these reforms, local CCGs are having to pay for most of the cost from their existing budgets at a time when they are already under pressure,” said Ms Berger.
Auditors identify mental health workforce discrepancies
“The new standards were meant to come into effect at the beginning of this month, but there are not enough staff on the frontline to deliver what is required and there isn’t the right information available to assess if the government is meeting its target or not,” she said, adding that the report should act as an “urgent wake-up call” for minsters to deliver the reforms.
A DH spokesman said: “We are well aware of the challenge ahead – our ambitious goals for mental health are backed by an additional £1bn funding by 2020.
“We have made big improvements in mental health data, publishing more statistics than ever before and launching the first national survey of children and young people’s mental health since 2004,” he said.
He added: “We will publish a five year plan for mental health data by the end of this year – as recommended by NHS England’s independent mental health taskforce in February.”