Evidence submitted by Rethink (Def 24)
1. We are pleased to have the opportunity
of contributing to this inquiry. Rethink is the charity for people
who experience severe mental illness and for those who care for
them. We are both a campaigning membership charity, with a network
of mutual support groups around the country, and a large voluntary
sector provider in mental health, helping 7,500 people each day.
Through all its work, Rethink aims to help people who experience
severe mental illness to recover a meaningful and fulfilling life
and to press for their families and friends to obtain the support
they need.
2. For the main part of our evidence, we
would like to focus on the consequences of the deficits for mental
health, and the effect on care. Rethink has been campaigning about
cuts over recent months, and have conducted our own investigation
into mental health budget cuts, and the effect that this is having
on those directly affected by any changes to services—service
users and carers. It is from this basis that we feel well placed
to comment on how NHS deficits are felt "on the ground".
3. The last financial year (April 2005-06)
was a difficult year for those using and working in health services.
Some NHS Trusts faced huge deficits and details of cuts to services
hit the headlines. The effect on mental health services, according
to service users and carers that Rethink are in touch with, has
been particularly acute, but less well publicised.
4. According to the Institute for Public
Policy Research and Rethink, mental health trusts are generally
below the standards of the average health trust.[38]
The Healthcare Commission performance ratings for 2004 revealed
that mental health trusts have the lowest number of three and
two star trusts and the highest number of no star trusts, compared
with acute, Primary Care Trusts specialist trusts and ambulance
trusts. Mental health Trusts often cited funding constraints as
causes for their difficulties.
5. And yet there have been huge developments
in mental health services since 1999 following the National Service
Framework for Mental Health in that year and the NHS Plan in 2002.
New services, such as early intervention and crisis resolution
teams, have supported a number of people through a crisis and
helped a number of crises to be avoided. However, there is real
concern that these specialised services are being delivered at
the expense of other services that would help other people who
do not fall into the criteria for these particular specialisms.
6. The introduction of new services—"reconfiguration"—into
areas with already overstretched budgets puts mental health trusts
under even more pressure, and our campaign has so far uncovered
over £30 million cuts in over 30 areas in England. With little
new health money in the March Budget and future funding increases
under doubt as the Comprehensive Spending Review looms in 2007,
there is real concern that mental health will again live up to
its name as the Cinderella of the NHS. Further details of our
investigations and specifics about cuts we have heard about can
be seen in our report a cut too far (enclosed with this memorandum)
and can be downloaded at www.rethink.org/cuts
7. It was around the end of last year that
Rethink began hearing about worrying cuts to mental health services
around the country. Service users, carers and staff began alerting
us to plans that suggested health trusts were targeting mental
health services in order to "plug" gaps in their wider
budgets as the financial year was coming to a close.
8. Rethink responded by gathering as much
evidence as possible from our networks to start building a picture
of what was happening on the ground. We contacted the Department
of Health and Louis Appleby, National Director for Mental Health,
demanding an urgent investigation into the situation. Individual
MPs were briefed and many helped to pursue the matter directly
with the ministers in the Department of Health and made efforts
to find out the situation in their particular constituency.
9. As a result, the Department of Health
contacted 28 Strategic Health Authority (SHA) Finance Directors
asking for specific information about their financial situation.
The results were announced in a parliamentary debate on mental
health services in February 2006.
10. Twenty Strategic Health Authorities
reported no reductions to planned expenditure on mental health
services; the remaining eight reported that there would be reductions
in planned expenditure affecting 11 out of 84 mental health trusts
in England. Those trusts had planned to spend £894 million
in this financial year, and they are reducing their planned expenditure
by a total of £16.5 million—that is 2% of the total.
11. However, these "official"
figures do not sufficiently address the real fears and problems
service users, carers and those working on the ground in mental
health services are experiencing. Nor do they account for the
widespread experience of reduced services being felt by people
on the frontline—and, perhaps even more importantly, do
not take account of more cuts planned for the current financial
year. Some examples of the effect this is having on services users
and carers can be seen through comments Rethink received in response
to our campaign, from service users and carers:
12. "As a user of mental health services
I am extremely worried . . . I had a relapse earlier this year
and was not admitted to hospital due to lack of beds." Service
User, Cambridgeshire.
13. ". . . what struck us all straight
away was the fact that the mental health services, whose budget
was not in deficit, were going to have to contribute to the overall
deficit of the healthcare Trust in order to reduce this."
Carer, Cornwall.
14. ". . . patients and carers will
have to travel much longer distances for treatment and visiting,
for prolonged periods in many cases, and damaging upheaval and
stress is being caused by the enforced change of psychiatrists
and Community Psychiatric Nurses." Carer, Buckinghamshire.
15. "Management will not say there
will be cuts. The term used is modernisation." Carer, Worcester.
16. The new budget year of 2006-07 sees
new financial and accounting arrangements being introduced across
the National Health Service. Trusts are being told to budget for
a surplus this year—and not just break even. Payment by
Results, an internal payment system designed to encourage money
to follow the patient, will introduce a new level of financial
instability into a system that historically has relied on predictable
flows of money from pre-set block contracts. "Tariffs"—centrally
set costs for a range of medical procedures—will benefit
those trusts with low costs and place a new burden on those with
higher costs.
17. Of course, mental health services are—for
now—excluded from the payment by results and tariff systems,
but that does not mean they will be unaffected. Just as in the
last financial year of 2005-06, when the NHS looked to mental
health as a "soft touch" to share the pain of deficits
run up in physical health, so cash-strapped trusts that fail to
get to grips with the new financial regime and its in-built instabilities,
will again look to mental health spending to make up the difference.
18. But there are signs that mental health
is no longer such a soft touch. Campaigners took to the streets
in Cambridge and Oxford when mental health was threatened last
year and across the country individuals raised the issue of local
mental health cuts with their MPs and local media. It is the responsibility
of government to take seriously any evidence of cuts and act appropriately
to prevent the negative impact they have on those using services
and their carers—and on the government's long-term mental
health reform programme.
19. The very success of the government's
mental health reform programme is threatened by the cuts we and
others have highlighted. But it is a reform programme that has
raised the expectations and aspirations of people using mental
health services, their families and the people who work in them.
20. In response to our report, the government
stated that there was no evidence that mental health services
were being disproportionately targeted for cuts. They are refusing
to acknowledge both the scale of the existing problem, and the
scale of potential problems linked to greater financial instability
this year (as previously discussed above). However, Rethink has
been encouraged privately by trust Chief Executives and lay members
of primary care trusts, as well as senior staff in the Department
of Health, to challenge the official figures provided by Strategic
Health Authorities in the pre-Christmas exercise, which none of
these people have any confidence in. The government are unable
to accurately track financial flows from the centre to mental
health locally.
21. Rethink and our networks are extremely
concerned that the situation for mental health services will only
get worse in the future if more is not done now. We must protect
services that help support the most vulnerable members of society.
Current increased investment in mental health and the broader
NHS will not continue at its present rate and the government,
trusts and all those involved in service provision need to work
together to protect current services and safeguard them for the
future.
22. We have therefore called on the Department
of Health to take action and to do so as a matter of priority.
This must include:
— An assurance from both government
and trusts that mental health remains a key health priority both
at a national and local level.
— The government must order an urgent
investigation into all potential budget cuts it is alerted to,
including those included in our report a cut too far.
— The government and Trusts must work
together to develop an emergency plan to overcome the funding
crisis.
23. We welcome the inquiry that the Health
Committee has launched into NHS deficits as we feel strongly that
the effect on mental health services must be included in any investigations.
We would be happy to contribute oral evidence to this inquiry.
Please do contact me directly if you would like any further information.
Paul Corry
Director of Public Affairs, Rethink
2 June 2006
38 Rankin, R (2005) Mental Health in the Mainstream.
Institute for Public Policy Research, London Back
| 
