Evidence submitted by the Royal College
of Psychiatrists (Def 08)
1. The Royal College of Psychiatrists is
the leading medical authority on mental health in the United Kingdom
and the Republic of Ireland and is the professional and educational
organisation for doctors specialising in psychiatry.
BACKGROUND
2. In submitting a short memorandum as requested
by the Health Committee we have concentrated on the effects
on care that we are sure will result from the levels of disinvestment
that are being levied. Our access to accurate financial information
on a national basis is limited but we have reason to believe that
disinvestment of the magnitude we do know about is likely to be
widespread. We understand that the deficits in health spending
have been generated almost entirely within the acute and primary
care sectors.
3. In March this year Professor Louis Appleby,
the National Director for Mental Health, drew our attention to
a rising total of £16.5 million cuts in planned funding to
11 mental health trusts. According to the mental health charity
Rethink cuts have actually occurred in over 30 areas of the country
(A cut too far, Rethink, May 2006). These cuts are not
to do with the inefficiency or non-effectiveness of the mental
health services but are being used to subsidise other parts of
the health service going into overspend.
EXAMPLES OF
CUTS
4. London is facing very substantial disinvestment
in mental health services. Lambeth and Southwark Primary Care
Trusts (PCTs) have recently asked for a reduction in mental health
services of 5% and 7.2% respectively (in addition to the London
1% surplus requirement and the 2.5% Cash Releasing Efficiency
Saving (CRES)), which is to say a reduction of £4 million
each from mental health services and this with only 6 weeks' notice.
This has resulted in damaging cuts to Adult Mental Health, Older
Adult services and Child and Adolescent Mental Health Services
across the board.
5. The Cheshire and Wirral Partnership Trust
is one of the 11 noted by Rethink and acknowledged by the Department
of Health to have had money withheld in 2005-06 because of serious
financial problems in other parts of the local health economy.
This is despite the Trust breaking even every year since its formation
in April 2002. Colleagues in the area estimate that they are facing
roughly £5 million of pressures of which just over £2
million is the national 2.5% CRES and the rest is cuts due to
financial problems between primary care and the acute sector.
At these levels they will be closing mental health services and
reducing access as well as having significant job reductions including
medical posts.
A PERIOD OF
RECOVERY
6. Mental health services are in the middle
of a critical period of recovery. The mental hospital closure
programmes completed in the 1980s and 1990s were not balanced
by the development of effective alternative community services.
This was partly because there was no agreed and tested blueprint
for community services, and partly because sufficient resources
were not available. It was not uncommon for capital and revenue
released from mental health facilities to be used to bail out
overspending acute hospitals. Hence, by the end of the century
mental health services were ineffective, inefficient and in crisis
with dangerously overcrowded wards and increasing failures in
care. Staff vacancy rates were rising to threaten the viability
of services in many parts of the country.
7. The National Service Framework (1999)
and NHS Plan (2000) produced a blueprint for community care that
has won general approval from patients, carers, and professionals.
Implementation is producing real gains in effectiveness and efficiency
of mental health services. For example, "crisis resolution
and home treatment teams" are reducing hospital admissions
by 15 to 50%, and avoiding 10 to 25% of compulsory admissions.
"Assertive outreach teams" are closely monitoring and
meeting the needs of high risk patients. Many other specifically
funded innovations are gradually building confidence and improving
recruitment.
THE EFFECTS
ON CARE
8. Mental health funding started from a
very low base in 1999-2000. The new services that patients prefer
are not yet fully functional in many areas. The star system required
for foundation status shows that mental health trusts are well
behind acute trusts and PCTs. The mental health service was promised
a ring fencing of resources with segregation from acute trusts,
which instead has lead to reduced investment relative to that
provided for physical health care.
9. It is of the very greatest concern that
even small cuts in planned funding will disable local programmes
of service development that are still bedding in. Large cuts of
5% or more could destroy all progress made in the last five years
and return us to the massive inefficiencies and risks of depending
too much on hospital beds. Within the very large national budget
for health, mental health is only 14% (Glover, 2005). Taking away
a 5% margin of that 14% can have little value and effect on other
sectors of the NHS, but will be catastrophic for mental health.
CONCLUSION
10. The Royal College recommends to the Health
Committee that a system of much greater transparency and immediacy
is established requiring Commissioners to declare/publish any
intentions to transfer out or reduce planned moneys for mental
health with their justifications for doing so and explanation
of the consequences for patients of mental health services. Currently
it is not possible to identify or challenge changes in mental
health funding until well after the fact, indeed not until PCT
end of year accounts are available nine months after the year
in question and not until one year and nine months later to assess
full year effects.
11. The Royal College supports the World
Health Organisation's statement that there is "no health
without mental health" (Helsinki Declaration, Jan 2005).
We are concerned that mental health services, many of which are
well run, are being forced yet again to make cuts to subsidise
other parts of the NHS. We feel that the Government's commitment
to mental health is being compromised by the fact that these services
are the first to be cut when PCTs face financial difficulties.
It is important that mental health services are valued as a core
part of the NHS and that patients and their carers and families
can rely on receiving the care that they need.
May 2006
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