Mental health services for children and young people Contents

3Future NHS plans

Parity of esteem

16.The government has acknowledged that, prior to 2011, mental health services had been seen as of secondary importance to physical health services. However, as set out in the Health and Social Care Act 2012 and the NHS Constitution, the government has committed to providing ‘parity of esteem’ for mental health and physical health services. This means that mental health is valued as much as physical health, though that does not necessarily equate to equal funding and staff numbers. In fact, the government has not specified what achieving full ‘parity of esteem’ would mean in practice, for example in terms of patient access to services, waiting times or patient outcomes. The Forward View sets the ambition for 35% of children and young people with a diagnosable mental condition to access NHS-funded treatment by 2020–21. But neither the Department nor the NHS have specified what percentage would access services under full ‘parity of esteem’.29

17.The Department and NHS England have taken a pragmatic approach to identify what they think they can achieve with available funding, rather than considering what long-term improvements are required to support all children and young people in need of mental health support. New estimates, published in November 2018, show that the number of children and young people (five to 15 year olds) with a mental health condition increased from 10.1% in 2004 to 11.2% in 2017.30 This will impact how long it will take and cost to achieve full ‘parity of esteem’ between physical and mental health. For example, the National Audit Office estimated that, if prevalence was 50% higher than the 2004 estimate, the NHS would either need to treat an additional 186,000 young people over and above current planned, to meet its present target of treating 35% with a mental health condition; or else it would need to reduce its target (as indicated in the Forward View). In either case, there would be implications for the workforce, time, and money required to achieve ‘parity of esteem’ with physical health services.31 The NHS expects to publish a new ten-year plan in December 2018 and the recent budget suggested that there will be at least £2 billion additional funding earmarked for mental health services. NHS England did not specify how much of this will be allocated to children and young people’s services but expected that those services will be one of the priorities in its plan.32

Data weaknesses

18.At the start of the Forward View, the NHS lacked the necessary baseline information to measure progress against its plans. For example, two important targets in the Forward View were to treat an additional 70,000 children and young people per year by 2020–21 (compared to 2014–15) and an associated target to increase the access rate (i.e. the proportion of children and young people with a mental health condition who receive treatment) from 25% to 35% by 2020–21. However, there was no robust national data collection for 2014–15, so the NHS has not been able to report progress directly against the number of additional children and young people treated. Instead it focuses on achieving the access rate target, assuming that if it achieves its access rate target it will also achieve its target to treat an additional 70,000 children and young people. However, this assumption may not hold, since calculations of the two targets are based on different estimates of the number of children and young people who require treatment.33

19.NHS Digital introduced the new Mental Health Services Data Set in January 2016. It is designed to be the first-ever comprehensive data set that includes children and young people’s mental health services. The NHS intended that this data set would provide much of the information it needed to understand progress against key objectives, including providing the number of children and young people accessing services from December 2016. However, the data set is behind schedule in providing reliable data and is still classified as experimental. Reflecting that the dataset was incomplete, NHS England and NHS Digital had to undertake a one-off data collection for 2017–18 to understand how many children and young people were accessing NHS services. NHS England still does not have the data to understand growth rates in patient access to services. It now intends to repeat the one-off collection for 2018–19 so that it will have comparable data for 2017–18 and 2018–19. The Mental Health Services Data Set is also behind schedule in providing other important information. For example, the NHS had expected to have reliable data to monitor patient outcomes in 2018–19, but now expects this in April 2019.34

20.Going forward, NHS England told us the Green Paper will test which prevention and early intervention services in schools are effective, including how they impact on the demand for more specialist NHS services. Since these new services are only being rolled out across 20–25% of England at the pilot stage, it will be important that these pilots are set up from the start to generate sufficient data to inform the approach towards a later roll-out for the rest of the country.35

21.In 2014 and 2015 the government committed to providing an additional £1.4 billion of funding to transform children and young people’s mental health services. In the Forward View, the NHS set out is intention to invest £1.4 billion in these services in addition to existing investment, largely through clinical commissioning groups. However, a lack of reliable financial data up to 2016–17 means that NHS England cannot be sure that clinical commissioning groups spent all the additional funding provided for children and young people’s mental health services as intended, prior to 2017–18. Since 2015–16, NHS England has worked to improve data on clinical commissioning groups expenditure on children and young people’s mental health services, by clarifying guidance and carrying out more intensive quality checks. It considers 2017–18 expenditure data to be much more reliable. From 2018–19 NHS England expects clinical commissioning groups to spend additional funding provided for children and young people’s mental health services on those services; and will monitor this as part of its annual planning process. Despite the uncertainty over expenditure prior to 2017–18, NHS England gave us its commitment that it would ensure that all the £1.4 billion committed to children and young people’s services will be spent as intended by 2020–21.36

29 Q 84–90; C&AG’s Report, para 1.3, 1.5

30 NHS Digital, Mental Health of Children and Young People in England, 2017 [PAS], 22 November 2018

31 Qq 34, 89, 154, C&AG’s Report, para 1.4, 1.12, 1.15, figure 6

32 Qq 79, 85, 88–89, 121–122, 243–244; C&AG’s Report, figure 1

33 C&AG’s Report, para 2.4–2.5, figure 8

34 Qq160–162, 184–187; C&AG’s Report, para 11, 2.4–2.6, 2.8, 3.10–3.11, 3.14–3.17, figure 8