Funding plans offer encouragement for one million people

An under-reported boost to mental health funding is highlighted by the President of the Royal College of Psychiatrists, Professor Wendy Burn.

Last week RCPsych got really excited about the contents of a deceptively low key document and two equally opaque acronyms in particular – and you should too, as they relate to good news on mental health care funding.

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The document was the 2018/19 NHS Planning Guidance. In short, it’s pretty important: it sets out what local NHS services across England are asked to fund and provide for the year ahead.

Good news for people living in regions that have been spending too little on mental health services

This was the first passage that excited us: “Each and every” commissioner must, after a year’s break, "meet the MHIS”. What is this acronym? And what does it mean?

The MHIS stands for Mental Health Investment Standard. It requires local areas to increase their spending on mental health services in line with their overall increase budget allocation each year.

In 2016-17 this requirement was in place and upheld.

But last year's financial year’s planning guidance (2017-18) did not set the standard out as a specific requirement for each Clinicial Commissioning Group.

So when, last week, the new planning guidance for 2018-19 clearly stated that, once again, all CCGs 'must' meet the investment standard, the College breathed a huge sigh of relief.

In 2016-17, when the standard originally applied to every CCG, 32 (15%) still failed to meet it. But it is likely that the relaxation of this policy this financial year has made this situation worse and that more CCGs are now on course to fail to meet the standard. We hope that reinstating it will help reverse this trend.

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The MHIS is not a fix-all. Meeting it does not mean that mental health services in an area are perfect. There is wide variation in mental health spending in local areas. The MHIS in itself won’t provide a solution to the gap between the lowest spenders and the average.

But importantly, reinstating the requirement that all CCGs must meet the MHIS should stop it getting worse and widening. Over time we would hope that the spending gaps would close when all CCGs are investing the right proportion of their budget on the mental health needs of their population.

As the expectations on CCGs to meet the MHIS are high, the risk of money intended for mental health services being spent elsewhere is reduced.

Commitment remains for one million more people to receive treatment

Another important acronym appeared in the NHS planning guidance last week: FYFV. This is the Five Year Forward View for Mental Health, which is the government backed and funded plan to be able to treat a million more people with mental illness by 2021.

We are approaching the halfway mark for this plan.

Last autumn the commitment to see it through appeared to be wavering. The RCPsych ran a campaign asking for assurance from NHS England that the funding commitment would be honoured. The campaign was successful and the new NHS planning guidance states that the funding earmarked for delivering this transformation in mental health services must be delivered.

The College has said several times before - and will continue to stress - that if the ambition to treat a million more people with mental illness is to be realised, we need to make sure that money is spent on frontline services

What’s next?

Even more transparency is needed on mental health spending. We want scrutiny of spending in local areas to be further enhanced, including through the publication of a traffic light-style (Red, Amber, Green) rating of MHIS by NHS England. This would avoid Clinical Commissioning Groups disinvesting in mental health or using additional monies to prop up other services.

The decision to strengthen the MHIS is great news but without clear figures showing what each CCG has spent on mental health it will be well nigh impossible to establish whether or not the standard has been met.