Spending review pledges need more detail

George Osborne’s latest Comprehensive Spending Review (CSR), published last week, provided a classic case of ‘there’s good news and bad news’ for mental health service users. While some measures seem promising, others will cause concern.

First, the good news: every accident and emergency (A&E) department is to have constant access to mental health professionals and a there was a commitment to ensure that more adults and young people have access to psychological therapies.

On the face of it, both of these measures are great news, and something that leaders in the sector have been advocating for some time.

However, as is always the case, the devil will be in the detail. For instance, how will the new system to have mental health professionals on tap at A&E departments work? Will new posts be created for this? Will they be based in the A&E department? Will existing mental health professionals be used for these purposes? These are all questions that need to be answered before drawing any firm conclusions.

This could form one part of the Government’s plan for greater integration of health and social care services – £3 billion funding for this was announced in the CSR – which could also be a good thing for mental health service users.

However, I do wonder about how greater integration will work. While this is something that has again been called for over many years, quite how it fits in with the Government’s prevailing policy for opening up health and social care services to more private sector competition I’m not sure. It is sometimes difficult enough to get NHS and local authority services – and in some cases even different NHS departments – to talk to each other about coordinating care, so how it will work when various private sector providers are involved as well I don’t know. I worry that the government doesn’t know either.

The same goes for the commitment to providing more psychological therapies. The experience with Improving Access to Psychological Therapies over recent years shows that where it works it is proving to be effective for many people, but provision is inconsistent. This is an issue that must be addressed if it is to be further expanded.

Again, I’ve yet to see the detail for how increased access  will be implemented. As it is not planned to take effect until 2015, I guess we won’t see much detail for a while yet.

Then there was the bad news. The further 10% cut announced to local government budgets was not unexpected. Given that social care is generally the largest spend in a local authority, it seems inevitable that more social care cutbacks will be forthcoming, and mental health services are likely to suffer, along with everything else. Given that these come on top of existing cuts, frontline services could suffer. Again.

The proposed cap on welfare benefit spending – excluding pensions – was perhaps not as expected. There were suspicions that benefits would be in the Chancellor’s sights again as costs are not coming down as he’d like, and so it proved. Again, while light on detail, it would seem likely to me that if the cap was in danger of being exceeded the eligibility criteria to quality for a benefit would be ramped up.

This will just add to many mental health service users’ existing worries about benefits, which include the assessment process for employment and support allowance, and re-assessments for the new personal independence payment, which is replacing disability living allowance.

So, the CSR was a mixed bag for mental health service users. But how mixed will only become clear in time, when first the implementation plans are published and then when the measures kick in.