NHS mental health providers have slashed beds and staff levels as they cope with real term funding cuts and the soaring cost of sending patients hundreds of miles away for treatment.
These are the chief findings of an investigation carried out by LGC’s sister title Health Service Journal and based on Freedom of Information requests and financial accounts of all 57 NHS mental health providers. The analysis revealed that mental health trusts suffered a 2.3 per cent real terms funding cut between 2011-12 and 2013-14, when figures were adjusted for inflation.
One in five trusts saw income reduce by 5-9 per cent, while five saw budgets plunge by more than 10 per cent.
Data obtained under FoI requests from 52 trusts revealed an overall reduction in nursing staff of 6 per cent from 2011-12 to 2013-14.
The number of doctors employed by mental health trusts fell by 2 per cent over the same period. Bed numbers also dropped, while the bill for sending patients out of area to other hospitals due solely to capacity issues shot up. These “placements” can be expensive and are considered poor practice.
Sir Simon Wessely, president of the Royal College of Psychiatrists, described the figures as a “glaring warning sign” that mental health was “running dangerously close to collapse” in places.
“It is particularly alarming to see such reductions in staffing, yet another decrease in the number of inpatient beds and such a dramatic increase in the number of people being sent outside their trust to get the care they need because their local services are inadequate,” he said.
Stephen Dalton, chief executive of the Mental Health Network, said the analysis painted a “worrying picture”. “[It] highlights the urgent need for political leaders and NHS England to stop talking about parity jam tomorrow and get on with addressing the funding deficit resulting from year on year cuts,” he said.
“In some parts of the country services are at a tipping point.”
Paul McCrone, a professor of health economics at the King’s College London, told HSJ the data presented a “very worrying state of affairs”. He said: “Out of area placements are a good indicator of heat within the system and how overstretched it is.”
Demand for out of area beds from mental health trusts has allowed some NHS hospitals to fund entire wards with patients from outside their area.
Central and North West London Foundation Trust has opened a 15 bed ward, funded almost entirely by selling spare capacity to other trusts.
Trust chief executive Claire Murdoch said more and more of her colleagues were expressing concern about service pressure and budget cuts. “There are points of crisis and clearly we should be concerned if there is regular ongoing use of out of area placements,” she said.
The independent sector has been one of the biggest winners from the increase of out of area placements. A recent report by the Nuffield Trust found private providers of mental health services had seen a 15 per cent real terms increase between 2011-12 and 2012-13.
Martin McShane, NHS England director for people with long term conditions, said its mandate to deliver “parity of esteem” for mental health patients was a five year plan that was “about much more than just the NHS”.
“In 18 months we have taken action to deliver parity, including creating choice, better physical healthcare for people with serious mental illness, better crisis care, better information and, with Monitor, are consulting on new payment systems.”
A Department of Health spokeswoman said: “We have gone further than ever before to put mental health on a par with physical health and have instructed the NHS to make sure every community does the same.”