Progress Improving Mental Health Services

Public Accounts Committee Closed Inquiry
Opened: 15 Feb 2023 Closed: 24 Sep 2023 Parliament page
The NHS has a long-standing ambition to close the gap between mental and physical health services. Since 2014 it has implemented various initiatives, including the Five Year Forward View for Mental Health and the NHS Long Term Plan. Based on the NAO investigation into progress improving mental health services , … Read more
2 Recommendations
25 Conclusions
1 Report
2 Oral sessions
1 Letter
2 Events
Activity timeline 7 events
24 Sep
2023
Report published
21 Jul
2023
Report published
15 May
2023
Correspondence
20 Apr
2023
Oral evidence
20 Apr
2023
Formal meeting (oral evidence session) · The Grimond Room, Portcullis House
17 Apr
2023
Oral evidence
17 Apr
2023
Formal meeting (oral evidence session) · The Grimond Room, Portcullis House
Oral evidence sessions 2 sessions
20 Apr 2023
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Progress Improving Mental Health Services
Amanda Pritchard · NHS England Claire Murdoch · NHS England Matthew Style · Department of Health and Social Care Professor Sir Stephen Powis · NHS England Sir Chris Wormald · Department of Health and Social Care
17 Apr 2023
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Pre-panel: Improving Mental Health Services
Andy Bell · Centre for Mental Health Chris Dzikiti · Care Quality Commission Peter Devlin · Essex County Council Victoria Tzortziou-Brown · Royal College of GPs
Title HC No. Published Items Response
Sixty-Fifth Report - Progress in improving NHS mental health ser… HC 1000 21 Jul 2023 27 Responded
Recommendations & Conclusions
27 results
2 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Improve mental health services data quality, sharing, and cost-effectiveness evidence.
Data and information for NHS mental health services still lags behind that for physical services. Service commissioners and providers need good data and information to manage and improve services, and this is also important to understand the impact and cost-effectiveness … Read more
Government Response
The government agreed, committing to implement MHSDS v6 by April 2024 and v7 by April 2025 to improve data quality and cost tracking. An independent evaluation including cost-effectiveness for Mental Health Support Teams has also been commissioned, with an update to the Committee in January 2024.
HM Treasury
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3 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Evaluate ICB support for mental health services and effectiveness of central support arrangements.
New integrated care boards and partnerships could struggle to prioritise mental health services and support, in the face of funding pressures and the need to reduce backlogs for physical health services. ICBs will be responsible for bringing forward many of … Read more
Government Response
The government agreed, outlining existing mechanisms such as NHS England's delivery assurance, annual performance evaluations, and the segmentation of ICBs and trusts. From 2023-24, ICBs must also include mental health expenditure in their annual reports, which NHS England will assure.
HM Treasury
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4 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Define 'parity of esteem' for mental and physical health services, detailing standards and funding.
There is still no clear definition of the end goal of ‘parity of esteem’ 12 years after the government first set out its ambitions. From 2011, the government set out long-term ambitions to improve support and services for people with … Read more
Government Response
The government agreed and committed to setting out what achieving full ‘parity of esteem’ means in practice, including comprehensive access and waiting times standards, outcomes, timescales, funding, and workforce requirements, in a joint letter to the Committee in January 2024.
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5 Recommendation Accepted
Sixty-Fifth Report - Progress in i…
Set out a plan for implementing new mental health service standards.
The Department and NHS England have still not committed to rolling out waiting times standards to all mental health services. From 2015, NHSE introduced specific waiting times standards for three service areas – talking therapy services, early intervention in psychosis … Read more
Government Response
The government agreed to set out its plan for new service standards. It committed to publishing data for mental health community waiting times by the end of the financial year, with work on setting appropriate standards to follow robust data collection and analysis. An update will be provided in January 2024.
HM Treasury
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6 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Outline plans to improve and expand mental health preventive and public health services.
Preventive and public health services for mental health have not had the same priority and focus on improvement as NHS mental health treatment services. Previous government strategies have emphasised the importance of preventive services for mental health and wellbeing, alongside … Read more
Government Response
The government agrees with the recommendation, committing to ensure the Major Conditions Strategy prioritises preventive mental health services. It outlines specific policies including a new impact assessment tool, support for employers, and increased mental health support teams in schools, adding that the final strategy report (due early 2024) will address workforce needs in conjunction with the NHS Long Term Workforce Plan.
HM Treasury
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1 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Committee received evidence from Department of Health and NHS England
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department) and NHS England (NHSE).1 We also took evidence from the Association of Directors of Adult … Read more
Government Response
Although the original item was a conclusion about evidence-taking, the government used its response to highlight its commitment to address mental health workforce challenges through the NHS Long Term Workforce Plan, aiming for 4.4% annual growth in the mental health workforce to 2036-37 and promising a refreshed projection every two years. An update will be provided in January 2024.
HM Treasury
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7 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Mental health workforce experiences increased burnout and turnover due to staff shortages
We were also concerned about the impact of staff shortages on the welfare of the mental health workforce. Stakeholders told us about increased workload and pressure leading to “burnout” of remaining staff, contributing to a higher rate of staff turnover, … Read more
Government Response
The government acknowledged the committee's concerns about mental health workforce shortages and announced the NHS Long Term Workforce Plan (published June 2023), which aims for the fastest growth in the mental health and learning disability workforce and outlines specific steps for recruitment, retention, and wellbeing, with an update expected by January 2024.
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8 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Short-term funding and lack of long-term plan hinder mental health workforce development
The National Audit Office (NAO) reported that funding settlements for workforce education and training have been short-term and the timing and levels of agreed funding have not always aligned with the pipeline levels the NHS estimated it needed for mental … Read more
Government Response
The government agrees with the committee's observations, pointing to the recently published NHS Long Term Workforce Plan (June 2023) which addresses workforce challenges, sets growth targets for mental health, and outlines actions for improved retention and productivity. NHS England will provide a progress update in January 2024.
HM Treasury
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9 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Progress on mental health service data collection remains slow, with many providers failing to submit
It is important to have the right data in place for mental health service commissioners and providers to manage and improve services, and to understand the cost effectiveness and impact of services, including patient experiences and outcomes.15 We highlighted data … Read more
Government Response
The government commits to implementing MHSDS v6 by April 2024 and v7 by April 2025 to improve data recording and patient-level cost tracking. NHS England also aims for 50% of relevant patients to record paired outcome scores by year-end and has commissioned an evaluation of Mental Health Support Teams.
HM Treasury
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10 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Mental health service data remains less comprehensive and granular than physical health services
Compared to physical health services, data for mental health services are less comprehensive and granular. The Department and NHSE acknowledged that data for mental health services still lag behind that for physical health services, but argued that they have taken … Read more
Government Response
The government will implement MHSDS v6 by April 2024 and v7 by April 2025 to improve data recording and patient-level cost tracking. NHS England also aims for 50% of relevant patients to record paired outcome scores by year-end and has commissioned an evaluation of Mental Health Support Teams.
HM Treasury
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11 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Robust data on patient outcomes and experiences still lacking for most mental health services
There is a continuing lack of robust data on patient outcomes and experiences for most mental health services. Of the 29 integrated care boards surveyed by the NAO, only four said they had all or most of the data they … Read more
Government Response
The government agrees with the committee's findings and is implementing Mental Health Services Dataset (MHSDS) updates in April 2024 and 2025 to improve data recording. NHS England aims for 50% of patients in key services to record a paired outcome score by year-end and has commissioned an independent impact evaluation of Mental Health Support Teams.
HM Treasury
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12 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
NHSE unable to explain cost-effectiveness criteria for mental health service investment decisions
When we asked what criteria it used to decide on investment in one area against another, NHSE explained the consultative approach it took to prioritise services but could 13 NHS Long Term Workforce Plan, Overview, Chapter 1, paragraph 26, and … Read more
Government Response
The government commits to implementing MHSDS v6 by April 2024 and v7 by April 2025 for better data recording and patient-level cost tracking. NHS England will also aim for 50% of relevant patients to record paired outcome scores by year-end and has commissioned an independent evaluation of Mental Health Support Teams, including cost-effectiveness.
HM Treasury
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13 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Difficulties persist in accessing and sharing data for coordinated mental health care across organisations
Stakeholders stressed to us the particular importance of coordinated care for people suffering ill mental health.22 However, they were frustrated with difficulties in accessing and sharing data across different organisations, including between national and local bodies, and between health and … Read more
Government Response
The government agrees with the committee's findings and is implementing Mental Health Services Dataset (MHSDS) updates in April 2024 and 2025 to improve data recording, which will facilitate better data sharing. NHS England also aims for 50% of patients in key services to record a paired outcome score by year-end and has commissioned an independent impact evaluation.
HM Treasury
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14 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
NHS fails to meet waiting time standards for children and young people's eating disorder services
From 2015, NHSE introduced specific waiting times standards for three service areas —talking therapy services, early intervention in psychosis services and eating disorder services for children and young people—which set ambitions for people to enter treatment quickly. While the NHS … Read more
Government Response
The government agrees with the committee's observation, noting existing waiting time standards for several services. It aims to publish data for mental health community waiting times by the end of the financial year to inform the analysis and setting of appropriate new standards. An update will be provided in January 2024.
HM Treasury
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15 Conclusion Deferred
Sixty-Fifth Report - Progress in i…
Eating disorder waiting time standards unmet, while mental health standards remain too limited
We are concerned about the NHS still not meeting the eating disorder service standards, and how long young people suffering from eating disorders have to wait for treatment. NHSE explained to us that this is because it took time for … Read more
Government Response
The government acknowledges existing waiting time standards for specific services and states its aim to publish data for mental health community waiting times by the end of the financial year. After collecting robust baseline data, work will begin to analyze and consider appropriate performance standards, with an update in January 2024.
HM Treasury
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16 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Implementation of new mental health waiting time standards for community services remains uncertain.
In 2022, NHSE consulted on new waiting times standards for mental health services in the community and A&E for both children and adults, with most (81%) respondents to the consultation in favour of the new standards. If implemented, these would … Read more
Government Response
The government agrees with the committee's findings, noting ongoing work to develop new waiting time standards. It aims to publish data for mental health community waiting times by the end of the financial year to enable analysis and the setting of appropriate performance standards. An update will be provided in January 2024.
HM Treasury
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17 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Integrated Care Boards are now primarily responsible for commissioning most local NHS mental health services.
From 2022, the new integrated care boards (ICBs) are responsible for commissioning most NHS mental health services for their local populations. ICBs are NHS bodies, working alongside integrated care partnerships (ICPs) which bring together local government and NHS services on … Read more
Government Response
The government agrees and outlines mechanisms for holding ICBs accountable for mental health services, including the NHS Oversight Framework, annual performance evaluations, and new requirements for ICBs to report mental health expenditure from 2023-24. The Health and Care Act 2022 also mandates mental health expertise on ICB Boards.
HM Treasury
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18 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Most Integrated Care Boards lack sufficient capacity, resources, and staff to improve local mental health services.
We, and many stakeholders, agree that the introduction of ICSs offers opportunities to improve local mental health services. But many of the challenges they face involve longstanding and unresolved issues which we have repeatedly highlighted, most recently in our April … Read more
Government Response
The government agrees with the Committee's observations, outlining existing measures like the NHS Oversight Framework, ICB reporting requirements, and Health and Care Act mandates to ensure accountability and support for mental health services within ICBs.
HM Treasury
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19 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Funding pressures and physical health backlogs risk Integrated Care Boards deprioritising mental health services.
More immediately, the Centre for Mental Health and other bodies told us that, in the face of funding pressures and the need to reduce backlogs for physical health services, ICBs and ICPs could struggle to prioritise mental health services and … Read more
Government Response
The government agrees with the recommendation, noting that from 2023-24, ICBs must include mental health expenditure in annual reports to increase accountability and that the Health and Care Act 2022 requires mental health expertise on ICB Boards. NHS England will continue to oversee ICBs using existing frameworks and monitor this approach.
HM Treasury
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20 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
NHSE reorganisation and staffing cuts risk its capacity to monitor and hold ICBs accountable.
In line with the approach for all health services, the 2023–24 planning guidance for NHS trusts and ICBs reduced the number of nationally mandated objectives to six for mental health.38 Although the national programme led by NHSE has maintained a … Read more
Government Response
The government agrees with the Committee's observations, highlighting existing oversight through the NHS Oversight Framework, ICB reporting requirements on mental health expenditure, and statutory mandates for mental health expertise on ICB boards to ensure accountability and address local inconsistencies.
HM Treasury
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21 Conclusion Acknowledged
Sixty-Fifth Report - Progress in i…
Government's long-term ambition remains achieving ‘parity of esteem’ between mental and physical health services.
From 2011, the government acknowledged a large ‘treatment gap’ for people with mental health conditions. It set out that its long-term ambitions were to improve support and services for people with mental health problems and achieve ‘parity of esteem’ between … Read more
Government Response
The government agrees with the recommendation and states that DHSC is working with NHS England to produce a definition of parity of esteem, with an update expected in January 2024.
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22 Conclusion Not Addressed
Sixty-Fifth Report - Progress in i…
Despite increased access, significant treatment gaps and long waiting lists persist for mental health services.
It is good to see that the number of people accessing NHS funded mental services has increased, from 3.6 million in 2016–17 to 4.5 million in 2021–22. However, this equates to only around one third of people with mental health … Read more
Government Response
The government's response did not address the committee's conclusion regarding the persistent treatment gaps and long waiting lists in mental health services, instead providing a boilerplate agreement and an update on defining 'parity of esteem'.
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23 Recommendation Accepted
Sixty-Fifth Report - Progress in i…
A clear definition of ‘parity of esteem’ for mental health services remains absent after 12 years.
In our 2018 report on mental health services for children and young people, we noted that the Department had not clarified what ‘parity of esteem’ meant in practice. We recommended that the Department clearly defined the criteria it would use … Read more
Government Response
The government accepted the recommendation, stating that DHSC is working with NHS England to produce a definition of 'parity of esteem' and will provide an update on progress by January 2024.
HM Treasury
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24 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
NHS England welcomes a ‘parity of esteem’ definition; the Department refuses to provide one.
When asked, NHSE told us that it would welcome a definition of ‘parity of esteem’, which could encompass parity in funding, waiting times and outcomes, as well as the provision of data and information on services. The Department contended that … Read more
Government Response
Although the committee's text was a conclusion noting the Department's reluctance to provide a definition, the government accepted this implicitly and stated that DHSC is now working with NHS England to produce a definition of 'parity of esteem', with an update expected by January 2024.
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25 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Mental health improvement programmes underinvest in prevention and early intervention, risking long-term sustainability.
The improvement programme led by NHSE focuses on the expansion of treatment for people who have already developed mental ill health, with limited investment in areas relating to prevention and early intervention such as mental health support teams in schools.48 … Read more
Government Response
The government agrees and, as part of its Major Conditions Strategy, commits to implementing a new mental health and wellbeing impact assessment tool, outlining support for employers, and increasing mental health support teams in schools. A final report with workforce considerations will be published in early 2024.
HM Treasury
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26 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Preventive mental health and public health services lack prioritisation and sufficient funding.
Previous government strategies have emphasised the importance of preventive services for mental health and wellbeing alongside treatment for mental illness. However, we, and many stakeholders, are concerned that preventive and public health services have not been given the same priority … Read more
Government Response
The government agrees and, through its Major Conditions Strategy, commits to implementing a new mental health and wellbeing impact assessment tool, outlining government's role in supporting employers, and increasing mental health support teams in schools and colleges. A final report for the strategy is due in early 2024.
HM Treasury
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27 Conclusion Accepted
Sixty-Fifth Report - Progress in i…
Major conditions strategy risks losing focus on wider mental health determinants.
We heard that, given the breadth of factors that affect good mental health, an effective preventive programme requires actions from across government.52 In April 2022, the government, led by the Department, consulted on plans for a new 10-year cross- government … Read more
Government Response
The government, while stating agreement, responded by detailing its Major Conditions Strategy (published August 2023) and explaining how it addresses mental health, prevention, and cross-government support, effectively reaffirming its chosen approach despite the committee's concerns about the strategy replacing a 10-year plan.
HM Treasury
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Government Response AI assessment · 27 of 2 classified
Accepted 24
Acknowledged 1
Deferred 1
Not Addressed 1
Total 2 recs + 25 conclusions
Correspondence 1 letter
15 May 2023 Public Accounts Committee session on progress in improving mental health services on 20 April 2023 – follow up letter
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