Sixty-Fifth Report - Progress in improving NHS mental health services

Select Committee
Public Accounts Committee HC 1000 21 July 2023
Report Status Government responded
Conclusions & Recommendations 27 items (2 recs)
Source View on Parliament website
Government Response (AI assessment · 27 of 27 classified)
Accepted 24
Acknowledged 1
Deferred 1
Not Addressed 1
Government response
Treasury minutes: Government response to the Committee of Public Accounts on the Sixth-fifth report from Session 2022-23 · published 24 Sep 2023
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Recommendations & Conclusions

27 results
2 Conclusion Accepted
Improve mental health services data quality, sharing, and cost-effectiveness evidence.
Conclusion
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 Summary
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
Evaluate ICB support for mental health services and effectiveness of central support arrangements.
Conclusion
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 Summary
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
Define 'parity of esteem' for mental and physical health services, detailing standards and funding.
Conclusion
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 Summary
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.
HM Treasury
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5 Recommendation Accepted
Set out a plan for implementing new mental health service standards.
Recommendation
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 Summary
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.
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6 Conclusion Accepted
Outline plans to improve and expand mental health preventive and public health services.
Conclusion
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 Summary
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.
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1 Conclusion Accepted
Committee received evidence from Department of Health and NHS England
Conclusion
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 Summary
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.
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7 Conclusion Accepted
Mental health workforce experiences increased burnout and turnover due to staff shortages
Conclusion
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 Summary
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
Short-term funding and lack of long-term plan hinder mental health workforce development
Conclusion
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 Summary
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.
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9 Conclusion Accepted
Progress on mental health service data collection remains slow, with many providers failing to submit
Conclusion
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 Summary
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.
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10 Conclusion Accepted
Mental health service data remains less comprehensive and granular than physical health services
Conclusion
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 Summary
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.
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11 Conclusion Accepted
Robust data on patient outcomes and experiences still lacking for most mental health services
Conclusion
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 Summary
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.
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12 Conclusion Accepted
NHSE unable to explain cost-effectiveness criteria for mental health service investment decisions
Conclusion
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 Summary
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.
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13 Conclusion Accepted
Difficulties persist in accessing and sharing data for coordinated mental health care across organisations
Conclusion
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 Summary
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
NHS fails to meet waiting time standards for children and young people's eating disorder services
Conclusion
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 Summary
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.
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15 Conclusion Deferred
Eating disorder waiting time standards unmet, while mental health standards remain too limited
Conclusion
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 Summary
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.
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16 Conclusion Accepted
Implementation of new mental health waiting time standards for community services remains uncertain.
Conclusion
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 Summary
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
Integrated Care Boards are now primarily responsible for commissioning most local NHS mental health services.
Conclusion
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 Summary
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.
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18 Conclusion Accepted
Most Integrated Care Boards lack sufficient capacity, resources, and staff to improve local mental health services.
Conclusion
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 Summary
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.
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19 Conclusion Accepted
Funding pressures and physical health backlogs risk Integrated Care Boards deprioritising mental health services.
Conclusion
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 Summary
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.
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20 Conclusion Accepted
NHSE reorganisation and staffing cuts risk its capacity to monitor and hold ICBs accountable.
Conclusion
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 Summary
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
Government's long-term ambition remains achieving ‘parity of esteem’ between mental and physical health services.
Conclusion
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 Summary
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
Despite increased access, significant treatment gaps and long waiting lists persist for mental health services.
Conclusion
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 Summary
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
A clear definition of ‘parity of esteem’ for mental health services remains absent after 12 years.
Recommendation
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 Summary
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.
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24 Conclusion Accepted
NHS England welcomes a ‘parity of esteem’ definition; the Department refuses to provide one.
Conclusion
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 Summary
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
Mental health improvement programmes underinvest in prevention and early intervention, risking long-term sustainability.
Conclusion
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 Summary
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.
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26 Conclusion Accepted
Preventive mental health and public health services lack prioritisation and sufficient funding.
Conclusion
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 Summary
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
Major conditions strategy risks losing focus on wider mental health determinants.
Conclusion
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 Summary
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.
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