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

Select Committee
Public Accounts Committee HC 1000 21 July 2023
Report Status Response document linked Recorded deadline: 21 Sep 2023

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Conclusions & Recommendations 27 items (2 recs)
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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
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
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3 Conclusion
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
HM Treasury
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4 Conclusion
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
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5 Recommendation
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
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6 Conclusion
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
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1 Conclusion
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
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7 Conclusion
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
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8 Conclusion
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
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9 Conclusion
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
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10 Conclusion
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
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11 Conclusion
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
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12 Conclusion
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
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13 Conclusion
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
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14 Conclusion
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
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15 Conclusion
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
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16 Conclusion
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
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17 Conclusion
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
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18 Conclusion
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
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19 Conclusion
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
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20 Conclusion
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
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21 Conclusion
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
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22 Conclusion
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
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23 Recommendation
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
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24 Conclusion
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
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25 Conclusion
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
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26 Conclusion
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
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27 Conclusion
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
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