In austere times, health commissioners tend to raid mental health budgets to plug the growing deficits in the acute hospital sector
Mental health services form a crucial part of the NHS, and yet they have always been the poor relation in the health service. The Independent Mental Health Services Alliance has found that high demand and mounting financial constraints has resulted in the average deficit of NHS mental health trusts increasing by 6.3 per cent over the last two years.
The first quarter of this year has already seen 31 trusts, nearly half of all mental health trusts, experiencing deficit. The King’s Fund recently concluded in their analysis of services across England, that around 40 pc of mental health trusts experienced a cut in income in 2013/14 and 2014/15.
The independent think-tank points out that during the same period for acute health, 85 pc of hospital trusts saw their income increase. Indeed, commenting on this finding, Stephen Dalton the chief executive of the Mental Health Network, said that this was evidence of institutional bias that exists in the NHS and local authorities in how mental health is funded.
A further well-established fact is that in austere times, health commissioners tend to raid mental health budgets to plug the growing deficits in the acute hospital sector.
So in some ways, Manchester’s mental health services are no different. Or are they? I have been a GP in Greater Manchester for over 30 years, and I have known for that duration that mental health and learning disability services have struggled for survival.
I have witnessed many reforms in these services but it seems to me that good intentions have not delivered on the much needed stability to a service that is as vulnerable as its patients. A pivotal moment could have been when mental health was disinvested from the three acute hospitals in Manchester to create a single trust in 2002. Manchester Mental Health and Social Care Trust was unique in that it combined health and social care, being only one of five to do so in England and Wales.
The prospect of providing seamless care across the two spectrums offered a real advantage to patients suffering serious mental disorders while needing community social care. However, what is unique about the trust and mental health services as a general point, is that there was no will in the city’s health chiefs as well as within the local authority to see the trust flourish.
To survive in the NHS, it is necessary to have significant assets, such as estates, services need to be well resourced and there needs to be coherence in commissioning. Mental health services in Manchester have had none of these. Set in the backdrop of two private finance initiatives and a block contract, it was never going to be able to meet the rising demand, chronicity and complexity of mental disorders, an ageing population and reduced resources in real terms over the years.
There has been no recognition by those who commission these services that after many years of trying to make ends meet, one day the curtain will fall on the trust.
Matters have now come to head because of withdrawal of the health commissioners support to the trust and the burgeoning problem created by withdrawal of almost two thirds of the funding for social care by the council and resulting redundancy costs.
To a larger trust with better financial stability, this would have perhaps been absorbed in the overall budget but to a small trust the challenge was likely to prove too much to bear.
Kailash Chand is Deputy chair of the British Medical Association and a Tameside GP
Dr K Chand OBE @