Mental Health Taskforce Report

Heidi Allen Excerpts

Wednesday 13th April 2016 Westminster Hall

[James Morris]

My hon. Friend is absolutely right. We need to support people with depression back into work. The report makes a number of recommendations, which he may be aware of, on the use of strategies such as individual placement and support to get people with mental health problems back into work.

The report also talks a lot about data, which underpin our decisions about where we should focus our efforts on mental health. It refers to a “black hole” of data and calls for a “transparency revolution” in mental health. As I said earlier, for a long time—probably 20 years or more—we have not been collecting sufficiently robust data about what is actually going on in mental health services. We need better data on what is going on to have a firm basis on which to understand what is working, what is not working and what is going on at local and national level. Recommendation 50 in the report—this pertains to what my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) said about accountability—is at the heart of the implementation challenges that we face. It states:

“The Department of Health and NHS England should require CCGs to publish data on levels of mental health spend in their Annual Report and Accounts, by condition and per capita, including for children and Adolescent Mental Health Services, from 2017/18 onwards. They should require CCGs to report on investment in mental health to demonstrate the commitment that commissioners must continue to increase investment in mental health services each year at a level which at least matches their overall allocation”

of funding. That goes to the heart of our data challenge.

For too long, mental health services have not been properly resourced because we do not have an effective data set on what is actually happening in the NHS or, as the report highlights, an effective model in the NHS for paying for mental health services. They tend to be commissioned on what is called a block contract basis, which often has the effect of focusing on the delivery of a low-cost service, rather than on quality outcomes. We certainly do not have a model of care that focuses on an individual care pathway or a cure for an individual patient.

We need a different model of payment for mental health services in the NHS that focuses on quality and outcomes and reflects our aspiration, which is written into the NHS’s operating mandate, for parity of esteem—the integration of physical and mental health. How can we express that aspiration? To give an example, if I suffer from diabetes and a serious mental health problem, my treatment in the national health service is effectively split in two: there is a physical health pathway, which is paid for in one way, and a mental health pathway, which is paid for in another way. I believe that we need to move towards a payment-by-activity model in the NHS that does not discriminate between physical and mental health. That will certainly not happen overnight, but the report goes some way towards arguing for it in recommendation 47, which states:

“NHS England and NHS Improvement should together lead on costing, developing and introducing a revised payment system by 2017/18 to drive the whole system to improve outcomes”.

[Heidi Allen (South Cambridgeshire) (Con)]

Does my hon. Friend think it is right that we have a separate payment model for mental health, or should physical and mental health be treated together? Separating them could cause the very division that we are trying to lose.

[James Morris]

That is precisely what I am arguing for. Over time, we need to move to a model that does not discriminate between mental and physical health, with integrated payment reflecting the fact that there are a lot of conditions and a lot of comorbidity. Getting the payment system right in the NHS is fundamental to everything about the aspiration for parity of esteem. “Parity of esteem” is an interesting set of words, which can be interpreted to mean that we want a culture change or a system change—all of which is right—but to achieve it we need to change the payment model for how services are commissioned and purchased in the NHS.