Published on Feb 15, 2016
Mental Health Spending in North East Lincolnshire
Clinical Commissioning Groups (CCGs) were established in April 2013 and are made up of GPs, other people who work in health and care and members of the public who together decide what healthcare services there should be in their local area.
Each year, CCGs are told by the Government how much money they have to spend. They then have to decide how to share this money across the wide range of services that local people need. These are services like life-saving emergency care, the treatment of acute physical and mental illnesses, routine family health care and managing long-term health conditions. Long-term health conditions include dementia, heart and breathing problems, diabetes and their complications, which we see a lot of in this area. To do this, we work with our partners in the local council and public health as well as with and our community forum and the organisations that provide care to look at the health and social care needs of people in North East Lincolnshire and decide how to spend our money.
Our CCG is unique in England because it is responsible for most healthcare and all adult social care services for its population, although (like all other CCGs) it is not responsible for some specialist or preventative health services. Specifically in mental health services, the CCG is responsible for most services including community and inpatient services, but is not responsible for some specific areas such as secure mental health services or Child and Adolescent Mental Health services (CAMHS).
CCGs will always spend different amounts on Mental Health services, which is to be expected to some extent as they will have different levels of mental illness in their area and as outlined above, health spending takes into account local needs. The way that services are provided can also be very different, again reflecting local circumstances. But recent reports have suggested the proportion of healthcare money spent on mental health services in North East Lincolnshire was very much lower than in other areas, which is not the case. While this was a genuine misunderstanding of the unique way the health and social care budget is worked out locally, we are concerned this may have affected people’s confidence in the way we allocate our money.
The latest benchmarking information shows that in 2014/15 the CCG allocated 11.7% of its health budget to mental health. While this is below the national average of 12.7%, it is comparable to the Yorkshire and Humber average of 12.3% and is certainly not the lowest level of spend. And we are proud of the fact that our partnership working with our main local mental health provider, Navigo, has allowed us to spend less on sending people to out-of-area mental health services than some other areas have been compelled to do – which has helped us to focus mental health spending on local services for local people.
It’s no secret that health and social care are facing big challenges. Services are under strain because more people than ever need care, and care is getting more expensive. This means resources need to be stretched further. Across North and North East Lincolnshire the total healthcare community is currently spending £2 million per month more than it has coming in. That’s a big affordability gap and we can’t solve this just by making even more efficiency or productivity improvements (although we will always keep trying to be even more efficient in the way we spend public money).
In this challenging environment it is very important that the CCG considers and prioritises the provision of mental healthcare services as seriously as we consider physical healthcare. This is known nationally as ‘parity of esteem’. So the CCG has been steadily increasing the amount of healthcare money it spends with Navigo every year, increasing the contract value by more than £1million over the last two years and providing almost £1million on top of that in 2015/16 in recognition of the costs of service change, cost pressures and other challenges. The picture in adult social care is different, because the significant reductions in Local Authority funding has meant that they have had to make service changes and efficiencies that have reduced spending across a wide range of services, including mental health.
Navigo is providing much excellent care for the people of North East Lincolnshire, something that has been fed back from recent external inspections and through a number of national awards. Innovation and service transformation continues apace, a recent example being the ‘Home from Home’ service which has been developed over the past year through partnership working between Navigo and the hospital. In the past the care of these patients was led by the acute hospital, but the new service is led by Navigo. So the CCG will now be moving money across from the hospital contract to the Navigo contract to fund that service.
Nonetheless, we recognise that there are some significant cost pressures being faced by Navigo, which we need to address together. One example is the rising number of out of area placements they pay for, where the CCG has recently committed to provide £800,000 every year into the Navigo contract to help. We also are exploring options with them to develop additional local mental health beds to reduce the number of people needing to go out of area for their care, and the CCG is seeking to fund £500,000 capital costs to make this possible. Those extra beds would reduce the cost pressure faced by Navigo and bring money back from out of area services to fund that new local service.
There is also an annual “rise” healthcare providers get from the CCG to offset the impact of inflation (when the cost of living gets more expensive each year). Recently the recognition of ‘parity of esteem’ between physical and mental health has meant that the CCG invests more into the ‘rise’ for Mental Health services, including those provided by Navigo, than other local health providers. In the coming year that means a rise of 3.05% which is almost three times more than other local health providers will receive, and the same approach will be used in future years. Together with other planned investments, this all means that the CCG is proposing to spend around £1.9 million more of its healthcare money on Navigo services next year - demonstrating that we continue to recognise our local mental health services as a key priority.
There is no doubt that managing within our resources is an on-going challenge for us all. When we put more of our money into one area of care, there is, of course, less left for others. It is always going to be difficult to get the balance right when we are looking at the needs of the whole population which includes children and adults, mental health and physical health, frail elderly and patients with cancer. However, when organisations work together as one system, we can respond better to these challenges and make the budget go further. It is fortunate that all of our local leaders have been working together to develop new and innovative ways of working to maintain high quality care through these challenging financial times.
You can view a bar chart showing the most recent published benchmarking information for CCG healthcare spend on mental health services in the Yorkshire and Humber region here. The NEL CCG published figures have been adjusted to take out adult social care, because it is not included in any other CCG figures.
This bar chart shows how the healthcare core contract value between NEL CCG and Navigo has increased year on year (blue bar).
This bar chart shows that the value of the core contract for Adult Social Care services with Navigo is much lower than that for healthcare services, and in contrast to health funding it has been reducing each year (blue bar).