Norman Lamb, MP for North Norfolk and Liberal Democrat spokesperson for health, has spoken out after NHS England dropped a key financial incentive for NHS commissioners to improve mental health care.
The Quality Premium scheme is intended to reward clinical commissioning groups (CCGs) for improvements in the quality of health services they commission. However, recent guidance published by NHS England has revealed that mental health has been dropped from the list of national measures in next year’s scheme.
In response to a written parliamentary question asked by Norman Lamb, the Government confirmed that mental health Quality Premium measures will only retained next year (2016/17) if selected by commissioners as “a local priority area”.
The new guidance published by NHS England includes a list of 80 local indicators, including 17 categorised as ‘mental health’. However, commissioners are only able to select 3 of these, and mental health faces stiff competition from incentives to outcomes in cancer, circulatory conditions, maternity care, respiratory disease, trauma and other areas.
Norman Lamb has written to the Health Secretary, Jeremy Hunt, and the Chief Executive of NHS England, Simon Stevens, to ask if they will guarantee that these changes will not result in mental health being disadvantaged.
Commenting, Norman Lamb said:
“This development further exposes the appalling gulf between rhetoric and practice when it comes to mental health in the NHS.
“History tells us that mental health services are at the front of the queue for cuts when there are savings to be made, so NHS England should be doing everything in its power to incentivise commissioners to improve the quality of mental health care provided to patients.
“It speaks volumes that a scheme designed to deliver the ‘major priorities’ of the NHS, by the Government’s own admission, no longer includes national targets in mental health. Mental health should be a national priority, and it’s deeply disappointing the Government didn’t even see fit to discuss these plans with charities before a decision was made.
“The timing of this announcement, only a month after the Mental Health Taskforce published its landmark vision for revolutionising mental health services, is just extraordinary. But on top of Simon Stevens’ recent comments that there is unlikely to be any extra money for mental health next year, it’s clear that there are very difficult times ahead for people with mental illness.
“The Government and NHS England have offered enough warm words on mental health – it’s time these are backed up with action to end the continuing discrimination at the heart of our NHS. This has to start with a clear plan for implementing the recommendations of the Mental Health Taskforce.”
The questions tabled by Norman Lamb MP, and the Government’s joint response, are as follows:
To ask the Secretary of State for Health what assessment he has made of the likely impact of the removal of mental health Quality Premium measures in NHS England’s ‘Quality Premium Guidance for 2016/17’ on mental health outcomes.
To ask the Secretary of State for Health what discussions he has had with mental health charities regarding the removal of mental health Quality Premium measures in ‘NHS England’s Quality Premium Guidance for 2016/17’.
The 2016/17 Quality Premium (QP) scheme has been designed to support the delivery of the major priorities for the National Health Service, as set out in the Five Year Forward View and in the NHS Mandate. The QP scheme is reviewed annually, with the intention of having a range of high impact measures addressing a range of priorities across the Five Year Forward View.
However, there is scope for clinical commissioning groups (CCGs) to focus on mental health, if this is a local priority area in 2016/17. Each CCG is expected to select three local indicators from a menu of suitable measures aligned to the Right Care programme, which sets out a clinically led methodology for improvement and reducing variation in care. This menu includes 17 mental health indicators.
The QP scheme is a part of NHS England’s wider incentive system, including the Commissioning for Quality and Innovation scheme, which includes an incentive focussing on improving the physical health for patients with severe mental illness.
As the QP will be retaining mental health as an indicator there has been no new assessment of the effect of removing.
While there have not yet been any formal meetings with mental health charities about this, following the Mental Health Taskforce report, NHS England are keen to work with stakeholders-including mental health charities- to develop a new and robust mental health indicator for potential inclusion in the 2017/18 QP. This will align with the additional funding to drive improvements in ‘Improved Access to Psychological Therapies’ access from April 2017.