Mental health services bear brunt of NHS cuts

Mental Health Nursing,  Nov 2006  by Pulzer, Matthew

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The widespread financial deficits appears to have hit mental health services harder than most, though this has never been admitted. But the evidence is hard to ignore, as Matthew Pulzer reports

The financial problems in the NHS are well documented. Despite having a budget of almost £90 billion, it has a deficit of around £800million and trusts across the country are taking drastic steps to balance the books, including job and service cuts and hospital closures.

But despite practitioner and patient complaints, there has been no official acknowledgement that the drastic measures being taken by cash-strapped trusts are affecting mental health services disproportionately.

Yet the evidence is hard to deny. In November last year the charity Rethink appealed for information from its 8,000 members and professionals around the country after being alerted to worrying cuts to mental health services and planned budgets around the country.

Service users, carers and staff began alerting Rethink to proposals that said primary care trusts and mental health trusts were targeting mental health to 'plug' deficits in physical health services.

The ensuing report, A cut too far, highlighted over 30 controversial budget cuts currently affecting mental health services.

It showed there was more than £30 million of enforced and potential cuts across over 30 areas of England, which was almost double the government's own estimate of £16 million of cuts.

Cliff Prior, Rethink's chief executive said: These cuts are threatening the government's vision of improved mental health services - and it must act today to save it reform programme.

'NHS chiefs have been set a range of "must-do" targets for the year - and mental health must be added to the list.'

'We are worried that vital services, such as early intervention, are going to be severely damaged by these cuts. This is in spite of the government setting mental health as a top priority in 1999; outlining a comprehensive change programme through the mental health service framework and the NHS plan which included increased investment.'

'Mental Health services have a long history of chronic underinvestment compared to other NHS areas and Rethink is concerned that further cuts will have serious implications for those people directly affected by mental health problems - service users and carers.'

Rethink called on the government to give assurances that mental health remains a key health priority both at a national and local level, and to work with trusts to develop an emergency plan to overcome the funding crisis.

Earlier this year opposition MPs were stirred into action. They pointed out that more than half of the NHS trusts providing mental health services have had to close wards, despite none of them running up a deficit, with the money being used to helped bail out neighbouring trusts that have run up deficits.

Speaking in the House of Commons shadow health minister Tim Loughton said that 58% of trusts had had to close wards, while four out of five had introduced recruitment freezes.

He said: These cuts are the final straw for mental health services, which are already the poor relation of the NHS.

'Many of these trusts are having to sacrifice parts of their budget when they have already had to shelve plans for further mental health provision in an effort to balance their books in the first place.'

But in response, health minister Rosie Winterton issued a robust denial. She said: 'Mental health remains a key priority. There is no evidence to suggest mental health services are being disproportionately affected.'

However, this view appeared to be contradicted by Professor Louis Appleby, the national director for mental health.

Speaking in April he said: Of course I am not happy when you have good, financially prudent mental health services and they are predicting financial balance and good financial management and then because of problems somewhere else in the NHS they have to find extra money.'

And now Amiens says it now has more hard evidence that mental health services are being specifically targeted for job and service cuts.

According to a new survey carried out by the union, nearly three-quarters of mental health trusts and services in England (71%) are in deficit.

As a result, 56% are planning cuts to services and more than two in five (43%) are also proposing job cuts.

The survey of Amicus shop stewards and members working in mental health trusts and services demonstrates a reduction in mental health provision with a high number of service and job cuts either already happening or planned.

The survey reported frozen posts in 49% of trusts with financial pressures being cited as the reason in 90% of these cases.

Cuts include closures of an eating disorder service, children's inpatient service, an adolescent service and acute wards.

They also reported reductions and lost posts in child psychology community teams, day hospitals older person's services and substance abuse programmes.

Amicus' national officer for health, Kevin Coyne, said: These cuts are evidence that mental health services are being targeted by the financial pressures on the NHS.