The government’s goal to improve access to mental health services for young people and children is being hampered by a lack of reliable data and cross-government accountability, the National Audit Office has said.
The NAO has called on the government to establish a “coherent and coordinated cross-sector response” to growing demand for young people and children’s mental health services, including a new assessment of the scale of the challenge ahead.
The government has set up inter-ministerial and cross-departmental groups to discuss mental health policy, but is not managing its strategy for young people’s mental health provision as a single programme of work, it said in a report yesterday. Nor is there a single governance structure for its delivery.
And there is a concern the government is relying on out of date figures that underestimate the scale of demand for services, and does not have access to reliable data by which to measure progress on delivering its strategy.
“Significant data weaknesses limit the government’s ability to understand progress towards delivering its ambitions around access to children and young people’s NHS-funded services,” the report said.
NHS England’s Five Year Forward View for Mental Health in 2016 set a target to increase the proportion of children and young people in need of mental health treatment accessing services from 25% to 35% by 2020-21. This equates to 70,000 additional young people receiving treatment each year. However, the NHS lacks “consistent and reliable data” on the number of young people accessing treatment and therefore “cannot reliably report progress directly against the 70,000 target,” the NAO said.
In addition, a survey of children’s mental health needs due to be published later this year is expected to show an increase in the estimated number of young people in need of treatment. “[This] will make it even harder to achieve the government’s ambition” to increase the proportion of young people accessing services, the NAO warned.
The report also warned that there is no guarantee that funding has been spent as intended. The government announced a £1.4bn boost for young people’s mental health services in 2014 and 2015, but the NAO said NHS England was “not confident” that its commissioning groups’ spending records up to 2017-18 were reliable therefore could not confirm that all of the additional funding was spend on the indended services.
There is also little national accountability for how plans are progressing as NHS England monitors spending locally rather than nationally, the report said. This is “exacerbated by the lack of objectives relating to the quality of plans and the extent to which they focus on national priorities”.
Slow progress on expanding the mental health workforce is another “major risk” that could derail the government’s plans, the NAO said. Workforce data is patchy, and Health Education England, the training arm of the NHS, has underspent its funding for workforce development against the targets set out in Forward View, it said.
The report praised the government’s “laudable ambitions to improve mental health services for children and young people”, but said it has “not yet set out or costed what it must do to realise these aspirations in full”.
There is still limited understanding of how mental health services are being delivered and money spent outside the health sector, it added.
The Department for Health and Social Care must work with the NHS, arm’s-length bodies and other government departments to set out the scale of the challenge ahead of it, and the actions and resources needed to meet that challenge, the NAO urged. DHSC, NHS England, Health Education England and the Department for Education should meanwhile review workforce plans. it said.
Clear leadership was needed to increase accountability, it said, as well as mechanisms to improve understanding of spending on mental health support in schools and local authorities.