Summary Report

Mental Health Watch - July 2021 summary report

The health service has come under immense pressure over the last 18 months. Mental health services have faced a dual burden, with public health measures constraining capacity and an enormous uptick in demand on services. 

Mental Health Watch was launched as a tool to hold Government to account on the delivery of laudable ambitions in the Five Year Forward View for Mental Health and the NHS Long Term Plan. Following a year of upheaval, it now also offers a helpful snapshot of a new ‘baseline’ and highlights where key lessons can be learned. 

This summary examines a selection of the indicators tracked by Mental Health Watch in more detail and unpacks their relevance to the wider mental health sector. 


Eating disorder services struggle under pressure 

Current access and waiting time standards for children and young people’s eating disorder services state that 95% of children and young people referred should receive NICE-approved treatment within 1 week for urgent and 4 weeks for non-urgent cases. While the picture remains variable nationally, it is notable that only 8 STPs (19%) were able to achieve the urgent target in the 2020/21 financial year, with the same number reporting performance below 60%. 

There has been a marked decline in performance against this target during the pandemic.  In the period between January and March 2021, only 70.5% of urgent cases commenced treatment within one week, compared with 72.1% in the previous quarter and 80.5% in the corresponding period in 2019/20.  Importantly, this data must be read in the context of a significant growth in demand, with more than double the number of urgent pathways completed in the last quarter than the same quarter last year.  

There is real uncertainty about how demand will change over the coming months but the urgent question around how services can grow and adapt to meet the demand, particularly in the context of workforce and inpatient capacity constraints, remains.    

Still off track on inappropriate out of area placements 

The Five Year Forward View for Mental Health included a national ambition to eliminate all inappropriate out of area placements (OAP) by the end of 2020/21. It is now clear that the target was missed, with the number of OAP days continuing to rise since spring 2020. Across the period from January to March 2021, the number of inappropriate OAP days was 64,780, 7.0% higher than the corresponding period in 2020.  

We welcomed the Government’s recent investment to support effective discharge to more appropriate settings, which will increase the number of local beds available for patients that need them. We will of course continue to maintain a key focus on monitoring the impact of this funding on the delivery of care. This is particularly the case for the small number of trusts responsible for most inappropriate OAP days, where additional targeted investment to increase bed capacity will likely be needed. 

Increased spending on mental health 

The effects of the Long Term Plan’s commitment to increase spending on mental health are starting to be visible, with planned spending per head for 2020/21 in England now averaging £197.80, 4.4% higher than the previous year. A majority of STP areas now plan to spend over £200 compared to only 17 in 2019/20. As noted in the last Mental Health Watch Spotlight On Briefing, spending per head data is ‘adjusted for need’, with populations weighted based on factors such as service use and demographics. 

While an increase in the average mental health spend is good news, it is worth noting that the gap between the highest and lowest spenders is set to widen on the planned spending numbers to £111.24 between Cornwall and the Isles of Scilly (£255.18) and North East London (£143.93). Final spending figures are due to be published later this year, so keep an eye out for more in-depth analysis in the next Mental Health Watch update. 

Pandemic thwarts access to perinatal care 

Access to perinatal mental health services had been a ‘good news story’ for a number of years, with efforts under the Five Year Forward View for Mental Health (FYFVMH) seeing an additional 20,000 women accessing perinatal services each year by 2019/20. The NHS Long Term Plan’s Implementation Plan confirmed an ambition to see 47,000 women accessing services by 2020/21, a further 5,000 on top of the final FYFVMH target.

This would have been equivalent to the number of women responsible for 7.1% of total births each year. By December 2020, however, this was only at 4.7% for the last twelve months, with no English region attaining the level expected by March 2021. This would mean that during the first year of the pandemic around 16,000 fewer women accessed specialist perinatal mental health services than expected unless performance improved.

Importantly, MHW data also shows that it is possible to buck the trend. 12 CCGs and 2 STPs have still been able to meet the expectation for 2020/21, with a further 9 CCGs and 1 STP being potentially on course to meet expectations, currently reporting between 6.5% and 7.0% of women reached. At the other end of the scale, 22 CCGs and 3 STPs posted performance below 3.5% with North Central London (now both a CCG and STP) only reaching women responsible for 0.7% of births. 

The latest Spotlight On briefing looks in greater depth at this indicator. As efforts to control COVID-19 continue, we will be monitoring efforts to recover, but important lessons can be learned from the last 12 months on how to adapt services and maintain care for women in the perinatal period. 

A closer look at your local area 

We are excited to launch a new feature with this quarter’s Mental Health Watch update. Each quarter, you will now be able to access updated local area reports for each of the 42 STP/ICS areas, including a concise analysis of the most recent data and bespoke charts for key indicators. 

As the health system continues to adapt to the long-term effects of the pandemic, we hope these local area reports will help members and local decision makers understand how national trends are translating locally and support decision making to get back on track with the delivery of the Long Term Plan. 

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