Outdated mental health commissioning contracts are failing services

Outdated mental health commissioning contracts are failing services

A new report reveals that outdated mental health commissioning contracts are failing UK mental health services.

The report published by the Janssen Pharmaceutical Companies of Johnson & Johnson highlights that mental health services in the UK are falling behind physical health services, due to healthcare providers using outdated commissioning methods. The report brings to light challenges faced by the UK’s pressurised mental health sector, with a specific focus on schizophrenia. Mental health accounts for 28% the demand on the NHS but only 13% of its total clinical commissioning group budget. The report has been launched to coincide with the IPPR think tank’s Mental Health: Parity of Esteem event.

Schizophrenia accounts for the second highest number of total bed days of admitted patient care, compared to any other health (mental and physical) diagnosis, with approximately 2.5 million bed days in 2016/17. It is one of the most complex and challenging mental health conditions to manage and brings a significant burden to the NHS. Schizophrenia and psychosis cost the NHS £2 billion in 2012/13, a figure that is expected to rise with increasing patient numbers. On average, people with schizophrenia have 36.4 contacts with a healthcare professional each year.

Analysis in the report shows that mental health is continuing to fall behind physical health, predominantly because of the way in which services are organised and funded. Newer commissioning models used in physical health have been introduced in order to drive innovation and integration of care, however findings show that the vast majority of mental health providers are still using outdated commissioning practices.

Such practices include block contracts, which provide a set payment for delivery of services over a certain period of time. Results from the report show that the use of block contracts result in:

  • Delayed discharges
  • Ward overcrowding, bed shortages, out-of-area placements and appointment delays
  • Lack of personalisation and integration of care (no detail is collated about specific individuals and their care)
  • Cherry picking patients, avoiding those with more complex needs that might consume more budget and resources.

The need to resolve these issues has never been more important. 1400 more people are accessing mental health services every day compared to 2010. Whilst the NHS Mental Health Dashboard monitors achievement in providing mental health services across the UK, it provides no transparency in where this money is spent, and whether it is truly resulting in improved outcomes. This lack of accountability means that there is little incentive for commissioners to change practice.

The report emphasises that until significant changes are made to improve accountability within the commissioning system and incentivise the adoption of outcomes and quality-based commissioning approaches, there will be little development in frontline services for people with schizophrenia and other mental health conditions. Increased uptake of these more innovative and outcomes-driven funding methods will ultimately lead to earlier access to the right specialists and teams, more individualised care plans, and more rapid uptake of new medical innovations.

Janssen’s aim through this report is to highlight to decision-makers and mental health service providers the urgent change required to commissioning in this area, in order to improve outcomes for people with mental illnesses and schizophrenia, and the healthcare system as a whole.