Outdated commissioning methods are failing mental health services in the UK, reveals report

A new report published today 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that mental health services in the UK are falling behind physical health services, due to healthcare providers using outdated commissioning methods.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 pressurized mental health sector, with a specific focus on schizophrenia. Mental health accounts for 28 percent of the demand on the NHS but only 13 percent of its total CCG budget. The report has been launched to coincide with the IPPR think tank’s Mental Health: Parity of Esteem event, taking place in London today.

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.

We have campaigned for decades to see one of the most complex mental illnesses be funded and treated properly. It is disappointing that this report shows that those who are most in need are still being left behind.

Following the release of the NHS Long Term Plan last week, where services for people severely affected by mental illness have been set as a priority, we hope that those living with schizophrenia will be able to access the care that they need before they reach crisis point.”

Lucy Schonegevel, Head of Health Influencing, Rethink Mental Illness

The report shows that mental health is continuing to fall behind physical health, predominantly because of the way in which services are organized 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and integration of care, however, findings show that the vast majority of mental health providers are still using outdated commissioning practices.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 personalization 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. 1,400 more people are accessing mental health services every day compared to 2010.11

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 findings from this report highlight the extent of inequality of healthcare services between mental health and physical health. Improving the lives of patients, their families and carers is at the heart of what we do.

We welcome the increased focus on mental health funding from the recent Government announcement on the NHS 10-year plan, and this report shows how vital it is that the Government delivers on these promises, in order to truly achieve greater parity of esteem in mental health and schizophrenia.”

Jennifer Lee, Director of Health Economics, Market Access, Reimbursement and Advocacy, Janssen-Cilag Limited

The report emphasizes that until significant changes are made to improve accountability within the commissioning system and incentivize 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 individualized 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.


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