Wednesday 25 May 2011

NHS Cuts...and Opportunities

Health economists indicate that Wales will suffer the biggest real-terms cut in NHS spending compared with England, Scotland, and Northern Ireland (see the story here).

A freeze in cash spending obviously does mean an effective "cut" because of inflation but we need to watch out for NHS Health Boards trying to impose cash cuts in mental health services which actually means they would be being picked on more than other services. That is not to say that savings cannot be made in mental health services but these need to made intelligently and the savings used to fund gaps in mental health services - that's what the promised ring fence means or else it means nothing.

Hafal has pointed to two distinct areas where savings could be made:

(1) "Repatriation" of high-needs patients from expensive and untherapeutic placements out-of-county or even out-of-country where this is in the best interest of the individual patient.

(2) Rationalisation of mental health teams working within the community. This would require reform of the traditional CMHT functions and approach: instead of addressing problems planners and commissioners have "worked around" the CMHTs by setting up new teams, some very good but we need their modern approach to become the mainstream in a joined-up team.

In addition medium-to-long term there is a clear opportunity to rationalise commissioning of all secondary mental health services (80% of spending on mental health) through systematic analysis of the new, universal, individual Care and Treatment Plans required from next January under the Mental Health Measure. A wise LHB Director of Finance (and their Social Services equivalent) will see these Plans not as an additional expense but rather as a focused and efficient requirement for all expenditure on secondary services. In other words if it's not in somebody's Care Plan why are we paying for it?

In this they will have the support of patients who want spending to follow their individual needs, not to be told what's available and take it or leave it.

If LHBs and local government don't see the great opportunities presented by the coming of the new individual Plans for effective commissioning and spending then patients will need to tell them...