NHS spending on mental health

“Extra staff cost money so this is what the data shows last year alone spending on mental health went up by £575m”

Jeremy Hunt, 20 November 2017

“...with CCGs increasing spend by 6.3% vs an overall increase of 3.7% in their funding - in other words spending up both in absolute terms and as a proportion of NHS spend”

Jeremy Hunt, 20 November 2017

The biggest spenders in NHS England are a series of local bodies called Clinical Commissioning Groups (CCGs) that decide what hospital services to pay for. A lot of the rest of the money is spent by NHS England itself.

Mr Hunt’s point here is that mental health is now getting a bigger slice of the pie from CCGs.

That is correct, although the figures used in his examples don’t account for inflation, so the real increase in spending on mental health isn’t £575 million, it’s about £368 million in the last year.

This only gives us the general picture on mental health across all CCGs, it doesn’t tell us anything about how individual groups and hospitals are spending money on these services.

That’s also not all the money spent by NHS England on mental health as some is spent on specialised mental health services. We don’t have good figures on this extra money, but the Chief Executive of NHS England says it is also spending more on mental health.

£575 million isn’t the total increase in NHS England spending on mental health

When Mr Hunt said mental health spending increased by £575 million he was quoting just the increase in spending on mental health by Clinical Commissioning Groups.

CCGs are responsible for planning and purchasing care in their local area, and that includes spending on mental health services.

Mental health spending by CCGs in England totalled £9.15 billion in 2015/16, according to figures published by NHS England. This had gone up to £9.72 billion in 2016/17. That’s an increase of around £575 million or 6.3%.

But these figures don’t account for inflation. Once this is factored in the increase in spending is actually less: £368 million and a percentage increase of 3.9%.

But other money is spent on mental health by NHS England directly

The figures above don’t count all mental health spending by NHS England. We have slightly out of date figures on how much was spent in total on mental health.

£10.1 billion was spent in 2014/15 and £10.8 billion in 2015/16. In each year around 16% or 17% of spending was done outside of CCGs, and was spent directly by NHS England on specialised mental health services.

There are also several problems with these figures. They don’t account for inflation and the 2015/16 figures have been changed since to “take into account NHS England's planning guidance to clinical commissioning groups on consistent reporting of mental health spending”.

We haven’t been able to find any figures on this for 2016/17.

Last month the chief executive of NHS England, Simon Stevens, told a committee of MPs that “mental health spending by CCGs went up by 6.3% last year compared with their programme allocation growth of 3.7%.” This is the same claim Jeremy Hunt makes.

Mr Stevens then went on to say “Likewise for England as a whole—the national health service in England—mental health spending went up by 5.7%, when you take account of specialised services, compared with 3.4% overall growth in the NHS programme budget.”

Neither NHS England nor the Department of Health was able to direct us to the primary source for these figures.

When we asked NHS England for a source for their Chief Executive’s numbers, they told us to ask the Department of Health. The Department of Health told us that the comments by Simon Stevens were the best source of the figures as he made them to a committee of MPs.

We’ve no reason to distrust what Mr Stevens told MPs, but this still isn’t an adequate source for the figures. We should expect spending figures that are used in the public domain to be published in full so that anyone can check where they’re from and how they’re calculated.

It’s especially important that mental health spending figures are fully explained. This is partly because of their prominence, with politicians committing to ‘parity of esteem’ between mental and physical health. It’s also partly because people’s mental health and physical needs and treatment can’t always be neatly separated, so splitting NHS spending between the two will mean making judgements about which pounds go under which heading.

Overall CCGs’ budgets increased by 3.7% last year

Clinical Commissioning Groups spend their money of a wide variety of services, not only mental health. Overall, their core funding allocation (excluding spending on things like administration and primary care co-commissioning) increased by 3.7%, or £2.5 billion, between 2015/16 and 2016/17.

In 2015/16 the spending allocation was £68 billion and in 2016/17 it was £70.5 billion. Again these figures don’t account for inflation. The real increase was £1 billion and 1.5% once price rises between the two years are considered.

This isn’t necessarily the total amount that was spent over the course of these years—it’s the budgets that CCGs were given. We haven’t been able to find figures for what was actually spent on core services in these years, only the total amount spent by CCGs.

Update 28 March 2018

Since we originally wrote this article more information about total mental health spending across the NHS in England has been published. This showed that overall mental health spending increased by £375 million once inflation is accounted for, from around £11.2 billion in 2015/16 to £11.6 billion in 2016/17. That’s an increase of 3.3%.