Mental health care reform in Wales Promising early signs?

The Health Foundation’s latest analysis of the funding and demand pressures facing the NHS in Wales finds that the service could be sustainable in the long-term if immediate and sustained action is taken. Among other essential changes, reforming health care to meet the population’s changing and growing needs will be critical to securing the future of NHS Wales.

A key area for reform is mental health care due to the known links between mental and physical health. It appears that some progress has already been made in Wales on the path to sensible and effective change.

There has been a big drive in Wales to promote integrated and effective care for mental health patients. In 2010, the Mental Health Measure was passed, which placed legal duties on health boards about the treatment of mental health problems. The legislation has four main parts:

• ensure more mental health services are available within primary care
• all patients in secondary services have a Care and Treatment plan
• all adults discharged from secondary services to refer themselves back to those services
• every inpatient to have help from an independent mental health advocate if wanted.

In 2012, the Welsh government also introduced Together for Mental Health – a 10-year cross-governmental strategy for mental health and wellbeing that builds on the legal requirements of the Measure.

Together for Mental Health, amongst many other things, stated a desire for ‘equality of access to services across Wales and for interventions offered to be based on the best available evidence. Services should be delivered within the community whenever practical, allowing hospital services to be used most effectively, if required.’

The national data in Wales suggest that there is some progress in mental health care provision. Spending on community care for people with mental illness has risen by an average of 4.1% a year between 2010/11 and 2014/15 in real terms. This is in stark comparison to total NHS funding in Wales, which has been broadly flat in real terms.

At the same time, spending on mental health treatment in hospital has fallen since 2010, which is far from a typical trend in health data. For inpatients, spending has fallen by an average of 1.8% per year – £17m lower in 2014/15 compared to 2010/11. The number of inpatient treatment days for mental health has also fallen at 3.6% a year. Whether this is a genuine result of the increased spending on community services is not clear though.

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So what will this mean for health care outcomes?

Health care reform has had improved community care at its heart for a long while. Keeping people out of hospital (if safe to do so) is viewed as being preferable to both practitioners and patients. Unfortunately though, looking at these data tells us little about the patient experience, or whether the increased spending in community settings fully covers the reduction in inpatients, and therefore an increase in unmet need.

There is further reason to proceed only with cautious optimism. The data that we have only cover inpatient and community care – just over half of the £600m total spend on mental health treatment in Wales. So while they are promising and indicate a movement in the right direction, there are plenty of mental health treatments that we cannot account for. For instance, these data don’t tell us how the Measure has affected mental health treatment in a primary care setting.

However, the overall trend does appear to be positive and worthy of close attention.

To be fiscally sustainable, the NHS will need to make efficiency savings, while also adapting how services are delivered in order to better meet the needs of the future population. This need for change is particularly great in mental health care. The reform of mental health care in Wales has shown early signs of success, so we will have to watch eagerly for more evidence to surface.

Toby Watt (@tlswatt) is a Finance Analyst at the Health Foundation