Mental Health in England: Jeremy Hunt vs Ralf Little

In July the top judge of the Family Court condemned the “disgraceful” and “utterly shaming lack of proper provision in this country” for a girl who needed mental health treatment.

In October the Health Secretary said on TV “he was right to say that”.

It’s not controversial to say that many people are not getting the mental health treatment they need in England.

Yet the Health Secretary Jeremy Hunt still said on TV: “What has actually happened on my watch is the biggest expansion of mental health provision in Europe” when challenged on everything from lack of nurses to lack of beds by Andrew Marr.

Mr Hunt can’t have known whether that was true or not. Neither the Department of Health nor NHS England publish records of how much has been spent on mental health in the past. We still don’t actually know how much is being spent in total on mental health in the NHS right now.

What we do know is that the government is more than a year into a five year plan to try to tackle the problems. That plan commits to spending a billion pounds more on mental health by 2020/21.

After Mr Hunt’s TV appearance, the actor Ralf Little called him a liar on Twitter. Mr Little later clarified that he thought Mr Hunt might have got his facts wrong unwittingly.

Ralf Little and Jeremy Hunt swapped dozens of tweets, figures, and examples to back their claims. They clashed on the facts about spending, staff numbers, and crisis care.

So who’s right? Both sides invited factcheckers to the party, so here we are. At Full Fact, it’s not our job to decide whether someone’s lying. But it is our job to get the facts for you.

Weeks of research, press office pass-the-parcel and talking to experts later, here’s what we know.

It comes with a health warning: there’s a lot that isn’t known about mental health, and the Department of Health and NHS England haven’t always answered our questions, so if we get better information, we’ll share it.

Mental health staff numbers

Mr Hunt and Mr Little talked past each other. If you take the number of staff who specialise in mental health, the number of nurses is down by 5,000, and the number of fully-trained doctors in psychiatry and psychotherapy is down by 105. These are up-to-date versions of the staff numbers Mr Little quoted.

There’s some encouragement for Mr Hunt in them. If you include junior doctors who are still training for their specialism the number has gone up slightly since 2010, having fallen in between. So maybe we are starting to see more doctors entering this field.

If you take the number of staff working in a set of mental health trusts, as Mr Hunt did, it’s up by over 4,000. But some of those aren’t new people. Some are people who were already there when the trust they worked for got reclassified as a mental health trust. If you break the figure down, there are fewer nurses and slightly fewer doctors.  A big increase in ‘scientific, therapeutic and technical staff’ is what makes the overall figure go up.

Since we wrote our factcheck the Director General for Regulation at the Office for Statistics Regulation has written to NHS Digital, who publish the figures on the NHS England workforce. He requested that NHS Digital publish regular figures on the mental health workforce in an “accessible” way in order allow people to debate the figures more fully.

Read the full factcheck.

Mental health spending

Mr Hunt’s claims on spending talked about spending planned in future years as if it had already happened, overstated the value of the spending that has happened by ignoring inflation, and used partial figures. There are no complete figures published.

“We’ve put a billion pounds extra of resources into mental health”. Not yet: the government’s mental health plan says that mental health services will benefit from additional investment of £1bn per year by 2020/21. If he had said “We’ve committed to putting a billion pounds extra into mental health”, that would have been correct.

Mr Hunt also said “Over half a billion pounds more” was being spent now compared to last year. That ends up being closer to a third of a billion once you take inflation into account.

We don’t know what’s happened to the total amount spent on mental health by the NHS. The figures we do have which Mr Hunt quoted relate only to spending done by the groups who commission hospital and other care in local areas. They don’t include spending done directly by NHS England which pays for GPs themselves and some specialist mental health services.

The last point is a matter of judgement. If a government increases spending on something, but still isn’t spending enough not everyone would accept that the government is expanding that thing.

There is no complete data on what has happened to mental health spending in recent years so we can’t say what the picture of spending on mental looks like under this government or as Mr Hunt put it, on his watch.

But we do know that the backdrop of the new plan is concern about lack of spending on mental health during that time. Even the government’s own Mental Health Taskforce talked of “chronic underinvestment in mental health care across the NHS in recent years”.

Read the full factcheck.

More people getting mental health treatment

The government wants to treat a million more people a year by 2021. It says it’s on its way with 1,400 more people a day using mental health services than in 2010/11. NHS Digital, the body responsible for collecting the figures, told us in January that the figures can’t be compared to find an exact trend in this way, and that although they think more people are using mental health services, they’re not sure and they don’t know how many.

Read the full factcheck.

Areas of improvement

Mr Hunt pointed to some specific areas where he says things are clearly getting better, on talking therapies and A&E provision for mental health.

The data we have suggests there are thousands more talking therapists than there used to be, although in keeping with the mess of mental health statistics we’ve got used to, there’s no one or comprehensive figure for people providing talking therapies.

A&E crisis services are also being strengthened with more hospitals offering higher standard services. There’s still a way to go to meet the government’s goals for 2020/21 but Mr Hunt’s claim of “significant improvements” is backed up by the data.

That said, on A&E Mr Hunt is quoting unpublished statistics, so Mr Little had no chance of checking that himself, and nor did anyone else. Ministers should not be asking the public to take their word for it on something so important.

Read the full factchecks on talking therapies and on A&E mental health care.

An expansion of mental health provision?

Mr Hunt is counting his chickens before they’ve hatched. “We’ve put a billion pounds extra of resources into the NHS” isn’t something that has happened yet, and nor have many of the improvements it's meant to pay for. But it is something that the government has publicly committed to making happen. That plan is public, and it has support from mental health experts and charities.

The reality right now is hard to know but probably at best much more mixed. It’s only months since the judge warned of the “utterly shaming lack of proper provision in this country”. It’s too much to hope that has been solved.

The mental health data we have is poor and limited. Despite years of politicians of different parties emphasising the importance of mental health, it turns out that no one really knows what they are talking about. The government’s own plan talked about a ‘black hole’ of data, which is only beginning to be tackled.

Mr Hunt was asking the impossible of Mr Little when he invited him to prove him wrong. The invitation was in effect an empty one: our factchecking proves how inadequate mental health data is and how much easier it is to make claims than to painstakingly back them up.

We spent weeks and talked to a whole range of experts to find out what we could. As far as we can tell, a fair summary of the situation might be that the past wasn’t good, the present still isn’t great, but there is a serious plan to make mental health provision better by 2021 and improvements are starting to be seen at least in some areas.

Read more and decide for yourself:

• Mental health staff in the NHS
• Staff working in talking therapies
• Mental health crisis care
• Spending on mental health
• The number of people using mental health services

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%.

The unpublished figures on A&E crisis services have also now been published. NHS Digital has also published a report outlining the many different ways to count mental health staff working in the NHS in England.