Mental health spending in the English NHS

17 May 2019

The NHS in England planned to spend £12.2 billion on mental health in 2018/19. That’s roughly one in every ten pounds spent by the Department of Health and Social Care.

Looking at how spending on mental health has changed over the years is only possible in recent times. The farthest back we have comparable figures for is 2015/16, when £11.7 billion was spent—once inflation is accounted for. That’s an increase of 4% to 2017/18.

The £12 billion figure for 2018/19 also isn’t final as complete data hasn’t yet been published.

The published figures show that, compared to 2017/18, the amount of planned spending on mental health services within the NHS has gone down by around £34 million in real terms. But NHS England also says “over the course of 2018/19 there will be additional expenditure on projects that will be funded from additional resources that will be allocated throughout the year. This additional expenditure is not included in the planned spend for 2018/19 because the additional allocations were not known to CCGs at this point”.

As a result it’s unclear right now if more overall was spent in 2018/19 on mental health services than the year before.

Mental health services are expected to receive about £2 billion of the extra £20 billion announced for the NHS over the next five years.

The largest part of NHS mental health spending in England goes to clinical commissioning groups (CCGs)—groups of GPs, other doctors and nurses who buy health services for their local area based on need. The rest is spent on specialised services by NHS England—which are often services that there is less widespread demand for.

In 2016 the government published its plan for the next five years of mental health care. This highlighted the fact that, although around a quarter of NHS care in England goes towards mental health, the NHS spends about an eighth of its budget on mental health services in hospitals.    

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We don’t have earlier figures than this

It’s been claimed that we’re spending record amounts on mental health. That may well be the case—it’s certainly been true over the last three years and could well be in 2018/19 with additional spending—but we don’t have any comparable figures for earlier than that.

We know that £10.1 billion was spent in 2014/15 and £10.8 billion in 2015/16. But there are 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’ve written more about this here.

Spending on mental health trusts

Mental health trusts are bodies that provide health and care services for people with mental health problems. These trusts provide the majority of mental health services in the NHS, but they only received 6% of the increase in spending on mental health by clinical commissioning groups and NHS England in 2016/17.

Because figures aren’t publicly available it’s not possible to say where the rest of this money was spent, according to the Health Foundation think tank. It does say it’s likely that some was spent on talking therapies for adults with common mental health conditions.

In previous years many trusts saw reductions in their income. Between 40 and 50% of mental health trusts in England saw reductions in their budgets each year between 2012/13 and 2015/16.

This trend began to reverse in 2016/17 with just under 90% of trusts reporting an increase in funding, but there was less of an increase in 2017/18 when around 80% reported that funding had gone up. Figures for 2018/19 aren’t available yet.

The mental health investment standard

This was previously known as parity of esteem, the idea that there should be equality between physical and mental health services. It was introduced in 2016/17 and requires all clinical commissioning groups to increase spending on mental health in line with the total funding allocated to them.

90% of clinical commissioning groups met this target in 2017/18 and 100% are expected to have met it in 2018/19.

How much is spent on children?

Around £677 million was planned to be spent on mental health services for children and young people by CCGs in 2018/19—that’s not including spending on care for children with learning disabilities or eating disorders.

That’s up from around £652 million in 2017/18, once you account for inflation. We don’t have earlier figures than this available.

What’s going to happen to mental health spending?

The government recently announced that it plans to increase spending on the NHS in England as a whole by an extra £20 billion over the next five years. That works out at real terms spending increases of 3.4% on average each year.

But experts have said that due to higher than expected inflation the annual increases will be slightly less than that. At the time of the announcement experts at the Institute for Fiscal Studies (IFS) also said that “Increases of more like 4% a year would be needed to provide any improvement in services and to invest in priorities such as mental health, cancer and general practice.”

Analysis by the Health Foundation and IFS has found that, if the NHS in England increased the proportion of people with mental health conditions it treats from around 40%—which is roughly what it treats at present—to 70% by 2033/34 then spending would need to more than double to around £27 billion.

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