A week ago in Parliament there were several questions raised on the theme of Mental Health provision for young people that each led to the same response from a Health Minister which raises a further question. However this further question is directed at one of the key elements of the NHS that determines how mental health provision is set out, but which is also about to change its structure. The proposed structural change is from the Clinical Commissioning Groups (CCGs) which were established in 2013 to take over from Primary Care Trusts (PCTs). The concept that lay behind CCGs was that instead of a top down NHS control of primary care through the PCTs that previous Governments had established with some local consultation, that the coalition proposed asking GPs to work together to form their own structures that would enable them to commission services in an effective but local manner. However this change which came about when funding was being cut deeply into the NHS raised lots of concerns regarding both its value and its formation costs. After two years of discussions that involved lots of people including many GPs, several groupings of them in Sussex emerged which took some time to settle down. It is worth reminding ourselves of the top down model of PCTs which displayed a very clear sense that Sussex was relatively unique in the South East. There was one PCT in Surrey, three in Kent and at one time 10 across Sussex although they did reduce to four in the end! When the CCGs were formed they ended up with one covering Brighton and Hove which matched that PCT, two covering East Sussex which matched the end of the PCT development and three in West Sussex which matched a variation of the five PCTs that were initially formed there. The current proposals are for the three West Sussex CCGs to merge into one which is where the PCT ended up and in East Sussex for the two CCGs to merge into one. This will leave Sussex with three CCGs which is perhaps closer to the Kent PCT model. The irony which should be directed as a very sharp challenge to Jeremy Hunt and Lord Andrew Lansley is that had the two East Sussex PCTs merged in 2013 and had all PCTs been reformed to enable GPs to play a more active role, that we would have got to the same place as where we are now heading with a very minimal human and financial cost compared to the impact of the major changes forced on us. In 2010 Lansley with the support of Sussex Tory MPs called for CCGs to get set up which he claimed would enable local GPs to control commissioning even though it was opposed by many local GPs. Then in 2017 Hunt proposed making them much less local, an approach which was again supported by Sussex Tory MPs! Perhaps the Sussex Tory MPs can explain why they supported the costly break-up of the PCTs and are now supporting the merger of CCGs?
After Hunt had also moved on, last Autumn, his successor Matt Hancock responded to a question about mental health by stating “The Mental Health Investment Standard requires CCGs to increase mental health investment in line with overall growth in their allocations. The guidance noted “Each CCG must meet the Mental Health Investment Standard (MHIS) by which their 2018/19 investment in mental health rises at a faster rate than their overall programme funding. CCGs’ auditors will be required to validate their 2018/19 year-end position on meeting the MHIS”.” Then last week Tim Loughton asked some questions regarding mental health for young people. The Minister who responded to him said “The MHIS requires CCGs to increase the amount spent on mental health by at least as much as their overall budget. In 2018/19 it is expected all CCGs will achieve the MHIS level of investment.”
Given that it is three months since that year ended, perhaps we could have some answers now? A further response to Tim on two additional questions on the same theme was “we have now launched the first 25 trailblazer sites in England that will provide Mental Health Support Teams, as part of a new school-based service for those with mild to moderate mental health issues.” Sadly none of these sites are in Sussex although there is one in Kent. Let us hope they go well and in due course this scheme will roll out to provide support for young people in Sussex.