Source · Select Committees · Public Accounts Committee
Recommendation 3
3
Accepted
Evaluate ICB support for mental health services and effectiveness of central support arrangements.
Conclusion
New integrated care boards and partnerships could struggle to prioritise mental health services and support, in the face of funding pressures and the need to reduce backlogs for physical health services. ICBs will be responsible for bringing forward many of the ambitious programmes for mental health services in their area, for example, ensuring data sharing across local NHS, local government and voluntary sector organisations, and workforce planning and deployment. Many of the challenges that ICBs have to address involve longstanding and unresolved issues and as the Department itself notes, “the proof will be in the pudding”. But we remain unconvinced that many of the ICBs, at this stage of their development, have the maturity, resources or capacity required to meet the high expectations placed on them for mental health services. This is particularly the case as ICBs tackle reducing backlogs for physical health services while under funding pressures. We are also concerned about the ability of NHSE, during a period of significant reorganisation, including a 30–40% planned reduction of central staffing, to support ICBs, hold them to account for performance, and challenge inconsistencies in local practices such as the patchy implementation of clinical guidance across local areas for people with eating disorders. Recommendation 3: NHS England and the Department should evaluate how well the new integrated care boards and partnerships are supporting mental health services and how well their own support arrangements work to address variation between, and poorer performance in, local areas.
Government Response Summary
The government agreed, outlining existing mechanisms such as NHS England's delivery assurance, annual performance evaluations, and the segmentation of ICBs and trusts. From 2023-24, ICBs must also include mental health expenditure in their annual reports, which NHS England will assure.
Government Response
Accepted
HM Government
Accepted
The government agrees with the Committee’s recommendation Integrated Care Boards (ICBs) and trusts, utilising 63 metrics, 6 of which relate to mental health. NHS England will continue to undertake delivery assurance within the new model outlined in the NHS Operating Framework, which is complemented by central data repositories that provide an overview of performance at a national, regional, ICB and sub-ICB level. NHS England segments ICBs and NHS trusts on a scale of 1 to 4 and provides mandated support for the most challenged providers and systems. NHS England also conducts annual performance evaluation of ICBs. From 2023-24, all ICBs are also required to include a statement of the amount and proportion of expenditure incurred by the ICB in relation to mental health in their annual report, increasing ICBs’ public accountability for their decisions on mental health investment. NHS England will assure ICB spending plans and actual spend. To ensure mental health is sufficiently prioritised, the Health and Care Act 2022 requires that ICBs must have a member who has mental health expertise on the Board. NHS England is working within the new operating model to ensure systems are empowered to self-assure spending and delivery, but significant risks and issues will continue to be escalated to support a strategic response. NHS England and the department will continue to monitor this approach to ensure that appropriate support is being offered to ICBs.