Editorial

Citation

Caan, W. (2011), "Editorial", Journal of Public Mental Health, Vol. 10 No. 2. https://doi.org/10.1108/jpmh.2011.55610baa.001

Editorial

Article Type: Editorial From: Journal of Public Mental Health, Volume 10, Issue 2

Follow the money is a good tip in detective work. The Health and Social Care Bill now before Parliament (Lansley, 2011) will drastically alter health systems across England, including the organisation, funding and oversight of public health. The key organising principle is “localism” and most health care funding would sit with local, self-selecting “commissioning consortia” of general practitioners (GP). A joint local authority and GP “health and wellbeing board” would have some oversight of population health, and Directors of Public Health would move into each local authority, i.e. back where they were located until 1974. The still nebulous health and wellbeing boards will have the key role in “integration” of health service and local government commissioning for “public mental health” (Public Health Development Unit, 2010). When the voluntary group 38 Degrees conducted a National internet poll about the proposals in the current Bill, people were most worried about this issue:

Don’t let big decisions about health spending be taken behind closed doors and without democratic scrutiny (82.7 per cent of respondents).

My own concerns are also greatest around the commissioning of public mental health. Commissioning is a difficult skill to master, and for example 74 per cent of GP trainees feel they have not learned the skills for this role compared to only 9 per cent who feel prepared (Jacques, 2011). Previous experiments in commissioning like GP fundholders (Aldridge et al., 2011) or Primary Care Groups (Caan, 2011) did not show an effective range of planning skills and the new GP “consortia” will control much bigger budgets than those doctors did: roughly 80 per cent of the total health funds. During the recent government “pause” to listen to the concerns of the public, I wrote to the Secretary of State for Health. Andrew Lansley replied on 5 May 2011 that:

It has always been the Government’s aim […] that commissioning should involve the full range of experts […] and that the NHS is made more democratically accountable.

This summer it is vital that we use the best available evidence (Aldridge et al., 2011) and channels of communication (Department of Health, 2011) to advise the policy makers on effective and transparent use of public money. The government intends to respond to such expert advice in July (Ford and Dunton, 2011).

One challenge is to ensure the finite money for “mental health” is spent well (Naylor and Bell, 2010), for example, investing in child health to prevent later mental illness. The great economic return from low-cost interventions early in life is not recognised in the many piecemeal cuts now being inflicted on child and adolescent mental health (News, 2011). Another problem at the population level is the poor understanding by policy makers of positive mental health (Easterley, 2011). At the recent Public Health Congress (Birmingham, 4 May 2011), we began to address this commissioning need in our policy session on Why wellbeing matters to public health.

Good commissioning needs to be based on relevant, accurate and up-to-date health information. The strategy No Health Without Mental Health considers the need for good measures to indicate where commissioners should invest funding:

However, these indicators do not cover the full spectrum of positive mental health outcomes. The problem is not that outcome measures have not been defined – in fact, many outcome measures are in use by different provider organisations – but few are standardised and routinely collected across mental health services. We will work with partner organisations to agree and develop an appropriate number of key outcome measures and ways to collect them. This will provide the information that individuals need to make real choices between services and approaches, and will allow commissioners and providers to benchmark their services against one another. We will need to give consideration to the collection of more robust and systematic data in relation to all groups. (HM Government, 2011).

At a time of many cuts in services, health intelligence services are also shrinking. Local authority information seems to be especially vulnerable (Department for Communities and Local Government, 2011) just when the embryonic health and wellbeing boards will need to make their first plans. In this issue, Glover et al. describe a “prototype” of one way to evaluate mental wellbeing across England. When GP commissioners are counting their pennies, we must have hard numbers to help them make hard decisions.

Prime numbers:

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  One commissioning body is a bargain.

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  Two commissioning systems is a confusion.

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  Three commissioners is a confrontation.

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  Four funding streams is a fight.

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  Five funding systems is a frenzy.

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  A total of 300 “local” self-governing systems is a lunacy.

Woody CaanE-mail: woody.caan@anglia.ac.uk