Written evidence submitted by The King’s Fund (CMH0079)

 

The King’s Fund submission to the Health and Social Care Committee inquiry into Community Mental Health Services

The King’s Fund welcomes the Health and Social Care Committee’s inquiry into Community Mental Health Services. We are pleased to contribute to the Committee’s call for evidence.

About The King’s Fund

The King’s Fund is an independent charitable organisation working to improve health and care in England. We have a longstanding interest in mental health care. This evidence submission is grounded in both policy research and analysis, including our recent data-led review of mental health care in England: Mental Health 360, and work we conducted as the learning partner to NHS England supporting the development of the 12 early implementer sites of the community transformation programme.

Our interest in this inquiry

We wish to contribute to the inquiry using our research and analysis, focusing on areas where we have specific expertise or knowledge that we hope you will find helpful.

What is the current state of access for adults with severe mental illness to community mental health services?

  1. There is a mixed picture in achievement of the current access and waiting time standards in community mental health services. Targets which define the maximum amount of time from referral to receiving treatment in NHS Talking Therapies and Early Intervention in Psychosis services have been consistently met in recent years. However, the government set an ambition that at least 25% of people (1.5 million) with anxiety and depression would be able to access NHS Talking Therapies by 2021. In 2023/24 a total of 1.26 million people started treatment, meaning that there remain a substantial number of people likely to benefit from this support who are currently not accessing it. 

 

  1. In contrast the waiting time standard for children and young people with eating disorders have never been met. The standard has differential requirements around speed of access depending on whether referrals are deemed to be urgent or routine.  Performance has been improving, but currently only 83% of urgent referrals and 80% of routine referrals meet those requirements against a target of 95% of referrals (NHS England 2025).

 

  1. New waiting time targets for non-urgent treatment referrals to community mental health services aim for adults and older adults to start treatment within 4 weeks of referral. The latest data shows that the current average (median) waiting time from referral to the second contact (when treatment is deemed to have started) is 42 days. However, 10% of people have waited at least 258 days (NHS England 2025). This indicates that there is still some way to go to achieving the standard. 

 

  1. The use of access and waiting time standards is generally accepted to have improved access to care and treatment (National Audit Office 2023). However, the standards are not without issues; in particular, they may not fully reflect people’s experience and may underestimate the amount of time people have to wait. A National Audit Office analysis of waiting times in NHS Talking Therapies services identified notable gaps in the data, including where people drop out from treatment, are waiting between their first and second appointment or are discharged before attending at least two appointments (National Audit Office 2023). This leads to an under-estimation in the number of people who may be waiting and a lack of visibility of those who may be waiting for longer lengths of time.   

 

  1. It is important to note that access standards are also only one part of the picture. Even after having been assessed as requiring care, some people may face considerable waits. This may be due to insufficient capacity for staff to manage or co-ordinate an individual’s care, or availability of treatments and interventions. Most of these access issues are not transparent, because data on the service and the care provided beyond the initial two contacts is not routinely collected or published.

 

  1. Access and waiting time targets have often been established as part of the implementation of specific policies which relate to individual services. While the new targets extend the coverage of community-based mental health services, there remain gaps. For instance, recent years have seen a huge increase in the number of referrals and reported waits for assessment and treatment of attention deficit hyperactivity disorder, yet the lack of standardised data limits the ability to understand the scale of need and plan services accordingly.

 

  1. One of the early findings of trusts involved in the community mental health transformation programme was the identification of a high level of unmet need, which falls outside the programme’s focus on people with severe mental illness (Hodgson, Tazzyman and Fryer 2022). Similar findings have been reported in other trusts as they implemented the community mental health framework. Understanding the nature of these needs and responding with investment in appropriate support and intervention needs to be a priority in future years. 

How can community mental health services work with social care, the third sector and government to better address service user’s health and wider social needs that are wider determinants of mental health outcomes? 

  1. The community mental health framework embeds the role of the voluntary and community sector at the core of providing effective place-based mental health support. As our own work exploring actions to support partnership within the context of integrated care has shown, there are established barriers to work in partnership with the VCSE in relation to commissioning, service design and delivery; sharing data, intelligence and insight; and funding and sustainable investment (Ross and Gilburt 2023). In each of these areas, we identified examples of actions which could support greater integration which are applicable but in no means unique to mental health.

 

  1. Many of the actions we identified relate to ways of working at a local level which reflect more equal partnership. We also heard from those involved in the implementation of the community mental health transformation programme, that having clear expectations for involvement and investment of the VCSE sector outlined as part of the programme specification had been beneficial in some local systems. Other mechanisms for supporting partnership working and investment in VCSE include ensuring that funding programmes do not over-specify what and how funding can be spent, providing sufficient opportunity to invest in the VCSE sector. Furthermore, that timescales for applying for and submitting plans for funding were sufficient to engage and co-design with VCSE organisations.

 

  1. However, recent analysis showing that several ICS’s plan to reduce investment in VCSE organisations over the next year highlights the importance of supporting and building the strategic role of the VCSE sector as part of Integrated Care Boards (Launder and West 2024). Our own work highlights opportunities for national bodies to support the development and evolution of VCSE alliances which play an important role in creating an interface between statutory and VCSE organisations. National bodies can also set clear expectations for ICSs for the involvement of the VCSE sector in governance and delivering key workstreams, and for considering the role of VCSE alliances within the context of provider collaboratives.

 

  1. Finally, there is a need to better reflect the VCSE sector as part of a system of care. That includes being able to identify investment in the sector through financial reporting systems and ensuring that national programmes and policymaking considers the needs and role of the sector from the outset. Existing policy and processes should also be reviewed to identify opportunities to enhance greater integration. 
     

What blockers or enablers should policy interventions prioritise addressing to improve the integration of person-centred community mental health care?

  1. The availability and quality of data in mental health is a consistent challenge in being able to understand the delivery and effectiveness of care. Analysis of Care Quality Commission (CQC) inspection reports that The King’s Fund conducted as part our Mental Health 360 found that an insufficient understanding of demand was among one the key issues contributing to poor access. 

 

  1. Nationally and locally, mental health services collect a lot of data. Data collection often aligns with policy objectives and has been used to track implementation, for instance capturing number of people accessing care against a defined target. However, it is not always easy to turn into meaningful insights, time lags in reporting often limit the ability of services to identify and act on issues in real time, and there are notable gaps that make it difficult for policymakers, practitioners and patients to understand what is going on.

 

  1. Data quality including coverage and completeness has been a consistent problem. The lack of comprehensive and robust data limits the ability to manage and develop services and measure improvement. One of the consequences is a high level of unwarranted variation across mental health services without a clear understanding of what good looks like. 

 

  1. The data available also focuses primarily on access, which is only one section of the patient pathway. For example, there is no centralised data on treatments people receive, so trusts have to rely on national or local clinical audits, which are not an effective or viable mechanism for assessing routine interventions for the populations being served (Davidson 2021). Furthermore, without effective and standardised outcomes it is impossible to assess the effectiveness of a service and the treatment it provides.

 

  1. As the Darzi Review highlights, the NHS has focused its data collection and analysis on the acute hospital sector and many mental health trusts are faced with outdated systems for collecting and managing data (Darzi 2024, Strathdee 2023). Improving the use of data will require attention to be paid to both the infrastructure and capacity of mental health trusts, as well as appropriate accountability for submission and quality of data. 

 

References

Davidson I (2021). Mental Health – Adult crisis and acute care. GIRFT Programme National Specialty Report. Available at https://gettingitrightfirsttime.co.uk/wp-content/uploads/2021/09/Mental-Health-Sept21i.pdf (accessed 28 January 2025).

Darzi A (2024). Independent investigation of the National Health Service in England. Department of Health and Social Care website. Available at Independent Investigation of the National Health Service in England (accessed 28 January 2025).

Gilburt H and Mallorie S (2024). Mental Health 360. The King’s Fund website. Available at Mental Health 360 | Review Of Mental Health Care | The King's Fund (accessed 28 January 2025).

Hodgson D, Tazzyman A and Fryer K (2022). Evaluation of the Sheffield Primary and Community Mental Health Transformation Programme. Sheffield University Management School website. Available at Evaluating the Transformation of Mental Health in Sheffield | Management School | The University of Sheffield (accessed 28 January 2025).

Launder M and West D (2025). Revealed: 14 ICBs cutting spend on the third sector. Health Service Journal website. Available at Revealed: 14 ICBs cutting spend on the third sector | News | Health Service Journal (accessed 28 January 2025).

NHS England (2025). Mental Health Services monthly Statistics, Performance November 2024. NHS England website. Available at Mental Health Services Monthly Statistics - NHS England Digital (accessed 28 January 2025).

National Audit Office (2023). Progress in improving mental health services in England. National Audit Office website. Available at Progress in improving mental health services in England - NAO report (accessed 28 January 2025).

Ross S and Gilburt H (2023). Actions to Support Partnership. The King’s Fund website. Available at Actions To Support Partnership | The King's Fund (accessed 28 January 2025).

Strathdee G (2023). Independent rapid review into data on mental health inpatient settings: final report and recommendations. Department of Health and Social Care website. Available at Rapid review into data on mental health inpatient settings: final report and recommendations - GOV.UK (accessed 28 January 2025).

February 2025