Auditor General publishes follow up report on Adult Mental Health Services

Published: 13 July 2011

Important improvements made in adult mental health services- but some inequalities remain says Auditor General

There have been important improvements in adult mental health services in many parts of Wales since the Auditor General published a baseline review in 2005, although progress has been variable and some service gaps and inequalities remain.  In a follow up report published today, the Auditor General also says that the Welsh Government, NHS bodies, and councils face some new challenges in further developing services.

The report says that there has been a shift in resources from inpatient to community services and many areas now have a broader range of community services in place, although they do not always have adequate capacity and there is no clear link between the level and mix of resources and the variations in need across different parts of Wales.

Many GPs and practice staff have not received mental health training within the last three years, and limited progress has been made in increasing the number of GPs with specialist skills in mental health. However, steps have been taken to improve primary care provision of mental health services and to provide more GPs and practice staff with specialist support. 

Psychology therapy services waiting times can be very long and in excess of Welsh Government targets although services have improved in some parts of Wales. Since 2005 there has been an increase in the numbers of counsellors, psychotherapists, psychologists and community mental health staff trained in psychological therapies.

Information provided to service users is not consistently kept up to date in some parts of Wales and despite recent improvements in care planning in some areas, service users are not being consistently supported and involved in their care.

Action by the Welsh Government to promote and support improvements in adult mental health services has been partly effective, and the Welsh Government has delivered many of the actions it was responsible for under the revised National Service Framework. However, too many targets and key actions for mental health services have been set as a result of external reviews. These have not been co-ordinated and prioritised effectively at a local level, and the Welsh Government has not monitored effectively the implementation of its guidance on how some services should be provided.

It is not yet clear whether the Welsh Government’s attempts to protect NHS mental health expenditure have been successful. Expenditure on adult mental health has varied across Wales and there is a lack of information on which to assess the impact of different expenditure and service patterns on the outcomes for people using services.

New challenges have emerged in recent years. These include rising demand for services during a period of financial restraint, and a change in the focus of services towards maximising mental health and achieving a better quality of life lived as independently as possible.

The most recent NHS re-organisation provides an opportunity for the new Health Boards to drive forward change, but the Boards do not have effective arrangements in place to monitor how well they are responding to national advice on making service improvements and achieving cost savings.

The report makes a number of recommendations for the Welsh Government including:

• focusing its new mental health strategy on embedding key services elements in all parts of Wales and ensuring these services have appropriate capacity and operate effectively
  
• placing service outcomes at the heart of the new mental health strategy, including in relation to target setting, information gathering and performance management
  
• examining the potential for investing in those mental health services that will deliver a net saving to the NHS and the public sector as a whole.

Auditor General for Wales, Huw Vaughan Thomas, said:

“There have been encouraging improvements in adult mental health services since the 2005 baseline review. However, it is a mixed picture; progress across Wales has not been uniform and significant challenges remain. It is vital that the Welsh Government, NHS bodies and councils work together closely, and continue to develop and improve services so that the people of Wales who are affected by mental health issues receive the best care possible.”    

For further information including the report itself, please go here