Two thirds of NHS mental health trusts will not receive the funding they need this year to invest in urgent repairs or upgrade their facilities. This lack of investment is putting patients at increased risk and leaving many still being cared for in inappropriate dormitory-style wards.

A briefing from NHS Providers, Mental health services: meeting the need for capital investment, sets out findings from a survey of mental health trust leaders and warns that, although mental health services require a significant amount of capital investment in 2020/21, the majority of trusts will not be able to access enough capital funding to meet their needs.

The findings also reveal:

• For 27% of mental health trusts funding allocated for capital investment would not even meet half of their current need.
• Two thirds of trusts estimate that they need between £50m and £150m of capital investment over the next five to ten years. 
• One trust requires just over half a billion pounds to address maintenance and transform services to meet the needs of patients.
  
  

In the last three years, more than one in five trusts have faced enforcement action from Care Quality Commission (CQC) over the condition of facilities and the impact on quality and safety of patient care, but a number of trusts are not able to access the funding required to make these improvements. Two trusts warned that they are unable to meet over 70% of the costs necessary to address CQC's safety concerns.

Although mental health services require a significant amount of capital investment in 2020/21, the majority of trusts will not be able to access enough capital funding to meet their needs.

   

There are still 350 dormitory-style wards in use across the NHS in England which CQC have warned do not support people’s privacy or dignity and should not be used for patient care in the 21^st century. Mental health trusts urgently need access to sufficient capital investment to modernise care, address safety issues, and reduce out of area placements.

The chief executive of Derbyshire Healthcare NHS Foundation Trust, Ifti Majid said:

“While our acute dementia inpatient services are located in very modern stock, there is currently a real challenge to maintain privacy, dignity and a therapeutic environment in our acute mental health inpatient services, which are housed in older buildings that offer dormitory-style accommodation rather than single bedrooms.

“Many of those with acute mental health needs will come into hospital at the most vulnerable point in their lives; we have a duty to provide them with a physical environment that feels restful and welcoming, and where their privacy and dignity are maintained.

“Greater capital investment in these services would make a huge difference to our patients’ recovery and improve the morale of our hard-working, dedicated staff.”

The chief executive of West London NHS Trust, Carolyn Regan said:

“For far too many people, their experience of mental health care is dominated by the poor physical environment in which they receive this care. Staff who are committed to ensuring a therapeutic place of safety, calm and dignity are still too often caring for patients in buildings which have long outlived their original purpose.

“The St Bernard’s Hospital site in Ealing - parts of which have been described as the “worst mental health estate in London” - is a case in point, with more than half the buildings pre-dating the NHS itself.

Despite greater focus on mental health need and the stated commitment to parity between mental and physical care, this has not been backed up by the necessary investment.

Carolyn Regan    Chief executive

“Despite greater focus on mental health need and the stated commitment to parity between mental and physical care, this has not been backed up by the necessary investment. The reality is that a significant proportion of mental health estate is simply unfit for patient care in the 21st century.”

The survey findings also illustrate concern among mental health trusts about access to capital funding in the long-term, as well as current restrictions on trusts spending their income on these projects and effectively planning capital projects across systems in the future. 

NHS Providers, through its ‘Rebuild Our NHS’ campaign, is calling on the government to fix the current system of capital investment within the NHS by setting a multi-year capital settlement which roughly doubles the current budget, and ensuring all parts of the system are able to access funding based on need.

The deputy chief executive of NHS Providers, Saffron Cordery said:

“Through our Rebuild Our NHS campaign we have sought to make clear the urgent and critical need for capital investment across the NHS to tackle a growing backlog of repairs and to give trusts the tools they need to rebuild and upgrade services to meet patient need in the 21^st century.

“While we have seen some very welcome additional investment from the new government, this to date has overwhelmingly been focused on the acute hospital sector. This is a troubling oversight when there is such a clear need for capital investment in the mental health sector.

Vulnerable patients are being placed at increased risk because the facilities they need are no longer fit for purpose to deliver the specialist care they deserve.

Saffron Cordery    Interim Chief Executive

“We have warned repeatedly of the risks of neglecting investment in NHS mental health facilities. Vulnerable patients are being placed at increased risk because the facilities they need are no longer fit for purpose to deliver the specialist care they deserve. It is not acceptable that dormitory-style wards are still used when all evidence points to the fact they can do more harm than good to those patients. On top of this, it is hugely demoralising to staff who are working flat out to provide the best care they can despite the environment in which they are working.

“We also see the system struggle to bring down out of area placements because of a lack of access to facilities. Receiving treatment, for extended periods of time, away from home and support networks, can be a very distressing and challenging experience for these patients and their families.

“If we mean what we say as we set out to deliver a relationship of equals between physical and mental health, we need to match it with action and investment. We need to see trusts have access to capital investment over the longer term if we are to rebuild and upgrade our services to meet the growing demand for mental health services.”