NHS recovery plan: progress report 2023

Mental Health, Dementia, Learning Disabilities and Neurodiversity

The pandemic presented particular challenges for mental health, with an increased demand for services. As we progress through our Recovery Plan, we remain committed to delivering improved mental health and wellbeing support in a wide range of settings with reduced waiting times for Child & Adolescent Mental Health Services (CAMHS) and distress and ongoing implementation of our suicide prevention strategy.

Investing in our Mental Health Services and Workforce

We are continuing to see progress in ensuring that at least 10% of frontline health spending will be dedicated to mental health with at least 1% directed specifically to services for children and young people by the end of this parliamentary session.

NHS Mental Health expenditure rose from £1.25bn in 2020-21 to £1.3bn in 2021-22, an increase of £51.5m or 4.1% - representing 8.8% of total NHS expenditure. Expenditure on Children and Adolescent Mental Health Services (CAMHS) rose from £88m in 2020-21 to £97.6m in 2021-22, an increase of £9.3m or 10.6% - representing 0.66% of total NHS expenditure.

We continue to make progress in funding around 320 additional staff in CAMHS over the next 5 years, with the potential to increase capacity for CAMHS cases by over 10,000. The latest figures available for March 2023 show an increase of 148 whole time equivalent staff within CAHMS services as compared to March 2022.

Improving Access to Services

The pandemic resulted in significant impacts on children and adolescents mental health (CAMHS) resulting in increased demand for services, which has been maintained over the past year. We continue to work towards our target of 90% of people referred to CAMHS and Psychological Therapies being seen within 18 weeks, and we have seen significant improvements in waiting lists over the past year. Between June 2022 and June 2023 there has been an 85% decrease in the number of people waiting for longer than a year for CAMHS, and a 54% decrease in those waiting longer than a year for psychological therapies . As we continue to make progress and waiting list backlogs are tackled, we expect this activity to be reflected in improved performance, with all NHS Boards working towards meeting the 90% waiting times standard.

Eliminating long waits for CAMHS and Psychological Therapies is also challenging, but progress continues. By the end of June 2023, 10 of 14 CAMHS services had effectively eliminated their long waits. In 2021-22 we allocated nearly £40m additional funding to NHS Boards to improve CAMHS, which included £4.25m specifically for clearing backlogs. In 2022-23 we allocated a further £36.7m, followed by a further £48.6 million in 2023-24 via the Mental Health Outcomes Framework to improve the quality and delivery of mental health and psychological services for all. We continue to provide targeted, tailored support towards those Boards with the longest waits.

We continue to expand the use of digital mental health services and lock in new service innovations that have delivered good outcomes for people and ensured continuity of service provision. We have nationally rolled out two digital therapies, Sleepio and Daylight, which people can access without needing a referral from a mental health professional and are running pilots on the use of these digital therapies in prisons and for children and young people. We are also piloting the use of cross-border group therapies using video conferencing, allowing people to access group mental health sessions with people beyond their own NHS Board. This will help to reduce stigma and improve access for people in rural communities who may not have large numbers of support, or who are unable to access group therapies in person.

We published an ambitious new “Suicide Prevention Strategy and Action Plan” with COSLA in September 2022, supported by record funding to double the annual budget to £2.8 million by 2025-2026. A new partnership is driving delivery of this plan, with expertise and leadership from Samaritans Scotland, the Scottish Association for Mental Health (SAMH), Change Mental Health, Penumbra and Public Health Scotland.

Driving improvement

As part of our work to develop a set of quality standards for all Adult Mental Health services so that people know what they can expect from their NHS services, we have developed Core Mental Health Standards which are based on the draft quality standards for adult secondary services. We ran a public consultation on the draft standards for adult secondary services and received strong support for the content of the standards as well as widening the scope of the standards beyond adult secondary. We have refined the standards and expanded their remit based on the consultation results and plan to publish the final standards in Autumn 2023.

We have also established the Mental Health Standards Implementation Advisory Group which includes representatives from the mental health workforce, services providers and people with lived experience. This group will inform our approach to implementing the standards."

Our work to transform the integration of mental health within the unscheduled care setting by enhancing pathways for mental health presentations has continued to progress with investment from the Scottish Government supporting NHS 24’s Mental Health Hub to continue to increase its workforce capacity. This has allowed waiting times for support to reduce from 10 mins on average in July 2022 to 5 minutes on average in July 2023. The Mental Health Hub continues to operate a 24/7 compassionate national service and is staffed by Psychological Wellbeing Practitioners who triage people using a psychosocial assessment to either help manage their needs or direct them to the most appropriate form of support such as their GP, community psychiatric nurse, the 999 service or local emergency department.

In addition, 13 Health Board areas are providing local clinical support to Police Scotland and the number of Health Boards offering this clinical support to the Scottish Ambulance Service has increased over the last year, with 11 Health Board areas now providing this support . This allows first responders to provide improved care, closer to home, without the need to convey an individual to the emergency department.

Dementia, Learning Disabilities and Neurodiversity

We continue to support the needs of people with dementia to live well, including post diagnostic support through investment of over £6m in 2021-22 and 2022-23 in Post-Diagnosis Support for dementia, and further investment will be made this year. This ring-fenced funding highlights our commitment to improving support and we are working with Integration Joint Boards to understand the impact of this additional investment. This will inform our approach in 2024/25 as new national dementia strategy goes into delivery. We have also provided £1m to Age Scotland over 2 years to provide complementary community-based post-diagnostic support aimed at keeping people active and connected in their local communities.

To develop our work on mental health and adult neurodevelopmental pathways to support people with a learning disability, autism and ADHD, pilot work was undertaken which recommended the establishment of Health and Social Care Partnership networks and further work to address constraints around workforce, primary care and resources. Work to develop an action plan has started though a partnership with the National Autism Implementation Team.