£1.25billion for children’s mental health: what’s it worth and what’s it for?

When large sums of money are announced in public services there are two questions to ask yourself: (1) What is the money worth in the context of the existing system?; and (2) What will it be spent on?

Over the weekend, the Lib Dems said there will be £1.25billion for “children’s mental health services”. This money is to be over 5 years, equating to £250million per year.

Piecing together various bits of news (BBC, Mind) it seems some of this funding will also go on supporting pregnant women and new mothers with their mental health (i.e. perinatal mental health services) and doubling funding for veterans’ mental health services[1].

Let’s answer our first self-posed question: what is this worth?

Spending specifically on children’s mental health services has been cut by 6.4% since 2010. In 2009/10 some £766m was spent on children’s mental health, which by 2012/13 was £717m – a cut of £49m.

As NHS England and the Minister for Care Services, as source of these figures, make clear, this is only direct spend on children’s mental health services. The figures don’t include local authority spend on the same, where we know 60% of local councils have frozen or cut their children’s mental health spend since 2010/11. Nor do these figures include spending on adult mental health. We know this is relevant because (a) this is where perinatal and veterans mental health funding comes from, and (b) problems in children’s mental health mean that young people are often treated on adult mental health wards. Looking only at local authority mental health spending, this has been cut by £210m since 2009/10. (The question of levels of adult mental health spending in the NHS is questionable; at best, it has stayed static over the last year having been cut by 2.3% in real-terms between 2011-12 and 2013-14.)

In this context, £250m a year doesn’t seem so much, though any money is, of course, welcome[2].

What about our second question: what will this money be spent on?

Inevitably, given its provenance ahead of the Budget, details of how this money will be spent are unclear. The intention, though, seems to be for it to go on “early intervention schemes to stop children developing serious and potential fatal mental illnesses”. Such early intervention is to include therapy sessions, family support work, better training for clinicians and the development of help via websites and online apps.

This is better than I expected, though we should raise a word of warning: given the almost universal focus on children’s inpatient beds it will be hard for providers to not funnel this money into more inpatient beds. We should keep a close eye on where this money goes.

One suggestion I’d like to see is that at least some of the money should be ear-marked for use as Personal Health Budgets, including as part of the Integrated Personal Commissioning programme. Both the PHBs and IPC programmes have explicit focus on mental health and children and young people, and we know that this route leads to more control and more flexible solutions that can meet individual needs. We also know it can join up fragmented systems, and is likely to divert money away from institutionally biased provision.

Money is a blunt tool. Even if it’s questionable whether the amount of money being pledged to something is worth much, we should also ask how it will be spent and ensure it’s used not just to prop up more of what went before. The money to be pledged in the Budget on children’s mental health is a particularly acute case in point.

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Notes:

[1] – The Lib Dem press release also says funding will go to “extend access to services for children under five and those with autism and learning disabilities”, which is strange to say the least.

[2] – I think it is worth noting just how difficult it is to get hold of spending figures on children’s mental health. The Health Select Committee’s recent report on children’s mental health services noted (paragraph 15 here http://www.publications.parliament.uk/pa/cm201415/cmselect/cmhealth/342/342.pdf (pdf)) there is a “lack of information about service provision, including demand,  access and expenditure” and that the best source of such information is currently voluntary. The spending figures found by Young Minds took an FOI request!

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Closing the Gap in mental health – four observations

Four quick observations on the publication of Closing the Gap: Priorities for essential change in mental health (pdf).

1. It’s good to see it published and it’ll be a useful document to refer to.

2. The significant changes needed will come about only through an alliance of everybody affected by the mental health system, from both the top down and the bottom up. The target audiences explicitly identified in the document miss one half of this equation by not including people with mental health problems, their (representative) organisations or families/carers.

3. As @shaunlintern over at HSJ highlighted, the focus on parity in mental health is a sham when NHS England and Monitor have cut the 2014/15 tariff price for mental health (and community) services by a fifth more than the reduction proposed for acute providers

4. The signatories to the policy are Nick Clegg and Norman Lamb. No Jeremy Hunt, in his role as Secretary of State for Health, or (perhaps more noteworthily) as a Conservative. Are the Lib Dems looking to claim mental health as their own ahead of 2015?

Another switch by the Lib Dems

It’s getting hard to keep up. I noted a few days two examples of the Lib Dems doing something in government that was the opposite of what they campaigned for: the McKinnon extradition case and the Digital Economy Bill/Act.

To that list we can now add the like-for-like replacement of Trident, as reported by John Rentoul:

Last night, the Liberal Democrats voted in the House of Commons precisely for the “like-for-like” replacement of Trident against which they campaigned in the election.

Lib Dems: views in campaigning versus reality in government

I’ve noted my own and a good proportion of the public’s confusion over the what the Lib Dems stand for. In two concrete cases, the reason for confusion is clear.

Case 1: The Digital Economy Bill / Act, as described by Left Foot Forward:

As Left Foot Forward has previously highlighted, there is plenty to be worried about in the coming digital economy act. What is perhaps more worrying for progressives is that in retrospect the manipulative use of the digital economy saga in the lead up to the election by Mr Clegg now seems the act of an incredibly shrewd and calculating electioneer who sought to hijack a vacant progressive bandwagon rather than the that of a man of principle who is in tune with some of the more noble fibres of his own party’s philosophical and intellectual traditions.

Case 2: The Gary McKinnon extradition case, as described by Guido Fawkes.

Nick Clegg went to great efforts before the election to voice concerns about the extradition of autistic hacker Gary McKinnon. He even went as far to stand side by side in solidarity with Janis Sharp, Gary’s mother, at a protest and also said “It’s simply not good enough for Alan Johnson to shrug his shoulders and claim that nothing can be done”.

Fast-forward a few months and it’s quite a different tune “What I haven’t got the power to do, neither has the home secretary, neither has even the prime minister, is to completely reverse and undo certain legal aspects of this. It’s legally very complex.”

I’m not commenting either way on either of those issues – that’s not really my purpose here. But before the Lib Dems were in joint power with the Tories, I think most Lib Dem supporters were clear on the position of their party.

My questions is therefore whether those same supporters still clear where their party – part of the coalition government – stands now?

What the Lib Dems stand for (redux)

Just before the election, I asked (with genuine curiosity) what the Lib Dems stand for.

Turns out, I’m not the only wondering: a survey for the Independent last week noted that nearly two-thirds of voters say

they are not clear what the party stands for since it went into coalition with the Conservatives.

If anyone knows what the Lib Dems are after (apart from power, obviously) then let us – and two-thirds of the population – know. Cheers.

Analysing the Lib Dem position 1

Before discussing the position of the Liberal Democrats with regard to the complexities of their role as kingmakers, let’s consider the positions they find themselves in.

In the view of some, they hugely underperformed at the election. I think the distinction to make is that they hugely underperformed against expectations created. For me, it was clear they weren’t going to perform well (as per my prediction. The single factor that leads to this is the jump in support on the back of the leaders’ debates. This did not represent a decisive shift. It represented a castle built on sand.

Just look at the performance of the Liberal Democrats over the elections for which they’ve existed:

• 1983: 14.4%
• 1987: 13.6%
• 1992: 19.2%
• 1997: 18.0%
• 2001: 19.4%
• 2005: 22.1%

For the Lib Dems to jump from 22% to the high 20s or low 30s was unlikely at best.

So their result of 23.0% represents some form of progress. This said, the number of seats they won at this election was actually 5 less than in 2005. This suggests to me that, though their share of the vote increased by one point, this support was concentrated in areas where support already existed.

Even so, despite their relatively poor performance at the election, the Lib Dems are now the kingmakers.

By their own judgment, they should be uncomfortable with this.

Nick Clegg was fond of saying that Labour’s share of the vote was little more than a fifth of the electorate once you took into account the turnout. With 23% of the vote at 65.1% turnout, the Lib Dems have just 14.97% of the eligible vote.

So a party with the support of just over 1 in 7 of the electorate is likely to determine who forms the next government.

Some will think of this as making up for all the power the Lib Dems have previously deserved but never got because of an unfair electoral system. I just think of it as a peculiarity and fairly undemocratic outcome of our current electoral system.

Debating the debate: responding to my fisking

The 3 leaders’ debates have been and gone. Stef gave me a good fisking after the first debate, based on a post I wrote a few weeks ago. Now taking the long view, I thought I’d respond to each of his points.

Note: my original points in italics; Stef’s argument in italics below.

1. Debating points and issues in the debates won’t really be the aim. Instead, it will be used as an opportunity to trade blows, irrespective of the content of those blows
Stef: Some real issues were aired and some interesting debates did occur, albeit they were somewhat stymied by the short amount of time available for each question.

After the first debate, it did seem that some interesting debates might occur. But they didn’t. I was wrong in the sense that the debates would be used to trade blows. Instead, they were used to just say and then repeat their key messages. This wasn’t really 3 debates; it was one debate repeated 3 times. (And the format of the debate, as Stef rightly says, stymied the debate.)

2. What goes on in the debates is almost neither here nor there; it’s how they get spun afterwards that matters.
Stef: Whether the debates were of Aristotlian profoundness or playground pettiness, how they get spun afterwards was always going to be as important, if not more important than the debate itself. This does not invalidate the debates themselves, what went on in the debate did make a difference to how the debate was spun.

My original point safely holds. There were clearly prepared lines and put-downs which were echoed in the post-match spin. Related to point 1 above, the debates weren’t genuine debates; they were just an opportunity to establish and repeat key messages, not debate the merits or otherwise of each other’s policies.

3. I’m not one of those that complains about the American-isation of politics, and in particular the cult of personality in politics. The leadership debates will do nothing to assuage people who do complain about this.
Stef: Agreed.

We were agreed on this, so I don’t need to re-emphasize I was right in the first place.

4. Does anyone remember the one-to-one interviews between Jeremy Paxman and each party leader during the 2005 general election? If you do, you’ll remember they were not known for their jibber and jabber on policy issues but instead adversarial tosh focused disproportionately on specific issues (e.g. the number of illegal immigrants in Britain).
Stef: [T]here was a disproportionate amount of focus on the issue of immigration. Yet because of the uniquely non-adversarial format of the debates, we got into more detail and more clarity on policy positions than any PMQs or Question Time.

We did get into a bit more detail about a very few things; but focusing disproporionately on specific issues – particularly immigration, interestingly enough – did happen. The debates were narrow in their focus.

5. The worry about ‘losing’ the debate, or being the subject of a terrific putdown is precisely what leads to the score-draw results assigned to most presidential debates of the last 12 years. Even though this is the first time debates have been held here, the tendency will be for the candidates to play it safe.
Stef: Yes, it was a play-it-safe debate for all the candidates but especially the ‘incumbents’ but Clegg did better because he played it less safe. Here’s betting that the next two will be a bit livelier. A real good put-down may win it.

The perspective of the 3 debates shows that the debates were primarily safe. For all the media tried to find one, there wasn’t a significant moment in any of the debates.

6. Most people think these debates will be good for Gordon Brown. I don’t agree because (1) the Tories are good at precisely this sort of thing, being the presentation of policy rather than what the policy is; and (2) it depends which Gordon Brown turns up. I suspect it will be the one that has turned up at Prime Minister’s Questions for the last 2 years, which is no good thing.
Stef: Patently wrong on both accounts. Cameron inexplicably failed to present himself and his policies at all well, usually his forte. Brown, clearly dreading the event, actually did much better than he thought he would. Although in my opinion he came ‘last’ it was not by much and he, along with Cameron, can only improve over the next two debates.

I was certainly wrong on (1): Cameron did an awful job in the first debate, did marginally better in the second and was his best in the third. Brown was consistently stodgy. The polls for each of the debates bare this out – only in rogue polls did Brown not come third.

7. The spare wheel: there will have to be air time for Nick Clegg as leader as the Lib Dems. This will just be embarrassing for everyone concerned.
Stef: Erm, I’ll let Rich defend himself on this one. Yes the Lib Dems won’t be the largest single party but hell, the kaleidoscope has been well and truly shaken.

I wouldn’t try to defend it: Clegg clearly did well. I’m going to write a post on my wider thoughts on the Lib Dems over the last two or three weeks.

8. Which television stations will cover this? If not everyone can cover every debate, what will the implication be?
Stef: 9 million viewers for a 90 minute political programme on ITV without adverts is absolutely astonishing. The Sky debate will have next to bugger all viewers, mores the shame. What I’d give for a Channel 4 debate with the mighty Jon Snow.

The ITV debate had 9.4m viewers – around 37% share of the viewing audience that night if I remember correctly. Sky had just over 4m and I still don’t know the figure for the BBC debate (which I expect will be the highest viewing audience). This partly anticipates my riposte to point 9 below, but I don’t think the turnout will be higher than the 1997 election (i.e. 71.4%). Viewing figures aren’t much of a proxy for this, but I think the media is more excited by them than the voting public.

9. Does anyone seriously think the debates will engage a wider audience than those engaged in politics anyway? I doubt it very much.
Stef: Policy by anecdote warning! This weekend I had my first ever party political conversation with my brother whom is not atypical of the disengaged voter but a good proxy. He did not watch the debates but read about them afterwards and looked at some of it on YouTube. His verdict. Cameron “Don’t trust him” (Incidentally my mother thought he looked like a porn actor) Brown “Doesn’t know what he’s doing” Clegg “Seemed straightforward and normal”. Policy by anecdote completed. This is why anecdotes are, in the right context, very powerful. My brother and many like him will possibly vote for the first time ever because of the debate and many may well vote Lib Dem, fundamentally changing the political landscape in this country. This would not have happened without the debate.

I’ll leave the point about whether or not the landscape has been changed by the Lib Dems to a later post (here’s a quick preview: I don’t think it has). But I stand by my original point: the leaders’ debates have not engaged a wider audience than those engaged in politics anyway. Ultimately, this will be borne out by the turnout of the election. But beyond the bubble that the media has created, and which has been supported by social media (especially Twitter), I suspect a significant proportion of the public will remain disengaged by this general election.

A #ge10 bet offer for #libdems

Following yesterday’s leaders’ debate, the Guardian is today reporting that

Nick Clegg now in contention as potential PM.

As I’ve just tweeted, therefore, I offer the following bet to the first 5 Liberal Democrat supporters to take me up on it: if the Liberal Democrats are the second biggest party (on seats) on 7 May, I shall buy them a pint.

What are you waiting for: get in touch!

What do the Lib Dems stand for?

I write this post out of genuine curiosity and would love to hear people’s views – particularly Lib Dems – on it.

(A note: as I’ve said before, the Lib Dems seem like perfectly nice people. Indeed, some of my best friends are Lib Dems. I thus want to be really clear that this isn’t a snide political point-scoring post – it’s a genuine enquiry.)

It boils down to one question: what do the Liberal Democrats stand for? I don’t mean in terms of particular policies relating to the current General Election – I’m pretty clear where they are on most issues.

Instead, I mean, in terms of political theory and ideology, what do the Liberal Democrats stand for? Are they to the ‘left’ of Labour, in between Labour and the Conservatives, or to the right of the Tories? Is there any theoretical or ideological room available to them that fundamentally distinguishes them from the two main political parties?

I know about their modern heritage, and I’ve got a pretty good understanding of the particular heritage of Liberal politics around the turn of the 20th Century. Neither of those periods particularly help with my question in a modern context, so it’s not a history lesson I’m after.

At a push I can see the case for a three-party political system. But in a first-past-the-post system such as ours (which I fully support and wish to see maintained), I don’t view the role of a third party as to pretend it can form a government. Instead, I view the role of a third party in such a system as being one that can create a space for innovative and even radical policy ideas to be proposed and debated, in the expectation that it admits those ideas to the mainstream political debate and thus, potentially, law, via the mechanisms of the two biggest parties.

So, can someone fill me in? I’d genuinely love to know more about the intellectual foundations of the Liberal Democrats.

Nick Clegg: A boring man on a boring background

I should try to engage with the Liberal Democrats a bit more, but I really can’t bring myself to do it. It just doesn’t seem worth the effort, even though they’re all clearly such nice people (well, apart from Chris Huhne, who seems a bit malevolent).

Unusually, my wife has plenty to say about them, the two things she’s said so far being

Who’s that?

when Nick Clegg came on the news once and, on hearing Vince Cable received the best ratings from the Ask the Chancellors debate, said

It’s not that hard to be the most popular when you’ve got Alistair Darling on one side and George Osborne on the other, is it?

Still, the Lib Dems have kicked off their general election campaigning in, erm, style, by launching a website for the “Labservatives”, of which Nick Clegg has the following to say:

Now, goodness knows I’m not a political strategist, but if I were in the Lib Dems, I’d be asking myself two immediate questions about this approach: (1) If the Lib Dems really are a change from the usual, why don’t they use their first major general election initiative to tell us why they’re different instead of spending all this time and money pointing out why the Labservatives are all the same?; (2) Why on earth would you put Nick Clegg – hardly the most colourful man on the planet – in a white shirt against that background?

If this is the best the Lib Dems could come up with then no wonder my wife didn’t have much to say about them.

And the fact that she – rather than me – didn’t have much to say about the Lib Dems is much more of a problem for them than it is for her.