Improving value, productivity and quality through capital investment

There are some parts of the country where significant amounts of money are being spent commissioning inpatient beds provided by the independent sector, or patients are having to be sent out of area inappropriately to receive the care they need, because of an underlying lack of local capacity. These are just two examples of how lack of access to capital funding affects mental health patient care. Enabling trusts to make strategic, long-term investments in their estates and facilities to address this lack of capacity would help to resolve the issue for the long term and be a far better use of resources and deliver a better return on investment. 

Mental health trust leaders believe that capital funding should be allocated with the following priorities in mind: increasing capacity to meet demand; funding new service developments; and resolving persistent quality issues. Mental health trusts are operating in some of the oldest parts of the NHS estate, which often do not provide suitable therapeutic environments for patients and affect their rehabilitation and recovery. 'World class inpatient environments improve people’s experience and outcomes considerably, promoting recovery and impacting positively on their wider health determinants. Having a high-quality physical environment is also important for staff morale and patient safety: large wards create a cramped and noisy environment and impact on staff’s ability to support patients safely. Increasing mental health trusts’ access to capital funding would also enable the sector to further support the government's aim to deliver more high-quality, integrated care in community settings.

Mental health trust leaders have highlighted there is an opportunity to explore using capital funding in innovative ways. For example, they would like to explore supporting the independent and voluntary sector through landlord arrangements to deliver more supported accommodation, which would help tackle delayed discharges. 

We have consistently heard from trusts that mental health services are either under-prioritised in capital allocations or, where they do have access, they cannot necessarily spend it. Last year’s urgent and emergency care capital incentive scheme is one example of successive national schemes that are set within parameters resulting in the exclusion of mental health trusts. There needs to be a more equitable and reliable approach to funding allocations, with mental health properly considered in every care pathway and eligible for associated pots of funding.

The lack of mental health trusts’ access to capital investment means they cannot make much needed improvements. What’s more, too often they do not have access to multi-year capital budgets which are critical to longer term planning and more effective use of the investment available.

To improve value, productivity and quality of care in mental health services, we need to: