HMI Welfare wanted to know what help was on hand for people with mental health problems in hospital Accident and Emergency departments. It seemed a simple question: How many mental health staff work in A&E?

What we found, however, was an inconsistency across NHS helplines about who to ask about the services available to mental health patients.

We contacted:

• NHS England,
• a number of clinical commissioning groups (CCGs),
• a central NHS Trust,
• the Health and Social Care Information Centre (HSCIC)
• The Bristol Commissioning Support Unit (CSU) press office,
• the Kings Fund,
• Avon and Wiltshire Mental Health Partnership Trust and
• Bristol University Hospitals NHS Foundation Trust

At first it seemed simple: follow the money. We found out that the CCGs allocate the budget for mental health, and NHS England directed us to the CCGs for that reason.

The CCG allocates the money – but can’t say how it’s spent

 

However, Bristol CSU (which services the CCGs) said that although the mental health budget is allocated at CCG partnership meetings, you have to ask the service providers – or those who dispense the budget.

In other words, Bristol CSU said that the CCG has a mental health fund they divide up, with each labelled pot getting a lump sum, these being:

• mental health trusts,
• community mental health,
• hospitals
• and so on.

So with this in mind, Bristol CCU said at first to approach the hospitals as they are the service providers.

Hospitals – or mental health trusts?

But then the Bristol CSU communications department changed their mind. They said we needed to contact the Mental Health Trusts, because it is they who are the service providers who split up the funding for different services.

However the CSU also said we should in any case approach both the Mental Health Trusts and the hospitals.

It seemed that they – like other sources we called – were not sure.

When we did as the CSU directed and contacted the Avon and Wiltshire Mental Health Trust communications department, they referred us back to the CCGs.

Running in circles: back to the CCGs

We pressed the trust for an answer. Their communications officer said that the Mental Health trust did have some liaison teams that work with services in primary care or the GPs, and invited us to send an email.

But their reply again passed the query back. It said:

“The provision of mental health in A & E departments is the responsibility of the CCGs (having taken over from PCTs earlier this year) as they are the commissioning body.

“As all CCGs have their own Press or Communications team, you can contact them directly.”

So that completed the full circle. NHS England also told us to go to the CCGs, and the Department of Health thought the CCGs might know – but if it was policy we wanted on mental health provision in A & E, to contact the mental health team in the Department of Health.

“Contact mental health charities”

Then the Health and Social Care Information centre (HSCIC) said… to contact mental health charities.

Finally, a specialist NHS employee – a commissioner – explained that usually the hospital will liaise with the NHS Mental Health trusts to agree what provision goes in to Accident and Emergency.

With primary care provision coming under CCGs nobody could inform HMIW who to send Freedom of Information requests to regarding mental health.

What, for instance, are the responsibilities of the MH Trusts liaison teams?

Did Mental Health come under primary care? Are Accident and Emergency departments part of acute care?

“Mental health doesn’t come under primary care and is commissioned differently,” Avon and Wiltshire Mental Health trust informed us.

“We do provide mental health services but if they are in a primary care setting such as an A & E department, it would still be a matter for the commissioners to decide what is needed and how to fund it.”

So it seems that Accident & Emergency is primary care. Relentlessly we rang up the advisory Kings Fund in case they knew more. Their reply to an email, which followed up the telephone call in order for them to consider the question more fully, included fourteen different links which did not answer the question.

So what then did the hospitals say? Those asked were too busy to reply. Aintree NHS hospitals trust did not reply to an email and on telephoning, the hospital switchboard directed to a recorded message with an emergency number.

Again after contacting the Patient Support and Complaints Team at University Hospitals Bristol NHS Foundation Trust, they too said to send an email which they acknowledged. In it they stated they aimed to reply within three working days but they are now well outside that target.

It seems that they do not really know or do not want to say. Sending in an FOI might make them find out. In any case, it is not a small area of concern. As Professor Sue Bailey, Royal College of Psychiatrists said in a Centre for Commissioning report :

“Commissioners need to know that 5% of accident and emergency attendances, 30% of acute inpatient bed occupancy, and 30% of acute readmissions are mental health related (RCPsych, 2004)”

It seems that if they do not know, they do need to find out.

Related: Guidance for commissioning integrated Urgent and Emergency care, A ‘whole system’ approach.