Background to the report

The government has acknowledged that, in the past, mental health services were seen as of secondary importance to physical health services. It has committed to providing ‘parity of esteem’ for mental and physical health services. Parity of esteem means that mental health is valued as much as physical health: an expert group, convened at the request of the Department of Health & Social Care (the Department), defined this as including equal access to care and an allocation of resources in proportion to need.

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The most up-to-date estimates (from 2004) indicate that 10% of five-to 16 year olds have a mental health condition, although as little as 25% of children and young people with a diagnosable condition actually access services. In 2014 and 2015, the government announced £1.4 billion of transformation funding for children and young people’s mental health services. In March 2015, it set out its vision for children and young people’s mental health services in Future in Mind.

Content and scope of the report

This report forms part of a wider programme of work on mental health, following our 2016 report Mental health services: preparations for access and our 2017 report Mental health in prisons. It examines whether the government is on track to meet its ambitions for children and young people’s services, taking Future in Mind as the starting point.

We focus in particular on how the government decided to implement Future in Mind; whether it is on track to deliver improved mental health services to young people; and accountability for spending and outcomes.

Report conclusions

The government has laudable ambitions to improve mental health services for children and young people. It started from a very low base when it developed its strategy and has prioritised improvement programmes which take an important, if modest, step towards achieving its aspirations. The government has not yet set out or costed what it must do to realise these aspirations in full and there remains limited visibility of activity and spending outside the health sector. While the NHS has worked to improve information on its activity and spending, significant data weaknesses are hampering its understanding of progress. Slow progress on workforce expansion to deliver NHS services is also emerging as a major risk to delivery.

The government must now ensure a coherent and coordinated cross-sector response, and that the right levers are in place to ensure local actions deliver the national ambitions. It has started to tackle issues of parity of esteem between physical and mental health services for children and young people, but it still has a long way to go, particularly as demand may be higher than originally thought, and an increased focus on mental health may uncover greater demand. Given these weaknesses and uncertainties, we conclude that the government cannot demonstrate that it has yet delivered value for money.

Jenny George shares her key takeaways from our latest report on Improving children and young people’s mental health services.

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“Parity of esteem between physical and mental health services for children and young people is a laudable aim. However, to deliver meaningful change, this must be matched by the necessary planning, resourcing and co-ordination. Despite a welcome start this aim remains far off. Current targets to improve care are modest and even if met would still mean two-thirds of those who need help are not seen. Rising estimates of demand may indicate that the government is even further away than it thought.”

Amyas Morse, head of the NAO

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Press release

View press release (9 Oct 2018)

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