King's Fund report states that people with conditions such as diabetes or heart disease are more likely to have mental health problems, with each costing up to 45% more to treat
The NHS is failing to address the problem of people suffering both long-term physical conditions and mental health problems, and could be costing the organisation as much as £13bn a year, according to a new report.
The report, published by the King's Fund on Thursday, says that people suffering long-term conditions such as diabetes or heart disease are two to three times more likely to suffer mental health problems such as depression, anxiety and dementia, with each costing up to 45% more to treat.
However, despite accounting for between 12% and 18% of the estimated £77bn spent on people with long-term conditions, the King's Fund says there has been a systemic failure in identifying problems and providing support. It says better integration between services for physical and mental health problems will be key to improving outcomes.
Chris Naylor, King's Fund fellow and lead author of the report, said: "The prevailing approach towards improving care for people with long-term conditions is at risk of failing unless we look at patients' needs as a whole, including their mental health needs. To achieve this, mental health provision cannot simply be tacked on to physical care but needs to be an integral part of it."
Around a third of people in England have a long-term condition, rising to half in those over 60, and are the most frequent users of healthcare services, according to the Department of Health.
But the report suggests that some figures may be higher. While 11% of the NHS's secondary healthcare budget is spent on mental health services, it says the figure doesn't include costs to primary care "or increased costs elsewhere caused by poor mental health exacerbating other health problems and hindering their treatment. Nor does it take account of the wider economic impact of mental health problems through their effect on employment and workplace productivity."
While the number of people in England with long-term conditions is likely to remain relatively consistent over the next decade, the number of people with co-morbid long-term physical and mental health problems is expected to rise by a third. They are more likely to live in deprived areas and have less access to resources which the report says contributes to – and perpetuates – health inequalities.
Sean Duggan, chief executive of the Centre for Mental Health said "failing to support the mental health of people with long-term physical conditions is costing the NHS billions of pounds at a time it can ill afford to spend money unwisely. Untreated or poorly managed mental ill-health among this group is cutting lives short, reducing quality of life and increasing health inequalities."
The King's Fund said better integration between mental health support, primary care services and chronic disease management was an opportunity to improve outcomes. It also recommends closer working between mental health specialists and other professionals, which is says is often neglected.
While integration has been moving up the healthcare agenda, the report says health and social care services in England are not currently organised in the best way to support those suffering physical and mental health problems.
It calls on clinical commissioning groups (CCGs) to make joint mental and physical care a top 10 priority. Mental health trusts that have received £2bn to fund more responsibilities for community services can also contribute, the report says, while other organisations such as the new NHS Commissioning Board and the regulator, Monitor, also have a duty to promote integration.
On a practical level, collaborative care arrangements between primary care providers and mental health specialists can improve the problem "with no or limited additional net costs", while redesigning payment mechanisms will remove some of the policy barriers to integration.
The report also suggests that "innovative forms of liaison psychiatry" show that better support can reduce physical care costs in acute hospitals.
Making changes will also help deliver on the government's Quality, Innovation, Productivity and Prevention (QIPP) agenda, the King's Fund says, which aims to develop innovation in health services and better outcomes with less money.
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