Local leadership in a perfect storm: delivering better mental health outcomes

Co-authored by Nicole Samuel, Bryony Langdon & Toni Beckton.

Mental health services stand at a critical juncture. Demand continues its relentless climb, a trend exacerbated by the pandemic, while financial pressures are squeezing budgets to unprecedented levels. It’s a perfect storm, and “business as usual” is no longer a viable option.

Despite government pledges, the proportion of the NHS budget allocated to mental health is set to decrease in 2025/26. For the first time, it’s not just acute trusts feeling the pinch; as the recent consolidated provider accounts show, mental health trusts are also reporting deficits as a sector financial picture was a 0.1% overspend in 2023/24, down from a 1.1% surplus in 2019/20. With NHS Providers and the Royal College of Psychiatrists expressing their concern over funding, how can systems cope with the rising demand?

This stark reality demands a fundamental shift in how we deliver care. The challenge, however, is also an opportunity for local systems to take ownership, innovate, and demonstrate how to achieve better outcomes with constrained resources. In this environment, improvements in inpatient flow emerge as a clear early priority. The rationale is compelling:

• Enhanced patient experience: Streamlining flow directly translates to a better experience for patients, their families and carers, minimising unnecessary waiting times for admission and facilitating more timely and effective discharge.
• Significant cost reduction: Reducing length of stay unlocks substantial cost savings by freeing up beds and optimising resource utilization.
• System-wide decompression: Improved flow within mental health services has a cascading effect, alleviating “failure demand” across the wider system, including A&E departments and social care services, where delays in mental health can create further demand.

It’s not just about the finances. Long inpatient stays can have a profound impact on a patient’s mental health and wellbeing. Staff are also impacted by the pressures of inefficient flow and become demoralised when they cannot deliver the care that they want to.

We’ve been working with some of the mental health systems facing the toughest challenges, especially for inpatient units serving individuals with complex needs. It’s tough, but change is possible. By really digging into the day-to-day pressures, using a behavioural science approach and bringing systems together to have better conversations, we’ve seen frontline teams deliver amazing results:

• 45% reduction in demand of people waiting for an inpatient bed
• Reduction of c£4.1k per admission and 5.5-day reduction in average length of stay
• 17% reduction in people with a length of stay over 90 days

These outcomes demonstrate that tangible improvements are achievable even amidst system-wide pressures. This work can provide valuable lessons for local systems seeking to navigate the current crisis:

• Multi-agency collaboration is non-negotiable: Mental health care needs to involve a multi-organisational approach, widening focus beyond just health. Many of the challenges we saw came from this interface. This isn’t just a nice-to-have; it’s a necessity. Effective collaboration between ICBs, mental health trusts, local authorities, and community organisations is paramount to address complex discharge barriers and improve patient pathways.
• Data-driven decision making is essential: Systems’ success is rooted in rigorous data collection and analysis to pinpoint bottlenecks and track progress. Local systems must invest in robust data capabilities to inform strategic decisions and measure the impact of interventions.
• Frontline empowerment is key: Change can only be achieved by working directly with frontline teams, empowering them to redesign processes and adopt new ways of working. This underscores the need to invest in staff training, support and autonomy.
• Prioritisation is crucial: Focussing on specific interventions with the highest potential impact (e.g., Care Act assessments, information flow) is essential to wholesale system transformation. Local systems must adopt a similar approach, identifying key priorities to maximise resource utilisation and deliver rapid results.

The reality is that given the financial climate, the national focus on acute care, and the rising demand, local systems must come together to drive change from the ground up. Initiatives that can deliver better outcomes for less are the priority. We’d argue that improving inpatient flow is no longer simply an operational efficiency measure; it’s a strategic imperative for the financial sustainability and clinical effectiveness of mental health trusts. Trusts will need to prioritise investments that deliver clear financial returns, and flow improvement initiatives offer a strong opportunity to achieve this. Funding should be leveraged to support:

• Development of robust, community-based alternatives to inpatient care to reduce demand for acute beds.
• Pathways and workforce models that facilitate efficient discharge planning and reduce unnecessary delays.
• Implementation of digital solutions to enhance communication, care coordination, and discharge planning.
• The situation facing mental health services is undoubtedly challenging. However, it also presents an opportunity for local systems to demonstrate their capacity for innovation and resilience. By embracing a proactive, data-driven, and collaborative approach, and by learning from successful examples like the Surrey case study, local leaders can navigate the storm and build a more sustainable and effective future for mental health care. The time for local leadership is now.