The excitingly named 'transitional support funds'
If we were to shift responsibility for mental health and well-being services to their most appropriate place - local authorities - then there would be some costs involved. We can estimate these costs, described by civil servants as 'transitional support funds', by looking at the recent transfer, in the UK, of public health units from health services management into local authorities (as described in Chapter 7). Health and social care systems differ very considerably from nation to nation. That makes it slightly difficult to translate costs of service change from one jurisdiction to another. However, it is useful to know that the UK Secretary of State for Health allocated a sum of ?15m to fund the transition of public health services.5 This sum was not, of course, intended to fund the services themselves, but to cover all the necessary costs involved in the physical transfer of services (legal costs, planning costs, the physical costs of moving, employment costs, office rental etc.). This is a surprisingly small sum, but does appear to have been sufficient for a relatively efficient transfer of responsibilities. It could be argued that mental health services are a much larger, much more complex, proposition than public health services - they employ many more people, in many more settings, doing very different tasks, including life-saving clinical services. So any transitional costs are likely to be much greater than the sums involved in public health. To be conservative, therefore, it might be reasonable to assume that the one-off costs involved in the transfer of legal responsibilities, employment and management systems, and so on, could be as high as ?100m. These would, again, be one-off costs, and ?100m is around 0.8% of the annual budget for mental health care in the UK. Other costs of the reforms I am proposing would, however, be recurrent.