We read with interest the editorial by Gyles Glover on allocations to health authorities for mental health care (Reference GloverGlover, 1999). It is important that the sums of money allocated to health authorities for mental health care be widely known. This will allow all interested parties to have ready access to information upon which to base any claims about the adequacy or otherwise of funds made available to health care providers.

We are aware there is wide variation in the amounts actually spent by health authorities, as opposed to the amounts allocated. For example, in the year 1997/98 Worcester Health Authority spent £24 per head of population on mental illness (excluding mental handicap), Solihull Health Authority spent £ 32 per head of population, and Lambeth and Southwark spent £138 (Chartered Institute of Public Finance and Accountancy, 1998). These amounts represent 4, 5.5 and 17.4 per cent, respectively, of the overall expenditure on health care per head of population. We do not have any information on the actual amounts allocated to health authorities in this period, but are concerned at the observed variation. We do not believe that this variation can be easily explained.

There is cause for further concern. The York formula, which is used in determining the level of resource allocation, for example, ranks Birmingham 8th in order of need but 20th in order of spend per head of population. But more worryingly, Birmingham is ranked 38th in order of spend : needs index ratio (further details available from Dr Oyebode upon request). This suggests that whatever the actual amount of money allocated, using a formula devised to take account of factors predictive of high psychiatric morbidity, health authorities may not be spending the indicative amounts allocated to them.

We believe that it is important that mental health services be adequately funded. The transparency of the arrangements for funding will become even more important as we move into an environment controlled by primary care groups or trusts. The risk is that substantial sums will be allocated but not spent on mental health services. It is clear that this is already the case but the situation could very well worsen if there is no control in the system.