Earlier this week, Health Education England published its strategy to secure the workforce required to deliver the Five Year Forward View for Mental Health. The strategy, Stepping Forward to 2020/21 sets out an ambitious plan to increase staffing levels in NHS funded mental health services in England over the next three years in order to meet the targets set in the Five Year Forward View in areas such as Improving Access to Psychological Therapies, crisis services, perinatal mental health care and liaison psychiatry in acute hospitals.
In sum, the strategy pledges to bring about a net 19,000 increase in the number of staff working in mental health services: 11,000 of them in ‘traditional’ professions such as psychiatry, nursing and occupational therapy and 8,000 more in newer roles such as peer support and psychological wellbeing practitioners.
Bringing about this change so quickly is not, as the strategy notes, straightforward. For professional roles, there is a limited supply of people now in training who can join the workforce during the next three years at the beginning of their careers, with particular concerns about the number of people training in mental health nursing following the end of the bursary scheme. Mental health services in England already have vacancy rates of 10% (equating to a total of 20,000 posts) with particular pressures in nursing and psychiatry in different parts of the country. And attrition rates are high (at more than 13% a year) with the impact of Brexit on this figure as yet impossible to quantify.
All of this means that to achieve a net increase of 19,000 people, action will be needed not just to recruit and train new staff but to fill the vacancies that now exist and to reduce levels of sickness absence and turnover. And as the strategy notes, “we will need to seriously invest in the development and reskilling of our existing staff and/or recruit from the global market”.
The strategy details a set of actions that national bodies and local organisations will need to take. These include a programme of support to NHS employers to help them to retain and retrain staff, to manage sickness absence and to support staff with caring responsibilities. They include a new Return to Practice programme for qualified mental health professionals not working in the NHS and a recruitment campaign to attract more people into mental health careers. The strategy also pledges an increase in the number and breadth of training places to bring about longer term benefits alongside a short-term plan to recruit internationally to fill the biggest current gaps.
At the local level, Sustainability and Transformation Partnerships will be expected to make their own workforce plans while employers will be expected to create new posts in growth areas while reducing the number of posts (by about 5,000) in other, unspecified services.
The strategy is an ambitious attempt to achieve a great deal in very little time. It also seeks to bring about longer term benefits and achieve bigger changes over time in the mental health workforce. It acknowledges that the mental health workforce is far bigger and more complex than the scope of the strategy allows. Social care, for example, provides an important component of the mental health workforce with unique responsibilities, but it is little mentioned in the strategy. Likewise the public mental health workforce is only briefly discussed and the critical (and growing) role of primary care in mental health is barely acknowledged. All of these will be crucial for future strategies to meet growing levels of need with limited resources in an unpredictable labour market.
Later this year, Centre for Mental Health will publish the results of our investigation into the future of the mental health workforce, looking beyond the current Five Year Forward View timeframe. In the meantime, the new workforce strategy gives a framework for local and national action to ensure that the Five Year Forward View has the best possible chance of success and to pave the way for longer term changes to the way we support people’s mental health and life chances in future.
