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Although the number of mental health staff has grown year on year since 2017, growth is unevenly distributed among staff groups, according to a new report
“The NHS Long-Term Workforce Plan needs the number of training places for mental health nursing in England to increase by 93% by 2031-32, yet the number of applicants to study nursing has fallen by 26% in just two years. This should sound alarm bells in government and across health and care.” Stephen Jones, head of practice and professional lead for mental health, Royal College of Nursing
The mental health workforce has expanded significantly since 2010, but staff are now less experienced, research has found.
A report by the King’s Fund, entitled 360-Degree Review of Mental Health Services, says that since 2017, the mental health workforce has seen a year-on-year expansion in numbers. Between 2010 and 2023, it grew by 23%. Growth was unevenly distributed across staff groups, however, and vacancy rates for NHS mental health staff are higher than for other parts of the NHS. In September 2023, there were 28,600 vacancies, representing 19% of the total workforce.
While the number of therapists and support staff increased by 45%, the number of mental health nurses, the largest staffing group overall, grew by just 3%.
In psychiatry, specialisms in old age and learning disabilities, have “consistently been unable to fill all available placements, limiting future capacity,” the report found. The number of child and adolescent psychiatrists grew by 22%, but this was “insufficient to address growing vacancy rates,” the report found.
The King’s Fund also found the increased staff numbers is being driven largely by the growth in numbers of newly qualified staff. In 2010, 15% of psychiatrists were “junior” but by 2022 this had increased to 27%.
The report added: “Changes in the level of staff experience and skill mix of services have led to concerns about being able to provide safe and effective care.”
It notes that increases in the number of nurses have been mainly in community settings, while the number of nurses in inpatient settings has fallen to a level that impacts on the quality of care. “This reflects the focus over the past 15 years on reducing the number of inpatient beds and expanding community-based mental health services,” the report says.
Stephen Jones, the Royal College of Nursing head of practice and professional lead for mental health, told HSJ: “The NHS Long-Term Workforce Plan needs the number of training places for mental health nursing in England to increase by 93% by 2031-32, yet the number of applicants to study nursing has fallen by 26% in just two years. This should sound alarm bells in government and across health and care.”
The staff shortages have an impact on patient care, the report says. Its analysis of Care Quality Commission (CQC) inspection reports found that staffing problems are a factor in all those services rated as “requiring improvement” or “inadequate”.
“One of the most common impacts for patients on wards was that they could not access staff when they needed them,” the report says. “Patients also reported not having one-to-one sessions, not receiving medication on time, and activities being cancelled due to insufficient staffing. Staffing issues also impact on community services, where a lack of qualified staff leads to long waits and undermines the service’s ability to provide safe care.”
The King’s Fund analysis of CQC inspection reports also shows that in inpatient services, staff regularly work extra hours or additional shifts. “Some staff felt they were put in a position where they had to help other wards, but this meant they were working in environments (and with patients) they were unfamiliar with,” the report says.
The report coincides with a decision by NHS England to overhaul its mental health leadership. Its national clinical director for mental health, Professor Tim Kendall, has left, and it is recruiting its first ever medical director for mental health and neurodiversity. The job advert for the new role says: “NHS England is looking to this role to support continued transformation in services and improved outcomes for people with mental health needs.”
It adds that the post holder will provide clinical leadership on care quality, developing “future strategies beyond the NHS long-term plan”, and medical workforce transformation; and work with other directors to engage clinicians.”
FCC Insight
The King’s Fund report has provided valuable information about the staffing of mental health services. While the number of staff has increased, they are unevenly distributed across job role, so we are still short of mental health nurses and psychiatrists with specialisms in key areas. Experienced professionals have left, and the sector now has a high proportion of junior and newly qualified staff. Inevitably a lack of staff has an impact both on the morale of existing staff and on the quality of the patient experience. There are no easy answers – while the Long Term Workforce Plan has a stated aim to increase training places for mental health nurses, it will take some time for the effect of that policy to work its way through. In the meantime, we are left with a situation of ever-rising demand for mental health support, and a lack of resources to meet that demand.