Further supplementary evidence submitted
by the Department of Health (WP 01E)
PURPOSE
1. The purpose of this note is to bring
to the attention of the Committee, the work of the National Workforce
Programme (NWP) of the National Institute for Mental Health in
England (NIMHE) in respect of mental health, as part of the Care
Services Improvement Partnership (CSIP). In particular, the Committee
may not be aware of our recent publication around our Workforce
Planning Pilot Programme; our work on New Ways of Working; New
Roles; Recruitment and Retention; and Education and Training.
BACKGROUND
2. CSIP is commissioned by the Department
of Health (DH) to help services implement national policies across
health and social care in respect of mental health; learning disabilities;
physical disabilities; older people; children and families; and
people with health and social care needs in the criminal justice
system.
3. NIMHE is part of CSIP and one of the
key national programmes in NIMHE is workforce.
NIMHE NWP
4. Working primarily at the national level,
the purpose of the NIMHE NWP is to support local workforce change
through the publication of guidance and practical support that
can enable greater flexibility for making change. Guidance is
developed through collaborative work with professional bodies
and other national workforce players and implementation is supported
through various local pilots and Accelerated Development Programmes
(ADP). Such development is for the whole of the mental health
workforce. This includes all staff, professionally qualified or
not, across the full age range of mental health services (children,
people of working age, and older people) and across all NHS and
social care commissioners and providers of mental health.
5. The NWP is supported by having a workforce
lead in each of the eight CSIP/NIMHE Development Centres (DCs)
across England. It also works very closely with other key stakeholders.
These include Skills for Health; Skills for Care; the Centre for
Clinical Academic Workforce Innovation (CCAWI); the DH; the Workforce
Review Team; Strategic Health Authorities (SHAs); the Mental Health
in Higher Education network; the NHS National Workforce Projects;
the various Royal Colleges; members of the voluntary and independent
sector; and service users and carers.
6. The role of the NIMHE NWP is to work
at the strategic, developmental level. The NWP does not have a
performance management function ie measurement against DH targets
under the National Service Framework (NSF) for Mental Health[4]
and the NHS Plan. [5]That
is for the DH Mental Health Policy and Performance Branch.
NATIONAL MENTAL
HEALTH WORKFORCE
STRATEGY
7. In August 2004, the NWP published a National
Mental Health Workforce Strategy that sets out six key aims:
— to improve workforce design and
planning so as to root it in local service planning and delivery;
— to identify and use creative means
of to recruit and retain people in the workforce;
— to facilitate new ways of working
across professional boundaries;
— to create new roles to tap
into a new recruitment pool and so complement existing staff types;
— to develop the workforce through
revised education and training at both pre- and post-qualification
levels; and
— to develop leadership and
change management skills.
8. The most recent publications produced
or commissioned by the NWP are set out in Annex A. A list of our
planned publications is at Annex B.
WORKFORCE PLANNING
PILOT PROGRAMME
(WPPP)
9.1 Workforce Planning has been an expectation
in mental health since the publication of the NSF where mention
was made about the production of a local workforce strategy to
include a review of local workforce issues. Initial and subsequent
self assessments by localities across health and social care showed
poor progress was being made. As a result, DH assembled a Group
to look at developing some Best Practice Guidance and this was
published in March 2003. [6]
9.2 What subsequently became clear was that
whilst the guidance was warmly welcomed, the Local Delivery Plans
showed that workforce planning is not sufficiently robust at Trust
level (nor is it in other organisations) and that localities required
help over and above the guidance.
9.3 The NIMHE NWP then decided to develop
a WPPP to explore in practice, what the issues were. A central
Team was set up to drive the project forward and it commissioned
each NIMHE DC to put forward no more than two sites each to help
test and support the development of the planning process set out
in Best Practice Guidance.
9.4 The aim was not just to help those particular
sites but to disseminate the lessons learnt by way of a published
Report available to all localities. This includes SHAs and their
Workforce Development Directorates; Primary Care Trusts (PCTs);
Mental Health and Foundation Trusts and Local Authorities (LAs)
and to provide advice and support by way of the NIMHE DCs.
9.5 The intention was to support one pilot
site in each of the eight DC areas but London was not able to
submit a nomination. The final sites were:
— Birkenhead and Wallasey and Bebington
and West Wirral PCTs
— Cambridgeshire and Peterborough Mental
Health Partnership NHS Trust
— Dartford, Gravesham and Swanley PCT—Kent
countywide project
— Dorset Healthcare NHS Trust and North
Dorset PCT as one county wide project
— Northamptonshire Healthcare NHS Trust
— Sandwell Mental Health and Social
Care Trust
— Tees and North East Yorkshire NHS
Trust
9.6 Following an extensive two year programme
of events, local workshops, site visits, preparation of supporting
materials, teleconferences, consideration of local draft reports
and plans etc, a Report on the WPPP was published in May 2006.
[7]
9.7 In essence, the Report set out a number
of lessons learnt to include 10 key points (see below), as well
as a number of resources to support the workforce planning function.
As part of the preparation of a local Integrated, Joint Workforce
Plan, the Report also made a link to mainstream health and social
care policy by making a cross reference to the White Paper, "Our
health, our care, our say" where it says on pages 185-186:
"Key to closer integration will be joint service and workforce
planning. The NHS and local authorities need to integrate workforce
planning into corporate and service planning". The Report
on the WPPP clearly helps meet that commitment by showing how
it can be done.
9.8 The 10 key points set out in the Report
were:
— Recognise Workforce Planning is important.
— Get senior (Trust) Board commitment
and support to the Workforce Planning process.
— Secure Workforce Planning champions
at all levels in the organisation.
— Keep it simple—link to existing
established processes such as business and service planning.
— Provide sufficient resources to carry
out the Workforce Planning function.
— Ensure there is both the capacity
and capability to undertake Workforce Planning.
— Use the Department of Health Best
Practice Guidance as a model.
— Develop an Action Plan identifying
what is to be done, by whom and by when.
— Consider piloting in some parts in
small areas first and do it in stages.
— Use it to meet local needs.
9.9 The NWP is now engaged in a programme
of dissemination of the Report by way of the web sites; presentations;
working with the CSIP DCs; the Foundation Trust unit; the NHS
National Workforce Projects group; the Mental Health Partnership
Group of Chief Executives etc.
NEW WAYS
OF WORKING
(NWW) OF THE
CURRENT WORKFORCE
10.1 A programme of looking at NWW in mental
health has been under development since 2003 under the auspices
of a National Steering Group. This has been jointly chaired by
NIMHE and the Royal College of Psychiatrists and representing
all professional and other staff working in close collaboration
with the CSIP/NIMHE DCs. The early work focussed on psychiatrists
and the need for change. Two reports published in 2004[8]
and 2005. [9]The
Interim Report provided guidance on a number of issues such as
medical responsibility and new models of service and the Final
Report provided a framework for the development of NWW across
the whole of the mental health workforce along with new, Joint
Guidance between employers and the College on the employment of
consultant psychiatrists. [10]
10.2 All professions eg psychology; nursing;
social workers; pharmacy; allied health professions; the non-professionally
affiliated workforce; and primary care are exploring what NWW
and workforce reform means to them. Current work streams are addressing:
— medical and clinical responsibility
across primary and secondary care including accountability of
non-medical prescribers in extending their practice;
— work with Coroners, the HealthCare
Commission and others to address the implications of NWW; and
— competences, Career Frameworks, Education
and Training (E&T), and the implications of new practitioner
roles for the existing professions.
10.3 The intention is to produce a progress
report in March 2007.
10.4 As part of the NWW initiative, the
NWP is also developing as Creating Capable Teams Approach (CCTA)
that will provide a methodology for mental health teams to review
their practice and so develop their capabilities and competences
to meet the needs of service users utilizing the opportunities
and flexibilities of NWW and New Roles leading to improved workforce
planning. The CCTA is scheduled for publication in March 2007.
MENTAL HEALTH
LEGISLATION
11.1 The Mental Health Bill introduces roles
that replace the existing approved social worker (ASW) and responsible
medical officer (RMO):
— The functions of the ASW, which include
submitting the application for a patient's detention under the
Mental Health Act, will be taken on by professionals approved
in the new role of Approved Mental Health Professional (AMHP).
The Bill allows this role to be taken on by a broader range of
professionals in addition to social workers. In England, this
may include mental health and learning disability nurses, occupational
therapists and chartered psychologists. Welsh Ministers will decide
which professional groups AMHPs can be drawn from in Wales. AMHPs
will be approved in the role by Local Social Services Authorities
(LSSAs), who must ensure that minimum training and competency
requirements are met before approval can be given. These requirements
will be laid out in separate regulations for England and Wales.
— The functions of the RMO, which include
being in charge of a patient's treatment, deciding if a patient
should go on leave of absence, have their detention renewed or
if they should be discharged, are being taken on by professionals
approved in the new role of Approved Clinician (AC). The AC with
overall responsibility for a patient's case will be the patient's
Responsible Clinician (RC). The Bill allows this role to be taken
on by a broader range of professionals, in addition to doctors.
In England, this may include chartered psychologists, mental health
and learning disability nurses, occupational therapists and social
workers. ACs will be approved in the role by Strategic Health
Authorities (SHAs), who must ensure that minimum training and
competency requirements are met. Welsh Ministers will decide who
will approve ACs in Wales and the minimum requirements for approval
in Wales, including the professional groups from which ACs can
be drawn. Minimum approval requirements will be set out in separate
directions from the Secretary of State and Welsh Ministers.
11.2 CSIP is working with professionals
and providers on the implementation of the AMHP and AC roles.
Employer Guidance, which will be drafted with the full input of
stakeholders, will set out recommendations and best practice on
implementation issues.
NEW ROLES
(NR)
12.1 A number of NR have been introduced
into mental health to help expand the workforce across health
and social care. These have been supported by the publication
of Guidance that includes:
— Primary Care Graduate and Gateway
workers who, trained in brief therapy techniques of proven effectiveness,
will help GPs to manage and treat common mental health problems
in all age groups (published in January 2003[11]);
— Support, Time and Recovery workers
who will support service users by giving them time and so help
their recovery (published in March 2003[12]).
The introduction of STR workers was supported by an ADP that will
conclude in March 2007 with the publication of a Handbook; and
— Community Development Workers for
Black and Minority Ethnic (BME) communities who will act at a
strategic level as a Change Agent; a Service Developer; a Capacity
Builder; and an Access Facilitator for the whole of the BME community
(Interim Report[13]
published in December 2004; Education and Training[14]
published in October 2005; and a Handbook[15]
published in November 2006)
RECRUITMENT AND
RETENTION (R&R)
13.1 In recognising the NWP cannot of itself
recruit and retain staff employed by NHS Trusts and LAs, it has
undertaken a number of strands of work to help local health and
social care systems with these functions. This includes:
— working with CCAWI and the University
of Lincoln to produce a report in December 2004 on the recruitment
of health and social care professionals in mental health; [16]
— commissioning a mental health R&R
research project[17]
that provides both a useful reference source as well as a Checklist
and Self Assessment Guide (published in January 2005);
— production of a Good Practice Guide
for mental health nursing[18]
as part of the Chief Nursing Officer's Review of mental health
nursing that sets out the potential actions that can be taken
to strengthen R&R of mental health nurses supported by examples
of good practice and a resource library of contemporary documents
about R&R (published April 2006);
— collaborative work with the Royal
College of Psychiatrists; the NHS Confederation; and the National
Mental Health Partnership Group of NHS Trusts to produce guidance
in October 2005 on the employment of consultant psychiatrists.
[19]This
set out new advice about how consultant psychiatrists may be recruited
to new or changing posts by using a more contemporary and flexible
approach that takes account of new and emerging models of mental
health care; and
— further collaborative work with the
Royal College of Psychiatrists; NHS Employers; DH; NHS Professionals;
and the National Mental Health Partnership Group of NHS Trusts
to produce a practical guide for handling consultant vacancies
as part of a national initiative to reduce the costs and use of
locums. The intention is to publish this in early 2007.
EDUCATION AND
TRAINING (E&T)
14.1 Despite the development and publication
of National Occupational Standards for Mental Health and the NHS
Knowledge and Skills Framework, it was clear that what staff working
in mental health services wanted was a clear, succinct statement
about what essential capabilities they needed to undertake their
work effectively. As a result, the 10 Essential Shared Capabilities
(ESC) were published[20]
in 2004. This provides, in one overarching statement, the essential
capabilities required to achieve best practice for E&T of
all staff who work in mental health across all ages in both health
and social care. Learning materials to support their introduction
have been produced and field testing evaluation, they are currently
being revised. The 10 ESC have been widely welcomed and the various
professional bodies in mental health are looking to see how they
can be incorporated into their E&T programmes.
14.2 In addition, the NWP, in collaboration
with a number of partners. has produced some learning materials
on Recovery and Race Equality and Cultural Capability scheduled
for publication in early 2007.
14.3 To help support the E&T agenda,
an E&T Toolkit is also in development with a planned publication
date of March 2007.
SUMMARY
15.1 This note provides a brief overview
on five key areas of activity for the NWP that relate directly
to the workforce needs and planning for the health and social
care service that the Committee might find useful in formulating
their Report.
15.2 We have demonstrated that integrated,
joint workforce planning can be undertaken successfully given
the right circumstances and support and there are valuable lessons
to be learnt that can be shared more widely. We are also collecting
evidence on the other aspects of our Programme that directly supports
the statement in the written evidence from DH dated 15 March 2006
where, under System Reform (on page 21), it said "...
In essence, the last five years has been 80% about growth and
20% about transformation and new ways of working. The next five
years will be almost exclusively about transformation of the workforce.
Future plans will need to incorporate new and extended roles and
new ways of working in order to deliver the gains in productivity
that will be necessary to achieve patient led care".
15.3 We stand by ready to discuss with the
Committee.
CSIP/NIMHE National Workforce Programme
Department of Health
December 2006
4 Modern Standards and Service Models: Mental Health
National Service Frameworks-September 1999 [NHS Our Healthier
Nation]. Back
5
The NHS Plan: A plan for investment: A plan for reform-July 2000
[NHS]. Back
6
Mental Health Services-Workforce Design and Development: Best
Practice Guidance [DH publications Ref: 31146]. Back
7
Mental Health Services-Workforce Design and Development: Report
on the NIMHE National Workforce Planning Pilot Programme (WPPP)-Best
Practice [DH publications Ref 274929]. Back
8
National Steering Group: Guidance on New Ways of Working
for Psychiatrists in a Multi-disciplinary and Multi-agency Context:
Interim Report-August 2004 [DH publications Ref: 40379]. Back
9
New Ways of Working for psychiatrists: Enhancing effective, person-centred
services through new ways of working in multidisciplinary and
multi-agency contexts [DH publication Ref: 270394A/B/C]. Back
10
Joint guidance on the employment of consultant psychiatrists-October
2005 [DH publication Ref: 271394]. Back
11
Fast-Forwarding Primary Care Mental Health: Graduate primary
care mental health workers: Best Practice Guidance Back
12
Mental Health Policy Implementation Guide: Support, Time
and Recovery (STR) Workers [DH publication Ref: 30742]. Back
13
Mental Health Policy Implementation Guide: Community Development
Workers for Black and Minority Ethnic Communities: Interim Guidance
[DH publications Ref: 265796]. Back
14
Mental Health Policy Implementation Guide: Community Development
Workers for Black and Minority Ethnic Communities: Education and
Training-Supplementary Guidance [DH publications Ref: 271259]. Back
15
Mental Health Policy Implementation Guide: Community Development
Workers for Black and Minority Ethnic Communities: Final Handbook
[DH publications Ref: 278271]. Back
16
time to act-Choosing to Work in Mental Health: The Recruitment
of Health and Social Care Professionals [The Centre for Clinical
Academic Workforce Innovation and the University of Lincoln]. Back
17
Mental Health Workforce Recruitment and Retention Research Project
[University of Central Lancashire]. Back
18
Recruitment and retention of mental health nurses: Good Practice
Guide [DH publication Ref: 274284]. Back
19
Joint guidance on the employment of consultant psychiatrists
[DH publication Ref: 271394]. Back
20
The 10 Essential Shared Capabilities: A Framework for the Whole
of the Mental Health Workforce [DH publication Back
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