2Staff
16.We heard that most of the cost of mental health services is the cost of staff.36 We also heard, however, that in terms of achieving access and waiting times standards, the biggest barrier appears to be workforce availability. It is important to have the right people with the right skills and, if staff are unqualified or not properly supervised, sometimes mental health interventions can do more harm than good.37
17.Providers must ensure they have enough suitably qualified, competent and experienced staff to provide high quality and safe care. Providers are responsible for employing staff and providing on-the-job training, while Health Education England, an arm’s-length body of the Department is responsible for providing leadership and oversight of workforce planning, education and training. Its role is to ensure that the NHS has the staff and skills it needs to meet current and future needs of patients. NHS England and Health Education England have some information on the current and future workforce requirements for improved access to psychological therapies but, until recently, very limited information was available nationally about the capacity and cabability of the current workforce to support early intervention in psychosis and liaison psychiatry services.38 Written evidence from the Royal College of Nursing pointed out that there is currently no way of monitoring the number of nurses and skill mix in services delivered by independent providers outside the NHS.39
Workforce planning
18.In our May 2016 report on managing the supply of clinical staff we concluded that, to align with financial plans, trusts’ workforce plans had consistently understated how many staff they would need.40 The National Audit Office again highlighed that there is a considerable discrepancy between numbers of staff that local providers estimate they will need and Health Education England’s forecasts. Trusts forecast, for example, that their demand for mental health nurses will fall while Health Education England estimates that implementing access and waiting time standards will require the number of mental health nurses to rise by 7%, from 39,000 in 2014 to 42,000 by 2020.41 In written evidence submitted to us, the Royal College of Nursing said there was a disconnect between workforce planning and service design. The Royal College of Nursing called for more transparency in workforce planning, saying that it was unclear how national forecasts would meet the increase in demand by 2020.42
19.Mersey Care NHS Foundation Trust agreed that trusts frequently underestimated staffing needs. He explained that this was because trusts have worked out what service they could deliver with the existing staff they have, rather than develop a staffing model to support the care model they are trying to achieve.43 The Department also confirmed that providers do tend to take a more pessimistic view, partly based on their experience over the last few years of the money they have had available to spend on staffing. The Department argued that Health Education England was justified in making a more optimistic projection in recognition of the five year ambition that has now been set out by the mental health task force and the extra money being made available to help achieve that ambition.44
20.The Department assured us that, through Health Education England, it is preparing a comprehensive new workforce strategy for mental health. The strategy is needed to understand the implications for staffing of the mental health taskforce report and to make sure that the right numbers of staff become available. The Department told us that the strategy should be ready by the end of this year.45
Training and retention
21.NHS England explained that the pace at which new staff can be trained means that an expanded workforce will only start becoming available between 2018–19 and 2020–21.46 The Centre for Mental Health called for a longer term view of the workforce needed that would look even further ahead, beyond the current five year horizon. Mersey Care NHS Foundation Trust also told us that there is about a three year time lag needed to train new staff, which is why decisions have to be made now about way into the future.47
22.The Department cautioned that, although it is confident that Health Education England can train adequate numbers of mental health nurses, there remains a concern because the health system has struggled with the rate at which nurses have been leaving the NHS over the last few years. This has meant that the numbers of staff being trained has not translated into equivalent numbers being employed by NHS providers.48 Mersey Care NHS Foundation Trust noted that it offered six-month or twelve-month contracts to liaison nurses and that recurrent funding to support long-term contracts would help attract the best people and make the liaison service feel like a positive career move.49 In that context, the Department told us that the way the Department and NHS England were setting out ambitions for the next five years, plus the fact that clinical commissioning groups’ know broadly what resources they will have over the next four years, should give them more confidence about making longer-term employment commitments.50
Working across organisational boundaries
23.The Centre for Mental Health pointed out that the mental health workforce is much bigger than the people employed by mental health trusts. Because 90% of people who receive any treatment for a mental health difficulty only ever see someone in primary care, GPs and their staff are incredibly important. Looking more widely, people working with children in schools and in youth services, for example, are also part of the mental health workforce.51 Dr Wannan commented that young people most value quality and continuity in the relationships with mental health services they have.52
24.The Centre for Mental Health particularly emphasised the importance of partnership working, both internally within the health system and between the NHS and other services such as the police, housing or employment services.53 The Department told us that there are some pilots going on between schools and NHS England that are exploring how schools and mental health services can work together.54 It also told us about its work to strengthen relationships with other parts of government, for example with the Department for Work and Pensions to better integrate mental health and employment support, and with the Department for Communities and Local Government to tackle issues arising from homelessness and housing problems.55
38 C&AG’s Report, paras 3.23–3.25
40 Committee of Public Accounts, Managing the supply of NHS clinical staff in England, 40th Report of Session 2015–16, HC 731, Summary and para 1
41 C&AG’s Report, para 3.27
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16 September 2016