The Mental Health Workforce
Workforce challenges, staffing and skill shortages across the NHS have a direct impact on patient care and staffing experience, none more so that within the mental health services. This article specifically explores current skill and staff shortages in mental health services and the innovations underway to address the imbalance.
According to the Edge Foundation skills shortage is impacting on the NHS with one in eleven posts left unfilled. (1) Over 214,000 posts are funded by the NHS to provide specialist mental health services in England. Mental health services offer a comprehensive range of roles across primary, community and secondary care services and includes multi-professional teams such as expert clinicians, doctors, nurses, psychologists, allied health professionals, and social workers. The Health Foundation, a leading UK independent healthcare charity in association with The King’s Fund and Nuffield Trust in March 2019 produced Closing the Gap, a report that focused on NHS healthcare workforce shortages and key areas for action, see here. Key takeaways highlighted that NHS hospitals, mental health and community providers reported serious staffing shortages of more than 100,000 FTE staff with nursing roles significantly affected. The report also highlighted a shortage of staff in specialties such as core psychiatry. Around 9% of UK consultant psychiatric posts remain unfilled (3). Vacancies for mental health nurses across the UK between July and September 2018 stood at 8,514.
In 2017 to start to address the decline in staff working in mental health services Health Education England unveiled a training plan which included employing 19,000 additional members of staff by 2020. (2) The training plan focused on mental health workforces such as mental health nursing, medical workforce and a wider workforce (psychology and psychological therapies - including adult IAPT, Occupational Therapy and other Allied Health Professions, and new roles). Many NHS trusts have pioneered several innovative work models to broaden the talent pool including utilising staff from non-professional backgrounds to deliver the competences required in a team. There has been the emergence of new enhanced roles such as peer support workers, nursing associates, assistant practitioners, assistant psychologists and graduate mental health practitioners to complement staff from traditional professions. For example, the development of a new roles such as the psychological wellbeing practitioner (PWP) and the education mental health practitioner (EMHP) are 12-month full-time education programmes that offers trainees a combination of study at university and supervised practice learning experience.
According to Claire Murdoch, National Director of Mental Health, NHS England,
‘’Working alongside service users, co-producing care, growing more peer support worker roles in all settings, introducing apprenticeships at every level, nursing associates, support worker roles across all settings and professions, mean that entry into the mental health workforce has never offered so much choice, flexibility and opportunity for such a wide range of skills and abilities.’’(3)
One way to address the shortages in mental health nursing is supporting students to embark on a more flexible undergraduate degree in mental health or learning disability training. For example, some degree courses enable students to study another area of nursing alongside mental health nursing and graduates can join a mental nursing degree on the second year of a course if they already hold a degree in a health-related subject, psychology, life sciences or social work. A more flexible option has recently been introduced by HEE in the form of Nursing Associates. The Nursing Associate Apprenticeship programme enables qualified nursing associates to go on to and train as a registered Nurse by putting their training towards a shortened nursing degree or completing a degree-level nurse apprenticeship.
The NHS offers apprenticeships in a range of careers and levels that can support people already working within the NHS or those eager to gain entry into and work in mental health services such as Health and Social Care Apprenticeships at intermediate and advanced level and the Assistant Practitioner (level-5 Higher Apprenticeship).
There is even more choice and flexibility through the traditional college pathway which offers a range of courses suitable for learners at different levels. This includes The Access to Higher Education Diploma, a qualification which enables people without traditional qualifications to study at university and available in a range of different subjects including nursing. The Certificate of Higher Education (CertHE) in Psychology, Counselling or Healthcare Practice and Foundation Degree in Health and Social Care or Healthcare Practice are courses for those keen to move into Higher Education.
- Skills Shortages in the UK Economy EDGE BULLETIN 5. July 2019
- Stepping forward to 2020/21: The mental health workforce plan for England July 2017
- Closing the Gap - Key areas for action on the health and care workforce March 2019
- NHS Improvement, Quarterly performance of the NHS provider sector: quarter 2 2018/19 (2018)