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Neal Suchak, policy advisor at the Recruitment and Employment Confederation, analyses the workforce challenges facing the NHS in the provision of mental health services
For decades the NHS has struggled to fill vacancies across the board, creating severe workforce challenges. This is mainly as a result of long-term underfunding, inefficiencies and poor planning. Between January and March of this year there were more than 86,000 vacant NHS posts, a rise of almost 8,000 compared to the same period in 2016. Nurses and midwives accounted for the highest proportion of shortages - 11,400 vacant posts in March 2017, and the Nursing and Midwifery Council (NMC) has reported that departures have risen by 51 per cent in four years.
Fewer doctors and nurses are entering the system than are required to meet demand, and a significant number of nurses in particular are reaching retirement age. On top of this is the reality that Brexit has started to hit home, meaning there are fewer nurses willing to work in the UK. According to the NHS European Office, five per cent of nurses and 10 per cent of doctors come from the EU. Since the Brexit vote the NMC has reported that there has been a 96 per cent drop in EU nurses registering to work in Britain, and only 46 nurses came to work in the UK in April, down from 1,304 last July.
Mental health focus
Against the backdrop of these staffing shortages, mental health has become a top priority for the Department of Health, with government focused on achieving parity of esteem for physical and mental health conditions. The Secretary of State for Health, Jeremy Hunt, has said he wants people with mental health conditions to receive better treatment, and part of that means having the right NHS staff.
As part of this focus, Jeremy Hunt has announced a new plan to recruit enough nurses, therapists and consultants to treat an extra one million patients by 2020-21, with a particular emphasis on child and adolescent mental health services, therapists delivering talking therapies for adults, and nurses working in crisis care. The government has said that an extra £1 billion already promised for mental health services in England would fund the scheme, as part of the £1.3 billion committed in 2016 to transform provision. The government’s strategy also includes plans to improve staff training, encourage returnees to the NHS, as well as tackling the high dropout rate among trainees.
Under these plans, the NHS intends to recruit 2,000 more nurses, consultants and therapist posts in child and adolescent mental health services, as well as 2,900 additional therapists and health professionals supporting adult talking therapies. The plans also include 4,800 additional posts for nurses and therapists working in crisis care settings, 570 extra consultants, better mental health support for women around the time they give birth, and early intervention teams working with people at risk of psychosis.
What is the problem?
It’s not surprising that these ambitious plans have come under scrutiny. In light of current workforce shortages, as well as the efficiency savings that the NHS has to make, many have questioned how realistic these government’s workforce plans are. Janet Davies, chief executive and general secretary of the Royal College of Nursing (RCN), has highlighted the dangerous lack of workforce planning and accountability, and has questioned the lack of detail in the Health Secretary’s plans.
She said: "It is clear the government will need to work hard just to get back to the number of specialist staff working in mental health services in 2010. Under this government, there are 5,000 fewer mental health nurses and that goes some way to explaining why patients are being failed."
The evidence suggests that the mental health sector is already on the back foot when it comes to finding staff to fill current vacancies. Jordan Mitchell, head of mental health at TFS Healthcare, one of the largest suppliers of mental health staff to the NHS, reports that from March 2010 to March 2017 there were 145 fewer psychiatrists (a drop of 1.64 per cent) and 5,161 fewer mental health nurses (a drop of 12.63 per cent). To put this in context, in this same period there has been a 40 per cent increase in the number of people in touch with mental health services, and there has been an 8.9 per cent increase in the number of patients detained under the Mental Health Act in 2016/17 compared to 2015/16.
Annette Sparks, Senior Clinical Nurse Lead for Meridian Health says that is increasingly hard to fill the gaps in staff cover for local Mental Health Trusts and particularly cites demoralised Registered Mental Health Nurses (RMNs) giving up work because of low pay and poor working conditions.
She says: “Conditions are very difficult, many [hospitals are] poorly staffed and some are staffed purely by agency workers. Since the announcement about Brexit, overseas nurses are concerned about working in the UK and we have seen a significant drop in applications from overseas staff.”
Role of recruiters
Health and social care recruiters are experts in the workforce planning and see first-hand on a daily basis the shortages that the NHS has to contend with. In addition, recruiters are perfectly placed to identify where the problems lie and to offer solutions to government. Many recruiters are specialists in the mental health sector and are acutely aware of the challenges that the NHS faces in providing safe care to patients with mental health problems.
Agencies such as HCL Workforce Solutions, who work with the charity Rethink Mental Illness, have a view of the big picture. Gary Chatfield, managing director at HCL, predicts that the lack of home-grown talent coming through the pipeline, as well as the NHS’s reluctance to use locums, means there will be the requirement to source a lot more workers from abroad to meet demand. However, with the barrier of Brexit and current concerns over the requirements of the International English Language Test System (IELTS), this is not going to be an easy task. In addition, there are currently very few international degrees recognised by the NMC for mental health, meaning that international recruitment is incredibly difficult.
The way forward
Not enough students are a considering nursing as a career, and it is becoming increasingly difficult to attract specialist mental health staff from overseas due to the uncertainty around Brexit. In addition, the UK is now competing with other countries which offer a better ‘package’ to its healthcare staff. The NHS needs to look at the obstacles currently faced by individuals wanting to embark on both permanent and a flexible careers in mental health nursing, and to make it a more attractive profession. It’s not just about having the right numbers, it’s also about having a motivated and skilled workforce in place to care for patients in a sector that is notoriously demanding.
The pay rise cap and the removal of the nursing bursary in favour of a tuition loan (which in many cases will run into the region of £50,000) will have a profound effect on the numbers of home-grown nurses entering the profession. Creating an environment in which all staff are paid appropriately for the work they do, are made to feel valued, and receive the training, flexibility and support they need, will be crucial in producing a workforce that is healthy, happy and able to deliver the best possible outcomes for patients.
The Recruitment and Employment Confederation (REC) will continue to work closely with agencies supplying vital staff into the NHS mental health sector, as well as working with NHS Improvement and the Department of Health to come up with solutions to the current workforce crisis. Patient safety is always paramount, and it starts with safe staffing levels. If the Department of Health is to truly level out the inequalities between physical and mental services, they must start with investment and staff retention.