Is it possible to recruit 21 000 extra staff for mental health services?
Authors: Gareth Iacobucci
Publication date: 15 Aug 2017
Targets for boosting NHS staff seem to trip off the health secretary’s tongue, but what does the reality look like? Gareth Iacobucci reports
The government’s ambitious target to create 21 000 new mental health posts in England by 2020-21 has been welcomed by the NHS, but there are questions as to how it will be achieved.
The £1.3bn pledge to deliver targets set in NHS England’s Five Year Forward View for Mental Health  is underpinned by a government mandated plan, developed by Health Education England, NHS Improvement, NHS England, the Royal College of Psychiatrists, and others.
But are the staffing targets credible within the tight timeframe or simply an example of ambitious headline grabbing on the part of England’s health secretary, Jeremy Hunt?
Ministers have promised 2000 new nursing, consultant, and therapist posts in child and adolescent mental health services; 2900 extra therapists and other allied health professionals to support expanded access to adult talking therapies; 4600 new posts for nurses working in crisis care settings; and big increases in perinatal support, liaison and diversion, and early intervention teams.
It also wants to expand the number of consultant psychiatrists working in these services (not including core acute and community mental health services) by 570 by 2020-21, a 47% rise from 1220 to 1790 posts. But with 13% of consultant posts currently vacant across mental healthcare, as the government’s plan itself admits, and with psychiatry having the highest proportion of unfilled training posts of any specialty (35%), translating words into reality looks a huge challenge.
Nursing has similar problems. With 5000 fewer NHS mental health nurses now than in 2010, the Royal College of Nursing has warned the government that it will need to work hard just to get back to the levels of seven years ago.
The Royal College of Psychiatrists is broadly positive about the government’s plan, perhaps understandably given its close involvement in developing it.
But Kate Lovett, dean of the Royal College of Psychiatrists, is under no illusions about the size of the task. “Given the vacancies, we’re 1300 consultants short on paper,” she says. “Our out-turn from our training programme is about 300 consultants a year, so without doing something very radical about retention, or employing doctors from overseas, the figures are not going to be filled just from our training pipeline from UK doctors currently in the system.”
To help tackle this shortfall the college wants the government to come up with a detailed plan to encourage mental health staff with “mental health officer” status (who have historically retired at 55) to remain in the workforce without having financial penalties on their pensions. It also wants action to mitigate the potential effects of Brexit.
“In psychiatry we rely on overseas doctors more than any other medical specialty, so clearly we’re worried about the potential to lose from our existing workforce,” says Lovett. “What we need to be thinking about in the short term is boosting the supply and removing all barriers for doctors coming to work here. It absolutely needs government policy to influence that.”
The college is also concerned that the specific short term focus on bolstering certain subspecialty areas risks destabilising core mental health services by retraining and diverting staff from areas where they are needed.
The former college president, Simon Wessely, says, “To create the 100 new perinatal psychiatrists, we’ve rebadged and retrained general adult psychiatrists. We’ve been robbing Peter to pay Paul, and we can’t keep doing that.”
Hunt has accepted that the staffing targets are “ambitious.” But he argues that major campaigns to encourage some of the 4000 psychiatrists and 30 000 trained mental health nurses not substantively employed by the NHS to return to practice, and to encourage more trainees to specialise in mental health, can help it succeed.
But the government’s progress against a similar pledge to increase the GP workforce in England by 5000 by 2020 invites scepticism. Despite a major recruitment campaign, new financial incentives for medical trainees to choose general practice, and a push to recruit 500 GPs from overseas, the policy has floundered, with The BMJ recently finding that only 38 doctors from overseas had been recruited to date.
Helen Gilburt, a health policy fellow at the think tank the King’s Fund with a special interest in mental health, believes that it will be “a big ask” for NHS England and local providers to find the staff required. “The reality is that this is the workforce plan that fits with what the government has signed up to. How realistic it is is questionable, particularly on obtaining sufficient staff. In some ways it’s a good thing to have a target, but I do think it will be very challenging to deliver.”
While Wessely said that he welcomed the extra investment, he said that “low hanging fruit” such as bringing in peer support workers (non-medically trained support staff with experience of mental illness) and wellbeing practitioners (non-medically trained staff who assess and help people with common mental health problems to manage their conditions themselves) could not compensate for the desperate shortage of specialists. “We can’t just magic up the level of skilled psychiatrists and skilled psychologists [that are] needed,” Wessely says.
Lovett says it is essential that the plan’s commitment to develop a strategy for the mental health workforce beyond 2021 is followed through. “We need to be thinking long term,” she says.
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- Health Education England. Stepping forward to 2020-21: the mental health workforce plan for England. Jul 2017. [Link] .
- Moberly T. Specialty training vacancies increase by 30% in a year. Jul 2017. [Link] .
- Rimmer A. International recruitment scheme brings 38 GPs to NHS. BMJ 2017;358:j3462. [Link] [Link] .
Gareth Iacobucci The BMJ