An ambitious recruitment drive for mental health provision in England has come under fire as leading unions say more still needs to be done.
Health secretary Jeremy Hunt announced his plan to tackle the "historic imbalance" of mental health provision by offering 24/7 services and fully integrated mental and physical healthcare.
The announcement also revealed plans to treat an additional one million patients by 2020 to 2021, creating thousands of new roles.
Although the Royal College of Nursing has welcomed the move, it has also warned that the government has a lot of work to do, even just to reach the same level of staffing as in 2010.
Janet Davies, RCN chief executive and general secretary, said: “If these nurses were going to be ready in time, they would be starting training next month.
"But we have seen that the withdrawal of the bursary has led to a sharp fall in university applications and we are yet to see funding for additional places.”
She added: “We welcome the development of new supporting roles but their responsibilities must be clearly defined to avoid down-banding or substitution.
"There must also be recognition of the excellent support roles already in place."
Unite the Union has also spoken out against the plan, slamming it is a "pie in the sky" idea.
Unite lead professional officer for mental health, Dave Munday said: “When Jeremy Hunt speaks of a 'historic imbalance', he seems to be totally unaware of the significant part he's played in creating it.
“Since the Conservatives came to power in 2010, the number of mental health nurses has decreased by 5,067. If that number had kept pace with population growth, rather than being cut by 12.5 per cent, we would now have a total of 42,657 rather than the current 35,563 mental health nurses.
“Hunt's prescription for improving the situation does not go anywhere near far enough. The longer he delays scrapping the destructive pay cap, which has led to staff leaving the service, and the longer he forces future NHS professionals to pay to train, then the longer it will be until these necessary and welcome improvements are realised."
What is the plan?
The plan has been developed by Health Education England (HEE) together with NHS Improvement, NHS England, the Royal College of Psychiatrists and other key mental health experts.
It shows how the health service will dramatically increase the number of trained nurses, therapists, psychiatrists, peer support workers and other mental health professionals to deliver on this commitment and tackle the ‘burning injustice’ of mental illness and inadequate treatment.
By 2020 to 2021 local areas will need to create 21,000 new posts in priority growth areas to deliver the improvements in services and support set out in the NHS’s Five Year Forward View for Mental Health.
Health Secretary Jeremy Hunt said: "We want people with mental health conditions to receive better treatment, and part of that means having the right NHS staff. We know we need to do much more to attract, retain and support the mental health workforce of the future. Today is the first step to address this historic imbalance in workforce planning.
"As we embark on one of the biggest expansions of mental health services in Europe it is crucial we have the right people in post – that’s why we’re supporting those already in the profession to stay and giving incentives to those considering a career in mental health."
These measures are ambitious but essential for delivering the high performing and well-resourced mental health services we all want to see.
All major specialisms will see an expansion in numbers, with the plan targeting areas where there are forecast to be particular shortfalls as demand on services increases. It concludes that there should be:
- 2,000 additional nurses, consultants and therapist posts created in child and adolescent mental health services
- 2,900 additional therapists and other allied health professionals supporting expanded access to adult talking therapies
- 4,800 additional posts for nurses and therapists working in crisis care settings, with the majority of these (4,600) being nursing positions
Perinatal mental health support, liaison and diversion teams and early intervention teams working with people at risk of psychosis should also see significant increases.
Among the groups expected to grow most in the planned expansion are:
- professionals working in child and adolescent mental health services
- therapists delivering expanded access to adult talking therapies
- nurses working in crisis care settings
It will be funded in part by the government’s commitment to an extra £1 billion for mental health services by 2020 to 2021.
To achieve this, the measures set out in the plan include:
- improvements in how employers retain their existing mental health staff, including targeted support for 20 Trusts with the highest rates of clinical staff exits - alongside a national retention programme to be run by NHS Employers and initiatives to improve career pathways
- a major “Return to Practice” campaign led by HEE to encourage some of the 4,000 psychiatrists and 30,000 trained mental health nurses not substantively employed by the NHS to return to the profession. NHS Employers will also work with providers to develop more flexible and supportive working environments and help more of them to draw on the skills of recent retirees
- a new action plan to attract more clinicians to work in mental health services and psychiatry, including a targeted campaign next year to encourage more trainees to specialise in mental health, as well as encouraging more junior doctors to experience psychiatry as part of their foundation training – either through a new ‘two-week’ taster programme, or through increased availability of rotation placements in psychiatry
- the development and expansion of new professional roles in mental health to help create more flexible teams and boost capacity, enabling clinical staff to spend more face-to-face time with patients, by providing more support staff to take on the non-clinical tasks – for example updating patient records
- co-ordinated action to tackle the high attrition rates among psychiatry trainees, with the Royal College of Psychiatrists working with higher education institutions to improve on-the-job training and support, encourage greater flexibility and develop a new Accelerated Return to Training programme for those who have abandoned training previously
- the plan also pledges action to improve the mental health and resilience of its own workforce; HEE will deliver a programme to improve awareness of mental health amongst NHS staff, including encouraging more GPs to undertake further formal training in psychiatry; HEE will also explore how to support Trusts in recruiting and training staff from abroad to meet short-term recruitment needs
Professor Ian Cumming, chief executive of Health Education England said: "Mental health is a key priority for HEE. The Five Year Forward View for Mental Health laid out an ambition to see an additional one million people being treated by mental health services by 2021, including 70,000 more children and young people. This is something the whole system is committed to working on to make sure patients get the best possible care.
"The workforce plan we have agreed with our partners across the system is based on the most comprehensive and robust study of the mental health workforce to date. We do not underestimate the scale of this challenge. To deliver the improvements we have said are required will require concerted action and focus from everyone working across the health and care system – this document lays out a plan to create that workforce.
"I am confident that the NHS can rise to this challenge and that this plan is a significant step to make the improvements to care we all know are needed a reality."