The impact of Covid-19 on the UK’s health services has been substantial, and one of the many likely consequences of the pandemic will be a peak in demand for mental health support.
Even before the virus hit, there was a drive for the NHS to provide mental health services to an additional two million people by 2023/24. Having a sufficient pool of mental health clinical support staff is vital to achieve this, as they typically provide the most hands-on, patient-facing care. This staff group is given little policy attention, but they hold significant potential to support the NHS’s long-term aims.
But relatively little is known about the mental health clinical support workforce, despite the fact that they account for one in three clinical staff working in mental health settings. Our new research has tried to address this knowledge gap by investigating the roles, responsibilities and diversity of mental health clinical support staff, as well as exploring their opportunities for training and career progression.
Who are they and what do they do?
The largest group are those defined as health care assistants and other similar roles like nursing auxiliaries. There are also training posts with a well-defined career path, such as trainee psychological wellbeing practitioners, which are classified as support staff until they complete their specific course.
Mental health clinical support staff are one of the most diverse groups in the NHS, with over a quarter of staff (27%) being male (compared with 17% of non-mental health support staff). There is also twice the level of black/black British representation among the mental health support workforce (14%) compared to non-mental health support staff (6%) and all NHS staff (6%).
Clinical support staff cover a wide range of roles, but there is substantial variation in what individual support workers are asked to do. The vast array of job titles, responsibilities and duties can give rise to ambiguity around what is expected from them, from the perspective of both the employer and the patient.
What are the working conditions like for clinical support workers in the NHS?
We identified a worrying juxtaposition between the NHS People Plan’s ambitions to “offer [NHS staff] flexible working from day one” and the reality of what was offered to support workers. At least half of the job adverts we looked at stated that flexibility was expected from the successful candidate, rather than offering a flexible working pattern – with many setting out expectations for them to work unsociable hours over a seven-day week.
This finding was supported by our analysis of the 2019 NHS Staff Survey, with only 56% of mental health clinical support staff satisfied with the opportunity for flexible working patterns (versus 62% of all mental health staff).
We also found that mental health clinical support staff experienced higher levels of physical violence (37%) and bullying/harassment (39%) from patients compared to all mental health staff (17% and 29% respectively). Mental health support staff may be more likely to be in direct contact with patients, and are therefore more likely to be exposed to such behaviours. But these instances must be taken seriously – particularly as they are detrimental to staff wellbeing and could impact on retention rates.
How much are clinical support staff paid and what progression opportunities are they offered?
Shortcomings in training provided to NHS support staff are long-standing. Our analysis of job adverts supported this, with limited offers of training and career progression for mental health support staff. Job descriptions rarely went beyond “training appropriate to the role”, and in some cases staff had to bear the cost of their development by undertaking training “at a reduced salary”. On top of this, the £1,000 per person for the continuing professional development of nurses, midwives and allied health professionals does not include clinical support staff.
For clinical support workers, the probability of progressing from the different NHS pay bands (Agenda for Change bands 2-4) is consistent, at around one in 10 staff. However, in mental health services, the probabilities vary. One in five of band 2 support staff (with a starting salary of £18,005 in 2020/21) progressed to a band 3 within the year, while only one in 16 staff within band 3 went on to a higher band.
Even after a number of years’ experience in the role, pay does not increase over £24,157 (or £28,988 in inner London) for the most experienced band 4 support worker. Only just over one in four (27%) of this group working in mental health settings felt satisfied with their level of pay. This was similar for support staff working in other health care settings (25%), while pay satisfaction was higher for mental health staff overall (41%).
Better valuing support staff
We have all witnessed the toll that Covid-19 has had on the UK’s health services, and the shifting landscape of the nation’s health care needs as a result. It is forecasted that up to 10 million people in England will need new or additional mental health support because of the crisis.
Yet mental health clinical support workers are one of the lowest-paid staff groups in the NHS, and they don’t consistently receive the same promises of better working conditions that are made to other NHS staff.
The first step towards better valuing these staff would be to incentivise prospective candidates for mental health support roles by developing clear job titles and descriptions, and mapping out a clear career progression route. Providing appropriate support for flexibility, career development and pay to staff when they are in post would also help in achieving greater access to high-quality, cost-effective care – which will be particularly needed for mental health services in the forthcoming years.
Rolewicz L (2021) “Tapping into the potential: putting mental health clinical support staff in the spotlight”, Nuffield Trust comment.