The NHS needs to ensure better working conditions and opportunities for the neglected clinical support workforce

Access to high quality mental health services could be put at risk if the experiences of clinical support staff working in these services continue to be overlooked.

Press release

Published: 20/08/2021

New research from the Nuffield Trust reveals significant differences between the experiences of over 41,000 frontline staff supporting mental health services, especially around flexible working, bullying, discrimination and career progression, in comparison to the wider NHS workforce. Clinical support staff make up more than a third of all NHS clinical staff working in mental health services. Therefore, this group will play a key role in helping to meet the increase in demand for mental health services due to the pandemic.

Untapped? Understanding the mental health clinical support workforce is the most comprehensive analysis to date of this underexplored and often overlooked group. It looks at electronic staff records, a bespoke data analysis of the 2019 NHS staff survey, freedom of information requests around recruitment and a review of job adverts.

Key findings include:

  • While some career progression pathways are accessible through apprenticeship routes, such as health care assistants progressing to nursing associates and then to registered nurses, only 1% of mental health support workers who are employed in the NHS for a year moved into trainee nursing associate roles.
  • Mental health support staff experience higher rates of physical violence (37%) from patients, their relatives or members of the public than across all staff working in mental health (17%) or clinical support staff working in other services (29%).
  • There is more than twice the level of black and black British representation in mental health support roles than the NHS workforce as a whole (14% vs 6%) and higher rates of discrimination based on ethnic background compared to all staff working in mental health services (48% vs 43%).
  • Opportunities for flexible working are limited, with over half of job adverts reviewed requiring flexibility from employees rather than offering flexible working patterns. Mental health support workers are less likely to be satisfied with opportunities for flexible working compared to all mental health staff (56% vs 62%).
  • There is a marked, unexplained variation in the experience, knowledge, qualifications, skills and values that NHS organisations seek when employing mental health clinical support staff.

Following the fieldwork for this report, the Government announced a further £500 million to support mental health services in their recovery from the Covid-19 pandemic.

Report co-author and Nuffield Trust Senior Fellow Dr Billy Palmer said:

“There has been a long-standing failure to address unmet mental health need in the NHS, and due to Covid-19, demand for mental health services has only increased.”

“Despite government commitments to expand high-quality mental health services to an extra 2 million people in the next two years, we find that the mental health support workforce, who are at the forefront of delivering patient care, are often left unsupported, not afforded flexible working and face increased discrimination.”

“Failure to attract people to these vital roles in mental health services could mean people waiting longer for treatment, and impact on care quality and other NHS services.”

    Notes to editors

    About the report: 

    • The clinical support workforce in this report belong to three categories: health care assistants and those in similar positions, those in ‘professional roles’ that require some further or advanced education such as nursing associates, and training posts such as trainee psychological wellbeing practitioners.
    • We report staff experiences using the 2019 Staff Survey as the available data from the 2020 survey used a different categorisation for staff groups.
    • The government’s plans to invest in mental health recovery was announced on the 27th March 2021 here:  
    • This work is an independent review and part of a wider project by the National Workforce Skills Development Unit (NWSDU). The NWSDU is creating a central resource for those responsible for workforce planning to assist the mental health support workforce. Visit the NWSDU website for more information.
    • With a view to improve working conditions and retention in the workforce, the report also includes a number of other recommendations. The recommendations focus on, for example, investment in training, flexible working and support for career development.

    About the Nuffield Trust: 

    • The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
    • For more information or to arrange an interview, please contact Meesha Patel on 07920 043 676/ or Simon Keen on 07780 475571/  

    About the National Workforce Skills Development Unit: 

    • The National Workforce Skills Development Unit (NWSDU) is based at Tavistock and Portman NHS Foundation Trust
    • The NWSDU was established in 2017 to meet the NHS’s healthcare workforce challenges.
    • The primary aim of the NWSDU is to ensure that those who work in mental healthcare are valued, developed and sustained so that everyone can fulfill their potential to impact positively on the health of the people they serve.
    • The NWSDU develops strategic initiatives to enhance mental health capability across the healthcare system.
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