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

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.”