Mental health and learning disability
What are the trends in staff numbers working across NHS mental health services in England?
In the region of 1.5 million people are referred to NHS mental health therapy services every year, with around 200,000 people being substantively employed by the NHS to care for the people who need these mental health services. However, building and maintaining a qualified workforce of committed staff can be particularly challenging in mental health and learning disability services. The nature of the work is incredibly demanding and requires dedicated, compassionate individuals and relies on a multitude of different health professions. There is also significant competition from those providing private mental health services, with more flexible working patterns and better pay.
Part of the £1.8bn investment detailed in the 2016 Mental Health Five Year Forward View was to recruit and retain a sufficient mental health workforce in order to deliver and support delivery of more accessible services. Since 2017, the number of professional mental health staff has grown by around 8,400, which did not reach the level needed to meet the target of 11,000 additional mental health professionals by 2020/21. On top of this, the Mental Health Implementation Plan published in 2019 outlined ambitions to increase the number of mental health professionals by some 27,460 by 2023/24.
About the target: Health Education England’s 2017 mental health workforce strategy sets the ambition for 19,000 more mental health staff – including an additional 11,000 mental health staff from “traditional” pools of professionally regulated staff (such as nurses, occupational therapists and doctors) to be employed by 2020/21. The exact professions that the 11,000 target is aimed at is not clear, nor is it clear whether it referred to full-time equivalent staff or headcount, but we have used the new definition of mental health workforce which narrows the focus on staff actually providing mental health services, such as doctors, nurses, midwives and psychologists, rather than the old definition which looked at all staff working in mental health trusts. The target of 27,460 from the 2019 Mental Health Implementation Plan includes all mental health staff, and this has been plotted on the chart along as well as the additional 19,000 staff detailed in the HEE strategy.
Mental health nurse numbers have been in decline in the last few years, despite the increase in demand for mental health services. As at June 2021, the number of mental health nurses appears to have decreased by over 4,300 since September 2009.
About the target: Health Education England’s 2017 mental health workforce strategy outlined ambitions for an additional 8,100 mental health nursing and midwifery staff. More recently, the 2019 Mental Health Implementation Plan stated an ambition of 4,220 mental health nurses in addition to the initial HEE targets.
Allied health professionals working in mental health services comprise a variety of different roles, such as therapists, scientists, technicians and managers. Since 2017, the number of such staff has increased by over 7,500 – exceeding the initial target to recruit an additional 4,200 allied health professionals by 2021. Based on current levels of workforce growth, it is also on track to deliver 8,130 more psychological professionals by 2023/24.
About the target: Health Education England’s 2017 mental health workforce strategy outlined ambitions for an additional 4,200 allied health professionals working in mental health. On top of this, the 2019 Mental Health Implementation Plan detailed targets for 8,130 more psychologists and other psychological professionals. These ambitions combined are represented by the blue dashed line. However, caution should be taken when comparing these targets to the workforce data we have used, particularly as it is unclear from the NHS Digital data which specific professions should be included in this measure. We have included those in the ‘Art/Music/Drama therapy’, ‘Multi-therapies’, ‘Applied Psychology’ and ‘Psychological Therapy’ care settings who are classified as ‘Allied health professions’, ‘Other scientific, therapeutic & technical staff’, ‘Support to AHPs’ or ‘Support to other ST&T’.
In 2015, the Migration Advisory Committee listed core psychiatry as an occupation experiencing a high rate of staff shortages. More recently, there has been an effort to address this gap, but although there has been an increase of 215 full-time equivalent consultants since September 2017, this increase was not enough to meet the target set by Health Education England.
About the target: The target of 570 additional consultant psychiatrists by 2020/21 was part of Health Education England’s mental health workforce strategy. The source of the figures in the strategy detailing the current number of posts in psychiatry has not been referenced, so caution should be taken when comparing the target to the data we have used for numbers of consultant psychiatrists. Consultants who work in mental health settings but are not in the ‘Psychiatry’ specialty group in NHS Digital’s workforce statistics have been excluded.
The number of learning disability nurses has been in significant decline over the last 11 years. As of June 2021, there had been a 2,440 decline of these nurses since 2009. In July 2019, Health Education England announced a commitment of £2m to boost the learning disabilities nursing workforce, which is intended to have some impact on numbers in forthcoming years.