Late last week, NHS England and the Department of Health and Social Care published their long-awaited plan to boost the NHS workforce over the next 15 years.
It’s an ambitious and wide-ranging plan – as it needs to be. It covers the full range of clinical specialities and related disciplines that provide us with health care from cradle to grave, including those involved in mental health services.
Workforce planning in the NHS has to be long-term. It takes many years to train health care professionals – and longer still from recruiting people into courses to developing people’s careers and skills over their working lives. The Plan acknowledges this, and with it the uncertainty that comes with projections covering the next 15 years when so much could happen that cannot now be predicted with any accuracy.
The Plan begins with some sobering figures. Vacancy rates in the NHS today are around 8%. They’re higher still in adult social care, which is excluded from this plan, and very clearly needs a plan of its own. And if nothing is done, the NHS alone will face a shortfall of between a quarter to a third of a million staff by 2036/37. So the Plan sets out how the number of medical school places will be doubled within ten years; how nursing school places will rise by over 90%; and how more people will come into the NHS workforce through apprenticeships and other non-traditional routes and roles. Alongside these figures, the Plan includes costings for the additional training places over the next six years.
For mental health services, the Plan notes that demand is set to rise here faster than other areas of health care – at 4.4% a year. Without action, it projects a shortfall of some 17,000 mental health nurses by 2036/37. Even with the steps the Plan sets out to close that gap, there is still a likelihood of a shortfall for some time to come. Alongside mental health and learning disability nursing, the Plan includes pledges to train more health visitors, school nurses, clinical psychologists, psychotherapists, approved clinicians (who have a vital role in administering the Mental Health Act) and peer support workers. All play an essential part in modern mental health care.
Yet there are some significant gaps – for example, there is no pledge to recruit further education and mental health practitioners to work in school and college Mental Health Support Teams. As social care is such an important part of the mental health system, its exclusion from the Plan leaves a worrying gap. The Plan also leaves out voluntary and community sector organisations, even though these provide an essential part of every mental health system, and many are dealing with the same pressures as their statutory sector partners – if not more so. Unless these crucial groups of workers are given equal consideration and investment, mental health services will be unable to provide holistic health care in the places people live in at every stage in their lives.
The Plan looks beyond training and recruitment to the equally important matter of retention, with an aim to reduce the attrition rate in the NHS, for example by improving opportunities for flexible working, career development, and the use of new technology. It also acknowledges the importance of staff health and wellbeing to the NHS’s ability to retain workers. It states that “the NHS must embed a compassionate culture built on civility, respect and equal opportunity.” But there is little to no detail on how the NHS will address systemic and structural racism. The Plan does not address the traumas and losses many health and care workers have been through over the last three years, or the burnout many now feel. With evidence from the Nuffield Trust clearly showing that poor mental health is the biggest cause of the rising sickness rate among NHS staff, the lack of detail on how this will be addressed is a worrying omission.
The vexed issue of pay is also not a part of the Plan. With widespread reports of health and care staff relying on foodbanks and the struggles many are facing just to get by, this is a major cause for concern. The Plan describes how NHS organisations can act as ‘anchor institutions’ for their local economies, for example, without a mention of paying living wages.
There’s a lot to welcome in the Plan: simply having a properly long-term plan is an improvement on what’s gone before, and with a promise to review the Plan every two years, it can adapt to social, economic, technological and political changes over time. It recognises the importance of building up the mental health workforce to try and keep pace with growing demand, and it sets out some significant actions to achieve this. And it acknowledges that we need to build a workforce covering many disciplines (new and old) with as much attention to retention as to recruitment and training.
But the Plan on its own will not be enough. It must now be supported by action to address the deeper issues that affect the wellbeing of NHS staff; it needs a commitment to invest in mental health services beyond the end of next year; and it must be followed by an equivalent plan for social care.
