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Overview

  • Since 2017, the mental health workforce has seen a year-on-year expansion in numbers overall. 

  • Despite this, the rate of workforce growth and retention has been insufficient to meet current demand and planned expansion of services.  

  • Vacancy rates for NHS mental health staff are higher than for other parts of the NHS.  

  • Increases in newly qualified staff, vacancies among clinical staff, and new unregistered roles are leading to a change in skill mix and experience of the mental health workforce. 

  • Insufficient numbers of appropriately trained staff is having a direct impact on staff morale and patient care.  

The mental health workforce is expanding 

A large number of staff roles are involved in delivering mental health services. Between 2010 and 2023, the NHS mental health workforce grew by 23% (full-time equivalent, FTE). The rate of increase varies greatly by staff group; the number of nurses grew by 3%, whereas therapists and support staff increased by 45%. 

The mental health workforce is increasing

Psychiatrists and mental health nurses play a core role in delivering mental health services. Between 2010 and 2023, the number of psychiatrists increased by 22% (compared with a 43% increase for doctors in the NHS overall). The number of nurses – who make up the largest proportion of the mental health workforce – fell substantially between 2010 and 2017 but has since increased and is now similar to 2010 levels.  

Nationally, there has been concerted focus on expanding the mental health workforce, with initiatives such as the Royal College of Psychiatrists’ Choose Psychiatry and the Retention Direct Support Programme led by the then NHS Improvement. In addition to doctors and nurses, other professions – notably psychological professionals and occupational therapists – make up a substantial proportion of the mental health workforce, but national data on their numbers is not routinely published. The most recent mental health workforce plan emphasised the opportunity to diversify the staffing of teams through new roles such as peer support workers, who use their lived experience of mental health problems to support others; however, their numbers remain relatively small. 

Workforce expansion is uneven across the sector 

Different roles have expanded at different rates. In psychiatry, for example, the greatest expansion in numbers has been in general psychiatry, whereas data on training placements shows that certain specialities, such as old-age psychiatry and learning disabilities, have consistently been unable to fill all available placements, limiting future capacity. Although the number of child and adolescent psychiatrists has increased by 22% since 2010, this has been insufficient to address growing vacancy rates. Key roles in social care have not seen similar expansion, with the estimated number of approved mental health professionals remaining stable for the past five years.  

There are also marked differences in the distribution of staff across service areas. Increases in the number of nurses have been mainly in community settings, while the number of nurses in inpatient settings has fallen to a level that impacts on the quality of care. This reflects the focus over the past 15 years on reducing the number of inpatient beds and expanding community-based mental health services.  

The workforce is becoming less experienced 

The increase in overall staffing levels means that a higher proportion of staff are newly qualified. For example, in 2010, 15% of psychiatrists were in more junior posts  ('junior’ here is defined as foundation doctor year 1, foundation doctor year 2 and core training) but by 2022 this had increased to 27%. There has also been a shift in the skill mix of the workforce. The NHS Mental Health Implementation Plan (2019/20–2023/24) aimed to expand workforce roles, including peer support and clinical support staff. However, some of the shifts in skill mix predate these policies. For example, data shared by NHS Benchmarking shows that in 2012/13, the skill mix of adult acute wards comprised 60% registered nursing staff and 40% support staff – a situation that is now reversed (as of 2022/23). Changes in the level of staff experience and skill mix of services have led to concerns about being able to provide safe and effective care 

Recruitment and retention are not keeping up with demand 

Despite training more staff, the number of vacancies in NHS mental health services remains high. In September 2023, there were 28,600 vacancies (19% of the total workforce), including 1,700 medical and 13,300 nursing vacancies. In every region of England, vacancy rates in mental health services are higher than the overall NHS vacancy rate.  

Vacancies vary by service and setting. The challenges posed by some settings such as inpatient care can also create difficulties in recruiting staff to these posts, and in some cases there is an increasing reliance on bank or agency staff. Retention is also a problem, with a 19% turnover rate in the overall workforce in the year to September 2023. 

The workforce is insufficient 

There are workforce shortages in terms of numbers of staff and skill mix. Both NHS England and the National Audit Office (NAO) have identified workforce as the main constraint to delivering current plans for service expansion and transformation. Reported increases in demand are likely to further stretch capacity. These concerns are echoed by staff: in 2022, only 30% of the mental health workforce thought there were enough staff at their organisation for them to do their job properly.  

'Staff told us it was very rare that they would have the full complement of staff available on the wards. Ward managers, modern matrons and allied health professionals were regularly being deployed onto wards to meet minimum staffing levels, and the service was relying on bank and agency staff to maintain patient safety.'

CQC inspection report 

The recent NHS Long Term Workforce Plan acknowledged the need for further expansion in the mental health sector. For example, it aims to increase training places for mental health nursing by 13% by 2025/26 and 93% by 2031/32. A survey of approved mental health professionals found that in order to meet the requirements for a 24-hour service there would need to be a 30% increase in the number of FTE staff, in addition to accounting for the vacancy rates of 11.2%.  

Lack of workforce impacts on staff  

The latest NHS Staff Survey (2022) shows that, overall, staff in providers of mental health care report more positive experiences of the workplace than the NHS average. However, there has been a decline in several markers of staff satisfaction. The proportion of staff who would recommend their organisation as a place to work fell from 67.6% in 2020 to 62.5% in 2022, reflecting the overall NHS trend. 

Some of this fall in satisfaction is due to staff shortages. Our analysis of Care Quality Commission (CQC) inspection reports as part of this work shows that in inpatient services, staff regularly work extra hours or additional shifts. Some staff felt they were put in a position where they had to help other wards, but this meant they were working in environments (and with patients) they were unfamiliar with. Similarly, staff in community services reported feeling worn out and finding work frustrating and stressful as a result of low staffing levels. 

Lack of workforce impacts on patient care 

Our analysis of CQC inspection reports as part of this work shows that staffing problems are a factor in all those services rated as ‘requiring improvement’ or ‘inadequate’. This impacts on patient safety, and wider patient wellbeing. 

'Staff shortages continued to increase the risk of incidents and the likelihood of staff being unable to observe people and carry out physical interventions safely. This meant that not only were people not being kept safe, they had reduced opportunities for positive engagement and activity.  '

CQC inspection report 

One of the most common impacts for patients on wards was that they could not access staff when they needed them. Patients also reported not having one-to-one sessions, not receiving medication on time, and activities being cancelled due to insufficient staffing. Staffing issues also impact on community services, where a lack of qualified staff leads to long waits and undermines the service’s ability to provide safe care.  

Mental health 360: funding and costs

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