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Mental health sector hit by dramatic reduction in nurse posts

NHS mental health providers have lost thousands of nursing posts, amid accusations services are being “looted” to implement safe staffing levels in the acute sector in the wake of the Francis report into Mid Staffordshire Foundation Trust.

More than 3,600 nursing jobs have gone in the past two years, with trusts suffering a 2.3 real terms funding cut, a major investigation into the state of the NHS mental health sector has revealed.

The analysis, based on freedom of information requests to the 57 mental health trust in England, found many had slashed beds and staffing levels – despite record demand for services and government pledges to ensure mental health was given the same priority as other sectors.

“Services locally and nationally are being stripped bare, with re-tendering and outsourcing putting jobs at risk”

George Coxon

Data supplied by 52 trusts revealed an average reduction in nursing staff of 6% from 2011-12 to 2013-14, with six trusts reporting reductions of more than 10% (see table below). This represents and overall drop of about 3,642 whole-time equivalent nursing posts.

The findings have fuelled concern mental health services have been seen as an “easy target” by managers struggling to cut costs and implement new rules on safe staffing in the acute sector.

However, mental health trusts said the drop was also down to efforts to move more care into the community and the creation of new types of services employing a wider range of professionals.

 

Table: Loss of registered nurse posts from NHS organisations 
Mental health trustsReduction in nurses between 2011-12 and 2013-14
Camden and Islington NHS Foundation Trust-18%
South West London and St George’s Foundation Trust-13.9%
Hertfordshire Partnership University Foundation Trust-11.7%
North Staffordshire Combined Healthcare NHS Trust-10.6%
2gether NHS Foundation Trust-10.5%
Solent NHS Trust-10.1%

 

George Coxon, chair of the Mental Health Nurses’ Association, claimed many services had been “plundered” in order to implement post-Francis safety measures and were now facing “a storm of difficulty”, as experienced mental health nurses opted to leave the profession.

“There has been a huge haemorrhaging of resources,” he told Nursing Times. “Mental health services have been looted to bail out Francis implementation and seen as an easy target when commissioners are prioritising within improvement plans.

Mental Health Nurses' Association/Unite

George Coxon

“Services locally and nationally are being stripped bare, with re-tendering and outsourcing putting jobs at risk,” he warned.

While Mr Coxon said only a few mental health nurses had been made redundant, many were simply not being replaced when they left while others were being redeployed into other roles.

Those that remained were suffering from stress with high sickness absences and “a lot of burnout”, he said. “A hell of a lot of people are just getting out and taking early retirement,” he added, noting that many existing mental health nurses were in their late 40s and early 50s.

Rebecca Cotton, director of policy at the Mental Health Network, described the fall in the number of nurses as “concerning”.

“NHS England funded the additional costs of implementing the Francis recommendations for acute providers yet withheld that funding from mental health services contributing to the overall fall in funding,” she said. “Earlier in the year we warned this would have serious consequences.”

Among those reporting the largest reductions in nursing staff was Camden and Islington Foundation Trust, which saw WTE nursing posts drop by 18% from 2011-12 to 2013-14.

“Mental health trusts in particular have been impacted by the NHS efficiency targets”

Jenny Oates

The trust’s interim deputy director of nursing, Jenny Oates, said all mental health trusts had been hit by “significant curbs on funding in recent years”.

“Mental health trusts in particular have been impacted by the NHS efficiency targets, where we face a greater tariff deflator than acute trusts,” she said. “There does not seem to be ‘parity of esteem’ in this regard.”

She added that the overall reduction in her trust’s nursing establishment in 2011-12 was part of a planned move to a new clinical model, which included the closure of two psychiatric hospitals.

A recruitment drive had led to a significant increase in nursing numbers, with 27 newly qualified nurses due to start in September, said Ms Oates.

South West London and St George’s Trust, which saw a reduction of 13.9%, said overall numbers of nursing staff had decreased because it was providing more care in the community. However, the trust was also in the process of recruiting staff for 70 WTE nursing posts.

Meanwhile, Hertfordshire Partnership Trust said its 11.7% reduction was down to some services being decommissioned and others, such as its substance misuse service, transferring to other providers. Other factors included reduced reliance on inpatient beds and new services such as Acute Day Treatment Units featuring a broader skills mix.

“Our reduction in registered nurses is less than our overall drop in income, which means we are spending proportionately more on nursing staff than three years ago,” said Oliver Shanley, the trust’s deputy chief executive and executive nurse.

The figures on staffing were identified as part of an investigation by Nursing Times’ sister title Health Service Journal, which revealed that mental health trusts suffered a 2.3% real terms funding cut between 2011-12 and 2013-14.

 

mental health funding cuts

Mental health funding cuts (Source: Health Service Journal)

Readers' comments (9)

  • Steve Turner

    In addition to reducing the number of nurses there has also been a down banding of posts in many areas, which has resulted in newly qualified nurses being thrown in at the deep end without sufficient experience and knowledge.

    I'm also concerned that the underlying premise in mental health seems to be that the recommendations of the Francis Report into Mid Staffs do not apply to mental health. This is truly shocking. An example of willful blindness. Users of services are suffering as a result.

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  • Yes, my old trust was down-banding posts from 2011 on, as well as reducing numbers of posts.

    They were doing it to OT and psychology also.

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  • I love the fact that Oliver Shanley tries to put a positive spin on this - "we are spending proportionately more on nursing staff than three years ago". That's management speak for saying "we've cut the amount we're spending on nurse, just not as much as we've cut in other areas."

    The other comment about services "transferring to other providers" is also management speak for privatisation of those services or farming them out to charities.

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  • From a patients perspective, try waiting for many months on end for therapeutic support to compliment the prescribed anti-depressants. (I believe to be the recomendation of the WHO'?)
    One starts off not being at risk but ending up giving up all hope, as the mental health services are crisis managing continuously, therefore cannot support those who may need fine tweeking of their life-style with either 'CBT' or 'Mindfulness'.
    The staff in mental health are stretched to the limit and beyond in what is a very demanding job which takes it's toll on those staff who cannot balance their case loads with a variety of dependent people but can only support the most severe cases. This untimately leads to burn-out of the said staff and a further reduction in staff availabilty.
    When are the 'powers that be' going to recognise that by investing in it's staff, they will have a far greater return?
    I still take the pills as 'yes' I do live on cloud cookoo land'!!!!!

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  • As an experienced RMN with over 30 years service I agree totally with everything Michael Thomas and the previous two commenters have said. Burn out is rife, services are cut to the bone and we are firefighting continuously across all sectors of mental health care. Nurses seem to have been particularly hard hit in terms of the cuts in service and impossible expectations placed upon them. We are unable to work therapeutically as we want to, and were trained for which means that the reality is we no longer have a clear identity as nurses but are risk managers. Increasingly we need to use the MHA to enable the acutely unwell patient to access the care they need due to lack of acute beds making the threshold for admission so much higher, and the turn around to discharge so much shorter. People are being treated as commodities as if they can be processed through the system as simply as the person with a broken leg and we are increasingly becoming agents of social control.

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  • This is fundamentally about society not deeming mental health care as important as physical health care don't you think. And is more realted to the cost saving (20 billion)that the government pulled out of the NHS to straigthen the books after the bankers beano as the Francis recommendation isn't a factor as it equally applies to mental health in-patient staffing.

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  • What goes around comes around.
    We in general nursing are having to look after the mentally ill as there are not enough mental health nurses doing what they should be doing.
    The elderly mentally ill are also staying longer in hospital as not enough placements available.
    I cannot believe what is actually happening, it is like I am on another planet or in a bad dream world.

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  • This is a very important story. It is the background to the destruction of the career of Ingra Kirkland featured two weeks ago. She was a UNISON steward who had made it clear to her employer that she would resist attempts to place nurses under even more pressure. Her employer, Worcs Health & Care NHS Trust, has now closed its day hospital facilities, one acute ward and has consolidated three older adult wards into one central unit.

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  • Are figures available to show if CEO's of Trusts that "save" money are rewarded with bonuses?

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