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Nurse shortage 'biggest obstacle' to improving child mental health

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Getting the right workforce in place is the “biggest barrier” to the government’s ambitions for children and young people’s mental health services, warns a committee of MPs.

The Public Accounts Committee has called for health chiefs to report annually on their progress in expanding the mental health workforce as a result of too many young people not getting the help they need.

“The biggest obstacle to improvement is the workforce crisis in nursing”

Fiona Smith

In a new report published today (see PDF attached below), the committee highlighted that during 2017-18, only three in 10 children and young people with a mental health condition received NHS-funded treatment, adding that many more faced “unacceptably long waits”.

The NHS’s five-year forward view for mental health aims to increase the proportion of children and young people with a diagnosable mental health condition who access NHS-funded treatment from an estimated baseline of 25% to 35% by 2020-21, the report explained.

However, NHS England told the committee that workforce was the “single biggest risk” to achieving this target.

The committee said work to increase staff numbers and develop the right skills had progressed “more slowly than planned”, highlighting particular issues in recruiting mental health nurses.

“The recurring issues with relation to the recruitment and retention of NHS staff remain unchanged and it is clear that the government’s inability to increase the number of mental health nurses is a roadblock to progress in this area,” the report stated.

Health Education England told the committee that if the retention of nurses had remained at the 2012 level, then 50% of current nursing vacancies would not exist today.

“The government’s inability to increase the number of mental health nurses is a roadblock to progress”

Public Accounts Committee

The report highlighted that the “removal of the nursing bursary and the cost of living in some areas” were affecting both recruitment and retention.

The Royal College of Nursing also warned the committee that cuts to continuing professional development (CPD) for nurses had made it “harder to provide them with mental health training”.

HEE has ambitions to increase the child and young people’s mental health workforce of around 11,300 by a further 4,500 staff.

However, the committee claimed that the organisation had limited information to develop its workforce plan and had no specific data to measure its progress.

In light of the issues uncovered, the committee asked the government and the NHS to provide it with annual progress updates on this agenda including on workforce.

“As part of the annual update to the committee, the Department [of Health and Social Care], NHS England and HEE should report on its progress in expanding the children and young people’s mental health workforce, setting out any changes they may have made to plans or targets and knock-on effects to other parts of the five-year forward view,” the report stated.

“It should also include an update on recruitment and retention rates for the mental health workforce and make an assessment on any knock-on effect on other professions e.g. nursing and midwifery,” it added.

“Children and young people with mental health conditions are being failed by the NHS”

Meg Hillier

A spokeswoman from HEE said it was “reviewing the recommendations made in the report and will be working with system partners to respond to them”.

The report also identified recently published figures which showed one in eight five to 19-year-olds had a mental health disorder and an increase in the number of five to 15-year-olds who suffered from an emotional disorder.

It highlighed that just 30.5% of young people with a diagnosable mental health condition accessed NHS-funded treatment in 2017-18 and added that most young people were not getting the treatment they needed. It added that under “current NHS plans this will still be true for years to come”.

In response to the report, the RCN claimed staff shortages prevented nursing staff intervening early and from providing services when young people were in crisis.

Royal College of Nursing

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Fiona Smith

Fiona Smith, RCN professional lead for children and young people, said: “The biggest obstacle to improvement is the workforce crisis in nursing.

“Staff shortages stop healthcare professionals intervening early and providing services when young people are in crisis,” she said.

The committee also noted that “new and important ways of supporting young people’s mental health through prevention and early intervention” were now being developed.

However, plans to introduce new mental health support in schools would only cover up to a quarter of the country by 2022-23, the report stated.

“Without enough school nurses, plans to prevent worsening mental health in schools will struggle, and without adequate mental health, learning disabilities and children’s nurses, children will wait longer for the care they need,” Ms Smith added.

Meg Hillier, MP for Hackney South and Shoreditch and chair of the Public Accounts Committee, said: “Children and young people with mental health conditions are being failed by the NHS.

“Provision is far below required levels and many people who do get help face long waits for treatment,” she said. 

Meg hillier mp

Meg hillier mp

Meg Hillier

“This can be devastating for people’s life chances; their physical health, education and work prospects,” she added.

Ms Hillier called for the NHS to accelerate its efforts to ensure it had the right staff with the “right skills in the right places”.

She said the committee would be “keeping a close eye” on the “real-world impact” of the measures proposed in the NHS long-term plan.

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