A government mental health strategy is at risk because most children and young people’s mental health trusts have nurse recruitment difficulties, suggests an independent report.
Experts evaluated whether children and young people’s mental health care had improved since the publication in March 2015 of the government strategy Future in Mind.
“Spending on agency staff has risen dramatically to fill the gaps”
The strategy, backed by £1.4bn over five years, aimed to modernise the way children and young people’s mental health services operated and tackle the current treatment gap.
The vision was to move towards a system focused on prevention and early-intervention, where specialist services were integrated with wider health and care support.
The Education Policy Institute think-tank set up a commission in December, which was chaired by Liberal Democrat MP and former health minister Norman Lamb, to assess the progress of the strategy during its first year.
Among its key findings, the commission noted that 83% of children and young people’s mental health trusts had experienced recruitment difficulties.
Based on freedom of information requests, it found 51 instances of a post being advertised with a trust only receiving two or fewer applicants.
“There simply isn’t the workforce to provide all children with the mental health support they need”
In addition, 80% of trusts had advertised posts on multiple occasions to fill roles, with mental health nurses being the most difficult to recruit, followed by consultant psychiatrists.
Such “recruitment challenges” had led to an 82% increase in expenditure on temporary staffing in the last two years. In 2015-16 nearly £50m was spent on agency staff by 32 trusts, said the commission in its report Progress and challenges in the transformation of children and young people’s mental health care.
However, there were significant regional variations in recruitment difficulties, with six areas not experiencing any problems, most notably in the Midlands and some parts of the North.
The commission also assessed each area’s local transformation plans for improving services in line with Future in Mind.
Of the 121 published plans, only 15% of areas were rated as having “good” plans. Of the remaining 85% that the commission said required improvement, 37% were deemed to “require substantial improvement”.
On average, plans for localities in the Eastern and West Midlands regions performed best and those in the South East and the East Midlands the worst.
Meanwhile, the institute warned that £119m has been allocated to local areas for 2016-17, but this has not been ring-fenced.
As a result, it said there was a risk that the overall budget for children and young people’s mental health may not increase or may even be reduced due to wider austerity measures.
Mental health nurse shortage puts strategy ‘at risk’
Emily Frith, director of mental health at the institute, said: “Mental health trusts around the country are struggling to recruit psychiatrists and nurses. Spending on agency staff has risen dramatically to fill the gaps.
She added: “The Department of Health and its arms’ length bodies will need a strong focus on recruitment, retention and improving skill mix to ensure that the children and young people’s mental health service has the workforce it needs to meet future requirements.”
In the autumn 2016, the institute said it would make “detailed policy recommendations” for national and local health and care leaders to address the barriers it had identified and ensure the implementation of Future in Mind was as “effective as possible”.
According to official workforce figures, there are currently nearly 5,000 fewer mental health nurses working in the NHS than in 2010.
Provisional figures from NHS Digital show that in April 2016 there were 35, 754 whole-time equivalent mental health nurses, compared to 40,744 in April 2010.
Fiona Smith, the Royal College of Nursing’s professional lead for children and young people’s nursing, said: “This report shows that though the intention is there, there simply isn’t the workforce to provide all children with the mental health support they need.
“The difficulty recruiting children and young people’s mental health nurses is symptomatic of the nationwide nursing shortage,” she said.
“Alongside falling levels of other support such as school nurses and health visitors, mental health services for children are fast diminishing,” warned Ms Smith.
She added: “A solid and effective workforce could not only help children in need now, but prevent numerous complications down the line.”