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Auditors identify mental health workforce discrepancies


Mental health services face “significant risks” in meeting new national waiting time targets, in particular due to a lack of understanding of the required number of staff, a report by the national audit body has found.

Problems with data – in particular on nurses – were identified by the National Audit Office in its analysis of how the Department of Health and NHS England were implementing their new requirements.

“It is important that these steps are supported by implementation in a reasonable timescale”

Amyas Morse

Estimates by local providers of the number of mental health nurses needed to meet the new standards “vary markedly” from forecasts produced by national workforce body Health Education England, noted the report – titled Mental health services: preparations for improving access.

NHS trusts have said they expect demand for mental health nurses to fall over the coming years, but HEE expected the workforce would need to grow by 7%, from 39,000 in 2014 to 42,000 by 2020.

The NAO found plans were still not yet in place to ensure the required number of workers were available to meet one of the standards, which aims to improve early intervention in psychosis, as well as the government’s ambitions for liaison psychiatry services.

In 2014 the government announced it would introduce new waiting targets from April 2016 that ensure 75% of people referred to talking therapies through the Improving Access to Psychological Therapies programme (IAPT) receive treatment within six weeks. In addition, 95% of people should receive treatment through IAPT within 18 weeks.

Meanwhile, more than half of people experiencing a first episode of psychosis should be treated with a care package that complies with National Institute for Health and Care Excellence guidance within two weeks of referral. It also said it would invest £30m in liaison psychiatry in acute hospitals.

“There are not enough staff on the frontline to deliver what is required”

Luciana Berger

The NAO found that, while figures show the IAPT waiting times were already being met at a national level, performance varied substantially across different geographical areas.

Nationally, in 2014-15, 79% of people entered treatment within six weeks of referral and 96% within 18 weeks. However, 39% of the 211 clinical commissioning groups did not achieve the six-week standard.

Complete information was not yet available to measure performance against the target for early intervention in psychosis, said the NAO.

In assessing the government’s ambition to boost liaison psychiatry services, the body found a survey of acute hospitals in July 2015 indicated only 7% had one operating 24-hours a day, seven-days a week, when NHS England requires 100%.

The DH and NHS England were starting to make progress with the actions needed to implement the standards but much more remained to be done, concluded the report.

National Audit Office

NHS workforce planning has ‘serious shortcomings’

Amyas Morse

“The Department of Health has recognised that mental health has been treated as a poor relation relative to other health needs for many years,” said Amyas Morse, head of the National Audit Office.

“This recognition, the goal of ‘parity of esteem’ and the setting of new standards for access and waiting times are all bold and impressive steps forward,” he said.

“It is important that these steps are supported by implementation in a reasonable timescale if they are not to be a cause for disillusionment, and this looks challenging in current conditions,” he added.

Luciana Berger, shadow minister for mental health and Labour MP for Liverpool Wavertree, said the report “shone a spotlight” on the “startling” lack of progress the government had made so far.

“Shockingly, despite the government promising new funding to deliver these reforms, local CCGs are having to pay for most of the cost from their existing budgets at a time when they are already under pressure,” said Ms Berger.

Labour Party

Auditors identify mental health workforce discrepancies

Luciana Berger

“The new standards were meant to come into effect at the beginning of this month, but there are not enough staff on the frontline to deliver what is required and there isn’t the right information available to assess if the government is meeting its target or not,” she said, adding that the report should act as an “urgent wake-up call” for minsters to deliver the reforms.

A DH spokesman said: “We are well aware of the challenge ahead – our ambitious goals for mental health are backed by an additional £1bn funding by 2020.

“We have made big improvements in mental health data, publishing more statistics than ever before and launching the first national survey of children and young people’s mental health since 2004,” he said.

He added: “We will publish a five year plan for mental health data by the end of this year – as recommended by NHS England’s independent mental health taskforce in February.”



Readers' comments (2)

  • One of the issues for frontline mental health nurses had always been the need for training in the appropriate psychological therapies (rather than often cheaper psychological therapists straight out of uni). It was common sense to have done this but the services tended to use less experienced fresh faced psychologists to do this. The other aspect is the plethora of legislation given to nurses to sort rather than specialised administrators. With back seat management, denial to increasing violence in real terms against staff and patients -,yes there is a problem. The decrease in need for MH pure economics and based on lean rubbish with privatisation. With an increase in extreme presentations and faster revolving door syndrome based on management approaches suicide and harm is more likely and I believe is happening now. MH nurses are one of the biggest working classthreats to DoH stability and other MH middle class dominated related professions and that is where the issue lies. They don't care about patients they only care about snobbery, false statistics leading to profession deletism by false performance and privatisation.

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  • Standards for access to EIP were supposed to be released last year: they still haven't been. I have had FOI requests for these standards turned down because they are due to be published - they still haven't been.

    Anyone who knows anything about EIP, either as a clinician or as a patient, knows that EIP has been (as with many other MH services) hacked to ribbons, and so most trusts will not be able to reach those standards.

    In over a quarter of a century working in MH (mostly CAMHS) I NEVER worked in a service which met things like NSF recommended staffing levels. And then after 2010 staffing, especially nurses, was cut...

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