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”
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 trusts||Reduction 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.
“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”
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.