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Warning over provider plans to redesign mental health workforce

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Analysis of service redesign plans drawn up by mental health providers has revealed reductions to senior nursing posts, but an increase in junior registrants and non-clinical roles in anticipation of further funding cuts.

A review of NHS board papers, reports and strategic plans by the King’s Fund think-tank found providers in England were also planning changes to role types – including more nurse prescribers and physician associates – a requirement for staff to adopt more flexible roles when delivering care, and upskilling of non-clinical workers.

The King Fund’s briefing document – called Mental health under pressure – noted the planned workforce redesign followed a period in which there had already been changes to services that had caused a “significant” reduction in the number of experienced nurses.

“In pursuing financial sustainability, mental health providers have arguably taken a leap in the dark in redesigning services, workforce and operations”

King’s Fund

There has been a 13% decrease in nurses working in psychiatric hospitals since 2010 due to a reduction in bed numbers, said the briefing paper.

During the 10-year period up to 2013, the number of whole-time equivalent mental health nurses overall fell by an average of 2%, it added.

Those behind the report said service redesigns so far had “undeniably delivered on financial sustainability in the short term and, unlike acute sector trusts, there are fewer examples of mental health trusts going into deficit”.

But, they warned, this had resulted in staff shortages, insufficient skill mix, and a move away from previously used evidence-based models of care and treatments.

“In pursuing financial sustainability, mental health providers have arguably taken a leap in the dark in redesigning services, workforce and operations,” said the report.

In addition, NHS England has predicted no service currently has the capacity to deliver the new access standards for early intervention in psychosis by 2016 when they come into effect, it added.

“Mental health trusts now need the security of stable funding, supported by a national focus on evaluating the changes to date”

Helen Gilburt

The analysis echoes recent work carried out in the south of England, which found up to 80% of staff working in early intervention in psychosis services had gaps in training required to meet the new standards.

“Many” mental health trusts were now considering another wave of large-scale changes in expectation of further cuts to mental health budgets, said the briefing paper. However, it said, the major changes across all parts of services were again being planned at a local level and without evaluation of the redesign that had only just taken place, which risks further reducing the quality of patient care.

“Historically, mental health services have often been the first to see their funding cut, so many trusts felt forced to look at what savings could be made through transformation programmes to pre-empt this,” said report author Helen Gilburt, a fellow in mental health policy.

“Trusts looked to move care from the hospital to the community, focusing on self-management and recovery,” she said.

“Few would dispute the intention and rationale for this – the problems arise with the scale and pace of the changes, which lack the necessary checks to evaluate their effectiveness and the impact on patient care,” she added.

“Mental health trusts now need the security of stable funding, supported by a national focus on evaluating the changes to date, improving practice and reducing variations in care,” said Ms Gilburt.

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