NHS Long-Term Workforce Plan: The positives and negatives
The demand for mental health support is rising in the UK and the NHS is under more pressure than ever before. In this blog, Kirsten from our policy team looks at the positives and negatives coming out of the long-term plan announced by the government for the NHS workforce, and how it will affect people living with mental illness.
In May 2023, almost 7.5million people were waiting for treatment from the NHS. Over three million of these patients had been waiting over 18 weeks; and around 385,000 of these patients had been waiting over a year.
The Covid-19 pandemic had a profound effect on the NHS, which continues to be felt. 307 times as many people have waited over a year for treatment than in May 2019; and the average waiting time for treatment is 14.1 weeks – almost double that of April 2019 – pre-pandemic.
To ease this pressure and reduce waiting times, there needs to be significant change.
- More staff need to be recruited.
- Working conditions need to improve to reduce the numbers of staff leaving the NHS.
- The government need to deliver on planned reforms, such as a reformed Mental Health Act.
- And the ongoing transformation needs to be delivered through the Community Mental Health Framework.
These are critical to improve services and outcomes for people with severe mental illness.
NHS Long-Term Workforce Plan
To ensure that the shortfall in staff does not continue to grow, the Government published the first-ever NHS Long-Term Workforce Plan in June 2023, with £2.4billion investment aligned with it.
The plan outlines an ambitious programme of recruitment, staff retention and training. It aims to grow the NHS permanent workforce by 73% to 2.2–2.3 million in 2036/37 which will enable the NHS to deliver more preventative and proactive care across the NHS by 2036/37.
A significant priority in the plan is to redirect the focus of the workforce towards early intervention and prevention, primarily delivered in the community.
What is good about the plan?
It is positive that mental health features prominently in the NHS Long-Term Workforce Plan. The NHS has committed in particular, to investing in mental health nursing, which will help to relieve pressure in services such as inpatient care and reduce waiting lists.
The mental health workforce will be further bolstered by the £600 million that will support the growth of the wider psychological professions' workforce over the next three years.
Approximately 15,000 more individuals will be trained to undertake psychological therapist and psychological practitioner roles. This could provide many more people with the opportunity access to talking therapies, an area where the targets have consistently been unmet.
The plan acknowledges the interdependency between health and social care services and has based this plan on current levels of social care performance. The government published a white paper in 2021 with a vision for adult social care reform and have allocated £250 million to bolster the social care workforce as a result.
The plan outlines the need to shift the focus of the workforce towards prevention, which is a welcome action following the commitment to prevention that was made in the NHS Long Term Plan.
What is lacklustre about the plan?
Training and recruitment takes time, and the impact of the workforce plan is likely to take a long time to realise. In the short and medium term, the NHS is going to have to continue to rely on temporary staff, especially in mental health services where recruitment from overseas is difficult because of the differences in practice.
As well as the funding that has been allocated in the plan, further long-term, sustainable funding will be required to bring those staff into services.
The plan recognises that staff in the private, social care, social enterprise and voluntary sectors are critical to the overall provision of services and delivery of the best and most appropriate care for the population workforce of social care. However, the scope of the plan only focusses on the workforce employed by the NHS and delivering NHS-funded services in NHS trusts and primary care. This is a major shortfall. Mental health social care roles like advocacy are key to delivering the Mental Health Act.
Whilst the recent £250m funding for social care is appreciated, the fact that the white paper for adult social care reform is being kept separate from this long-term NHS workforce plan, is not a true reflection of the emerging integrated world of health and social care. A long-term social care workforce plan that dovetails with the NHS one, could provide a more accurate and holistic approach.
In April 2022, the DHSC announced that it was committed to developing a new cross-government, 10-year plan for mental health and wellbeing for England. It consulted widely on this plan with the intention of addressing wider drivers of mentally ill health and including a focus on early intervention and prevention.
Unfortunately, in January 2023, the government announced they were shelving the 10-year cross-government plan and that mental health would instead be included in a new Major Conditions Strategy.
On 14 August 2023, the Major Conditions Strategy Interim Report was published, and whilst it has the potential to build on progress made through the NHS Long Term Plan, the final strategy needs to be a truly cross-government plan with scope beyond the NHS to tackle the wider social drivers of poor mental health, such as inadequate housing, poverty, and racism.
The NHS long-term workforce plan has been based on current projections of demand. There is a risk that if nothing is done to curb the wider determinants of mental health, the level of demand will grow faster than expected and, as we have seen with the impact of Covid, the service will remain left behind.
To address the wider social determinants of mental health and alleviate the pressure on the NHS the government should develop a long-term cross government plan along similar lines to the shelved 10-year Plan for Mental Health and Wellbeing.
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