Stepping forward to 2020/21: The mental health workforce plan for England

A report from Health Education England to support the delivery of the Five Year Forward View for Mental Health in England

Mental health has never had such a strong focus and support. Following the publication of The Five Year Forward View for Mental Health, the Government has committed to a more proactive and preventative approach to mental health by investing £1bn1 in:

• Improved access to services at an earlier stage: an extra one million people will be able to access mental health services by 2020/21 including 70,000 more children and young people gaining access to evidence based interventions and with a greater focus on prevention and mental wellbeing.

• Services accessible at the right time: 7 days a week, 24 hours a day when needed. There will be full coverage across England with evidence based Crisis Resolution and Home Treatment Teams and Community Perinatal teams providing care in local communities and improved access to Liaison Mental Health care in secondary physical care services; this will ensure no one experiencing a mental health crisis is turned away.

• Services delivered in a more integrated way: for example, through integrated primary care based clinics serving long-term conditions and depression and anxiety; by expanding perinatal services, so 30,000 more women have access to services; providing more mental health services in physical healthcare settings, expanding access to places of safety and improved crisis services.

• Embedding mental health services into the NHS: with better data, the right workforce, more investment in research, and local leadership to deliver the best possible outcomes. Those who access mental health services will be able to check how well local areas are
doing through published mental health dashboards.

This programme of investment and reform provides a rare opportunity to improve the way we provide care across all settings (including primary, community and secondary care services including urgent/emergency care), across all age groups (for example, with old age specialists), and across all health and care professions, with more care delivered in the community. The additional investment will deliver real improvements for those who access
mental health services and will increase the rewards, skills and opportunities available to the whole workforce, both formal (e.g. nurses, doctors and therapists) and informal (e.g. peer support workers and volunteers).

To deliver this growth and transformation agenda we will need motivated and multiprofessional teams focused on delivering person-centred care: expert clinicians, doctors, nurses, psychologists, allied health professionals, and social workers, combined with new and enhanced roles such as peer support workers, nursing associates, assistant practitioners and assistant psychologists.

The NHS will establish 21,000 posts and employ 19,000 additional members of staff by 2020. 11,000 of these will be drawn from the ‘traditional’ pools of professionally regulated staff, e.g. nurses, occupational therapists, or doctors. In addition, there will be 8,000 people moving into new roles e.g. peer support workers, personal wellbeing practitioners, call handlers, or nursing associates. The growing proportion of support staff represents both a broadening of the talent pool as we develop new roles, but also the emergence of new service models, e.g. the ‘Sunderland’ model for CRHTT teams, which relies on a wide range of roles to work alongside qualified staff and help ensure they are making the most productive use of their time.

All our staff need to be: highly skilled in partnership working, integrating care and coproduction with those who access mental health services and their carers; technologicallyadept; values-driven; and able to provide physical as well as mental health care. They will need the space to innovate and to work to their full scope of practice, as well as practical help to develop their skills, knowledge and competence so as to reflect the changing mental and physical care outcomes required by people with a mental health need, learning disability and/or autism. This may involve investing in staff training to increase skills, knowledge and competences in order to help them deliver care differently or to a higher standard, especially for marginalised groups, including black, Asian and minority ethnic (BAME) people, lesbian, gay, bisexual and transgender people, disabled people, and people who have had contact with the criminal justice system, among others.

This will only happen if we act now, in concert, to deliver it. Delivering the mental health plan will require providers to establish employ an 19,000 new members of staff, whilst maintaining and improving existing services. The sheer scale and complexity of the servicewide growth and transformation needed will demand aligned actions from providers, commissioners, local government and third sector partners, supported by Health Education England (HEE) and the other national ALBs. This document offers a workforce plan to help local systems deliver the Five Year Forward View for Mental Health to 2021.

It sets out:

• Where we are now: the overall numbers, skills and location of our current workforce in mental health.
• Where we need to be: our underpinning assumptions and modelling about the overall number and types of skills required to provide mental health services in the growth areas, whilst ensuring the service as a whole is maintained and improved.
• What we need to do to get there: who needs to do what and when to achieve the net growth in staff – with clear actions for local and national partners.

There are many different services, labour markets, and multi-professional teams across England. Some of these are delivering innovative models of care which we need to build on. HEE has developed a national workforce model as a framework to support local workforce plans. This will deliver the service models and growth set out in the Five Year Forward View for Mental Health. We will continue to work with our partners and stakeholders to develop a longer-term strategy, so we can plan sustainable improvements beyond 2021, which are aligned with emerging strategies in related areas such as primary care and maternity.