A parliamentary report into the state of NHS mental health services in England has aired concerns about staff shortages and “increasing pressures” on those who are in workforce.
The report, published by the House of Commons Public Accounts Committee (PAC) today, warned that staffing challenges were the “main constraint” preventing improvement and expansion of these services.
“The government must act to pull services out of this doom loop”
It also highlighted other issues holding back mental health services, including poor data sharing and a lack of clarity about how parity of esteem between mental and physical health can be achieved.
The PAC issued NHS England (NHSE) and the Department of Health and Social Care (DHSC) with six recommendations and asked them to report back in six months’ time with an update on how they are addressing the problems.
On workforce, the PAC warned that, despite some progress on growing staffing numbers, this was being vastly outstripped by rises in demand.
Between 2016 and 2022, the mental health workforce grew by 22%, but patient referrals rose by 44%, meaning the gap between staff and need was still there.
It also pointed to how therapists had been being recruited far faster than mental health nurses and consultants.
As well as concern for patient outcomes, the PAC said the workforce challenges were taking a toll on staff themselves.
It said: “Stakeholders told us about increased workload and pressure leading to ‘burnout’ of remaining staff, contributing to a higher rate of staff turnover, and therefore more staff shortages in a vicious cycle.”
Later on in the document, the PAC added: “NHSE noted that, in common with all NHS staff, mental health problems are one of the two biggest drivers of sickness.”
It quoted a figure of 17,000 (12%) staff leaving the NHS mental health workforce in 2021-22, up from 13,000 (9%) the previous year, with more staff citing work-life balance as a reason for leaving.
NHSE was asked, in the report’s recommendations, to – within six months – write to the PAC laying out exactly what will be done to improve the recruitment of doctors, nurses, therapists and other staff that mental health services need, and who will be responsible for this.
Royal College of Nursing professional lead for mental health nursing, Stephen Jones, said the report was a “stark demonstration” of what happens when the workforce doesn’t get enough investment and called on the government to make changes.
Mr Jones said: “This lack of workforce investment has led to overwhelming pressures on staff and services and put patient care at risk. Staff are put under unacceptable pressures, and this has forced many to leave the profession.
“The lack of appropriately skilled staff means far too often mental health roles are being carried out by those without the necessary qualifications or training. Vulnerable patients are at risk.
“This report must force ministers into action. The NHS Workforce Plan for England is step in the right direction but as it is implemented, it must include a commitment to bolster the numbers and development of mental health nurses.”
Meanwhile, the report pointed to problems with data collection and data sharing between services and the impact this might have on patients.
The PAC said: “We are particularly concerned about the lack of data on patient outcomes and experiences, and poor data sharing, for example between GPs and mental health trusts.”
NHSE and DHSC were both asked to write to the committee setting out how the overall data picture within mental health care will be improved.
Specifically, the organisations were asked to improve cost data, patient outcome information, and ensure that more data was shared between appropriate organisations.
The PAC criticised DHSC for having not specified an “end goal” of parity of esteem – a government pledge made in 2011 to give physical and mental health equal weight in policy, after an acknowledged “treatment gap” between the two.
The committee said health professionals wanted a definition of parity of esteem, and recommended the department sets out exactly what it means in its update within six months.
“The growing crisis in mental health services cannot be allowed to spiral and must not be overlooked”
The report further highlighted that DHSC had still yet to commit to rolling out standardised waiting times for all mental health care, and the department was recommended to include this in an upcoming update to the PAC.
Other recommendations for DHSC included an evaluation of how well integrated care boards and partnerships are able to support mental health services, and what is being done to avoid regional variations and inequalities.
Dame Meg Hillier, chair of the committee, said: “The findings of our inquiry must serve as a warning to the government that mental health is still in danger of not being treated with the same urgent priority as physical health.
“NHS mental health staff deal with some of the most challenging care needs there are. Staff in this space deserve not just our heartfelt gratitude for the job they do, but concrete support and training to work as part of well-staffed workplaces.”
Dame Meg continued that the report demonstrated a “vicious cycle” of staff shortages and poor morale in the workforce.
She added: “The short-term actions being taken by the government and NHS England to tackle ongoing pressure are welcome.
“But these numbers are still going in the wrong direction, as demand for care well outpaces the supply of staff to provide it.
“The government must act to pull services out of this doom loop. Invaluable care for some of our most vulnerable cannot and must not be provided at the expense of the welfare of the workforce carrying it out.”
Responding to the report, Sean Duggan, chief executive of the NHS Confederation’s mental health network, praised it for highlighting the issue of parity, and added: “Mental health has historically been a low priority for the government.
“We have seen mental health being deprioritised when it comes to capital spending as well as the government’s flagship new hospital programme, which was recently extended by a further eight NHS trusts – no mental health providers were included in the extension.
“Yet demand for mental health services has remained high, with 1.2 million people currently waiting for support.”
He continued that NHS staff would not be shocked by the workforce matters raised in the PAC report.
“Our members have been saying for a while now that workforce shortages are impacting on their ability to transform services and improve access,” said Mr Duggan, a former mental health nurse.
“We now have the NHS workforce plan, which will help, but there are still concerns in the short term.
“The growing crisis in mental health services cannot be allowed to spiral and must not be overlooked.
“The government must put mental health providers at the forefront of their plans, including for recruitment, and invest in public mental health and preventative approaches, which will not only benefit patients but be the most cost-effective approach and help the wider NHS.”
The DHSC has indicated that it will consider the report’s findings and respond in due course.
In the meantime, a DHSC spokesperson said: “As set out in the report, we have significantly increased the mental health workforce over recent years and remain fully committed to recruiting as well as retaining and re-skilling them to ensure we meet current and future needs.
“The first ever NHS Long Term Workforce Plan, backed by over £2.4bn of government funding, will deliver the biggest training expansion in NHS history and recruit and retain hundreds of thousands more staff over the next 15 years, including those who work in mental health services.”