Campaigning for the mental health workforce of the future

We have worked hard with national bodies and others to secure commitments in the following areas, embedding our priorities as they evolve.

• Stepping Forward to 2020/21: Mental Health Workforce Plan for England
  • In 2016 The Five Year Forward View for Mental Health was published by the NHS. It set out national plans for improving and expanding mental health care up to 2021.
  • In 2017 Stepping Forward to 2020/21: Mental Health Workforce Plan for England was published by Health Education England (HEE). It aimed to support the delivery of the Five Year Forward View, setting out how an additional 19,000 posts would be created by 2020/21 to staff pledged services. This included committing to 570 new consultant psychiatry posts and 8,100 new mental health nurse posts.
• NHS Mental Health Implementation Plan
  • At the beginning of 2019 the NHS Long Term Plan was published. It outlined the additional workforce needed to deliver ambitious commitments on mental health and beyond.
  • We engaged with national leaders to develop a vision for how people working in the NHS would be supported to deliver the plan.
  • Later in 2019 The NHSE Mental Health Implementation Plan was published. It included a commitment to increase consultant posts in psychiatry by a further 470 by March 2024 as part of a planned increase of 27,460 posts in the mental health workforce overall on top of the Stepping Forward commitment.
• 2023 Workforce Plan
  • In November 2022 the Autumn budget was announced by Government. They committed to publishing a “comprehensive” NHS Workforce Plan in 2023, including “independently verified forecasts for the number of doctors, nurses and other professionals that will be needed in five, 10- and 15-years’ time”. We worked with over 100 health and care organisations to call for the commitment.

• New posts: As stated in Stepping Forward to 2020/21: the mental health workforce plan for England and the NHS Mental Health Implementation Plan 2019/20 - 2023/24, NHSE (previously HEE) set a target to expand the mental health workforce from 2016, by having an additional 1,040 consultant psychiatrists and 12,320 mental health nurses in post by March 2024.

  The number of new consultant psychiatrists (268 of the 1,040 committed to) and mental health nurses (6,988 of the 12,320 committed to) fall significantly short.

• Medical school places: Alongside an increase in specialty programmes, there is a need for an increase in medical school places if workforce commitments are to be met in the long term.

  We were pleased to see this accepted by the Government, who in 2023 committed to increasing medical school places by one third to 10,000 per year by 2028/29 and by double, to 15,000 per year by 2031/32. The first new places will be available in September 2025.

• NHS Long Term Workforce Plan: In July 2023 the NHS Long Term Workforce Plan was published. It set out commitments intended to recruit and retain NHS staff, including the above commitment to increase medical school places.

  You can read our College briefing on the plan. We expect to see an updated plan published in 2025 and are engaging with stakeholders on this work.

Expanding the psychiatric and wider mental health workforce

• We are continuing to make the case for a bigger psychiatric workforce.
• We are recommending that increases in medical school places are accompanied by assertive action over the longer term to ensure medical students become trainees in under-resourced specialties, including psychiatry. This includes calling for continued expansion of core and higher psychiatry posts. We also encourage medical students to specialise in the discipline through our Choose Psychiatry campaign. This article highlights key findings from our work on understanding what interventions at undergraduate level might have an impact on students choosing psychiatry as a career. We are delighted that in 2020 and 2021, 100% of core psychiatry training posts were filled. This was followed by fill rates of 99.0% in 2022 and 99.8% in 2023.
• We have also been calling for more to be done to address capacity challenges affecting medical school expansion and risking the quality of student learning. These include problems related to educator capacity and infrastructure.
• We continue to call for the mental health and wellbeing needs of our workforce to be met as well as for the racism and discrimination staff face to be tackled. These issues are interdependent and are central to retention and recruitment.
• Read more about our evidence and recommendations on these issues:
  • Our submission to the Public Accounts Committee Inquiry into NHS England’s modelling for the Long-Term Workforce Plan.
  • Our submission to the Health and Social Care Select Committee - Inquiry into NHS leadership, performance and patient safety.
• We contribute to work the College’s Professional Standards Department is leading on related to Physician Associates. You can access more information about the role of a Physician Associate and the College's ongoing Review of the role of Physician Associates.

Comprehensive workforce planning

• We monitor progress on workforce plans and work with stakeholders to develop workforce policy. This includes continued engagement with the Government, the NHS and other bodies on the development and implementation of the NHS Long Term Workforce Plan. Moving forwards, critical areas of interest include retaining the health and care workforce as well as securing expansion of core and higher psychiatry posts.

Mental Health Act

• We need to see the Government reform and modernise the Mental Health Act (MHA).
• The Joint Committee on the Draft Mental Health Act Reform Bill recommended that the Government should publish alongside the Bill a comprehensive implementation and workforce plan containing clear actions and key milestones. The Government accepted this recommendation in its response and we look forward to seeing this in the next Parliament.
• You can read more about our work on the MHA, including workforce modelling which sets out how many additional psychiatrists would be required to deliver the reforms .

Inequalities

• We raise with national level bodies the necessity of addressing inequality and inequity faced by both staff and patients.
• We know that workplace inequalities and inequities can impact on workforce supply as people avoid or leave the profession. We continue to call for the workforce to reflect the diverse society we live in. Widening participation and tackling differential attainment are essential to the promotion of equality, diversity and inclusion. Individuals should be able to enter a welcoming and fair work environment and culture.
• With this in mind, in 2023 the College published guidance for mental health employer organisations on tackling racism in the workplace.
• We also know that health inequality and health inequity amongst the wider public is also increasing. Social disparities, unemployment and deprivation impact on mental health, affecting both children and adults. There is a heightened prevalence of mental health problems in certain groups of the population and a demand from the workforce to acquire new skills and new ways of working in order to identify mental health problems across different groups of the population. We continue to emphasise the importance of research on the longer-term impact of the Covid-19 pandemic on health inequalities and demand for mental health services; and to recommend that all healthcare professionals have appropriate skills and training to minimise inequalities – including holding the competences to deliver fair, non-judgmental, and less restrictive care.

Local systems

• Integrated Care Systems (ICSs) are partnerships of organisations that come together to plan and deliver joined up health and care services locally.
• Throughout their development we have been interested in the opportunity for ICSs to better integrate mental and physical health services, to make advances on public mental health initiatives and to improve recruitment and retention of the mental health workforce.
• Workforce continues to be one of the greatest obstacles to mental health transformation, with our members stating that recruitment and retention of psychiatrists and the wider multidisciplinary team is a major issue.
• We continue to engage in a range of activities as ICSs evolve and take on greater responsibility for workforce planning and transformation activities. We are launching a network in collaboration with the NHS Confederation to bring together all 42 ICB mental health partner members with representatives from our Divisions. This work will improve our understanding of regional contexts and support aims to bridge the gap between national and local policy decision-making.
• We are also supporting those of our members who are clinical leaders to influence and engage with the implementation of the NHS Long Term Plan in their region; and we are contributing to discussions on the oversight and governance of these systems, pointing out what they need to succeed. We have recommended that in addition to support at a national level, NHS Trusts should develop credible mental health workforce plans and should be able to meet an annual 4% improvement target in retention of mental health staff. This is part of our wider efforts to ensure decision-makers treat the mental health workforce on an equal basis to the workforce specialising in physical health.

We use data to track progress and trends, secure accountability and highlight concerns. This is through collecting and analysing our own data as well as analysing publicly available data from organisations such as NHS England, NHS Digital, Health Education England, the General Medical Council and the Organisation for Economic Co-operation and Development.

Our most recent workforce census provides important evidence of the challenges facing the psychiatric workforce. This allows it to be a valuable tool for analysing trends in England, Scotland, Wales and Northern Ireland, strengthening our policy development and campaigning.  

We want to make sure our campaigns reflect the direct experience of psychiatrists, patients and carers.

If you have anything you would like us to be aware of, or if you have any evidence or experiences that will be relevant, please send them to Safiya.Jones@rcpsych.ac.uk