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The Health and Care Bill will be make-or-break for the NHS workforce

3 min read

The mental health impact of the pandemic is well recognised. Many MPs’ inboxes have been full of heart-breaking stories of people stuck on endless waiting lists as their mental health deteriorates. Staff are rushed off their feet trying their best to deal with unprecedented demand, but there just aren’t enough doctors and nurses to ensure everyone gets the help they need when they need it.

Nowhere has the human impact of the workforce crisis been clearer than in mental health services, where patients have long borne the brunt of chronic staffing shortages.

In March there were 16,600 full-time equivalent vacancies across the mental health workforce, with 1,215 medical posts and 8,388 nursing posts unfilled. The latest biennial psychiatry census shows one in 10 consultant psychiatrist posts are vacant. The considerable workforce implications of the much-needed Mental Health Act reforms, promised by government, will make the problem much worse. Meanwhile, the pandemic is expected to lead to a long tail of additional mental health referrals, joining a waiting list that has already reached 1.5 million people.

Frustratingly, the current draft of the Bill does little more than enable the continuation of the current status quo

Those working in and using mental health services have been holding out hope that the government’s widely publicised Health and Care Bill would drive some progress on long-standing workforce challenges. Frustratingly, the current draft of the Bill does little more than enable the continuation of the current status quo. The government’s addition of a clause mandating the publication of a report describing roles and responsibilities for workforce planning and supply will bring clarity to an opaque system – but it doesn’t go far enough. Crucially, it fails to demonstrate whether we are training and retaining enough people to deliver services or provide clear governance and accountability for doing so. In other words, it fails to address precisely the problem that has got us in this mess in the first place.

The workforce plans launched alongside the Five Year Forward View for Mental Health and the NHS Long Term Plan were published too late to make enough of an impact. As a result, only 37 per cent of the 570 consultant psychiatrists and 8,100 mental health nurses needed joined the workforce between 2017 and 2021, and the Long-Term Plan requirements are already off track. The Health Secretary has promised a 15-year workforce framework, but this will not provide the ongoing transparency that is required in demand modelling, monitoring and accountability.

Luckily, there is widespread consensus on how to fix this. The Royal College of Psychiatrists is joined by over 60 organisations in supporting an amendment that would require the Secretary of State to report independently verified assessments of current and future workforce projections every two years. The infrastructure to deliver this already exists in the Office for Budget Responsibilities regular healthcare demand projections. And while the report won’t overcome the workforce crisis in and of itself, it will set a solid foundation for local, regional and national strategies, and regular parliamentary scrutiny would ensure that these are backed with appropriate policies and investments.  

Ultimately, it won’t be possible for this or any future government to deliver on grand promises of bolstering the NHS without laying these foundations. The Health and Social Care Committee has consistently reiterated the importance of getting workforce right, and the Committee chair, Jeremy Hunt’s amendment has achieved cross-party support. Now is the time for parliamentarians across the House to come together and set us on the road to building back better. 


Professor Subodh Dave is the Dean of the Royal College of Psychiatrists.

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