News / Mental health struggles with vicious cycle of staff shortages

The Commons committee said that workforce shortages were holding back the expansion of mental health services. Although mental health staffing increased by 22% between 2016/17 and 2021/22, this has been outpaced by a 44% increase in referrals. There has also been a doubling in the number of 17- to 19-year-olds with a probable mental health disorder, from 10% in 2017 to 26% last year. It also highlighted the increased pressure on staff, which can be seen in a rising number of sick days due to poor mental health and the number of staff leaving.

The committee called for NHS England to set out how it would source the doctors, nurses and therapists needed in the sector – as identified in the recent NHS long-term workforce plan. The report – Progress in improving NHS mental health services – also said there was a need for improved data and information to support the management of services. Although data had improved in recent years, it still lagged behind that available for physical health and improvements were taking longer than planned, with some providers still not submitting required data.

Integrated care boards were singled out as being key in taking forward a number of important programmes, including data sharing across local stakeholders and workforce planning and deployment. ‘But we remain unconvinced that many of the ICBs, at this stage of their development, have the maturity, resources or capacity required to meet the high expectations placed on them for mental health services,’ the report said. ‘This is particularly the case as ICBs tackle reducing backlogs for physical health services while under funding pressures.’

The committee added that cuts to running costs at NHS England – where staffing could be reduced by up to 40% – could undermine the national body’s ability to support ICBs and hold them to account for performance.

The MPs also called on the government to provide a clear definition of the end goal of ‘parity of esteem’ with physical health services. They pointed out that it had been 12 years since this was first set as an ambition. And yet it was still not clear how progress is, or should be, measured – despite the Department of Health and Social Care accepting an earlier recommendation that this needed to be defined.

Committee chair Meg Hillier (pictured) said the government needed to pull services out of their ‘doom loop’. ‘Our report warns of a vicious cycle, in which staff shortages and morale both worsen in self-reinforcing parallel,’ she said. ‘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.’

Sean Duggan, chief executive of the NHS Confederation's Mental Health Network said that mental health had historically been a low priority for the government, citing the lack of mental health trusts in the recent eight-trust extension of the new hospital programme as an example. ‘Yet demand for mental health services has remained high, with 1.2 million people currently waiting for support. Estimates also suggest that 10 million more people, including 1.5 million children and young people, need extra support with their mental health as a direct result of the pandemic. Mental health leaders and their teams are pulling out all the stops, but can only do so much in what are very constrained circumstances.’

He called for mental health providers to be put at the forefront of government plans and for investment in public mental health and preventative approaches.

Saffron Cordery, deputy chief executive of NHS Providers, agreed with the need for extra capital and a focus on prevention. ‘We need the right levels of long-term investment in and support for prevention and early intervention services to help tackle growing demand and inequalities,’ she said. ‘Despite the sector’s best efforts to make progress, too few staff and resources are, as the committee says, holding it back.’