Mental Health Workforce Strategy UK

Mental Health Workforce
Strategy
Mental Health Workforce Strategy
Contents
Contents....................................................................................................................................... 2
Foreword ...................................................................................................................................... 4
Executive Summary ..................................................................................................................... 5
Introduction .................................................................................................................................. 6
Mental Health Taskforce Public Consultation Feedback .......................................................... 6
Five Year Forward View Workforce Strategy Objectives .......................................................... 8
Current and Future Mental Health Workforce ............................................................................ 10
The current workforce picture ................................................................................................. 10
The future workforce............................................................................................................... 13
The workforce gap .................................................................................................................. 18
Cross-system strategic solutions- Five Pillars ............................................................................ 21
Pillar One- Increasing Productivity ......................................................................................... 23
Pillar Two- Increasing Attractiveness and Reducing Attrition ................................................. 24
Pillar Three - New Staff .......................................................................................................... 28
Pillar Four- New Roles............................................................................................................ 29
Pillar Five- New Skills ............................................................................................................. 31
Measurement and evaluation and data strategy..................................................................... 33
HEE Support Offer ..................................................................................................................... 33
HEE organisational structure .................................................................................................. 34
Patient and Public Engagement ............................................................................................. 34
Leadership Academy .............................................................................................................. 34
Technology Enhanced Learning ............................................................................................. 34
Sustainability and Transformation Plans ................................................................................ 35
Workforce and Career Planning ............................................................................................. 36
Career and Education Framework .......................................................................................... 36
New Staff ................................................................................................................................ 39
New Roles .............................................................................................................................. 40
New Skills ............................................................................................................................... 41
Transformation across key pathways ......................................................................................... 44
Children and young peoples mental health............................................................................ 44
Perinatal mental health ........................................................................................................... 46
Adult mental health: common mental health problems ........................................................... 47
Adult mental health: community, acute and crisis care ........................................................... 50
Adult mental health: secure care pathway and health and justice .......................................... 51
New pathway transformation .................................................................................................. 51
Beyond the Recommendations from the Five Year Forward View for Mental Health ................. 52
2
Foreword
To be written by DEQ team
Prompts include : Rising rates of poor mental health and suicide; Widening inequalities in
mental wellbeing and mental illness; Unsustainable health service provision - new models and
prevention focus; Reduced public resources impacting on core resilience;
Executive Summary
Health Education England exists to support the delivery of excellent
healthcare and health improvement to the patients and public of
England by ensuring that the workforce of today and tomorrow has the
right numbers, skills, values and behaviors, at the right time and in the
right place as set out in The Health and Social Care Act 20121.
The Five Year Forward View for Mental Health2 has made an unarguable case for transforming
mental health care in England. The costs of mental ill health whether to the individual, their
family or carer, the NHS or wider society are stark. The opportunity of action cannot be
ignored, and this document describes how we will enable change.
Over the past thirty years, mental health services have undergone a radical transformation, and
in many areas have gone further in developing multi-disciplinary, community-based alternatives
to hospital than any other part of the health system. This should provide the platform needed to
build the fuller vision of the Five Year Forward View for Mental Health and embed lasting
change.
People can, and do, recover from mental ill health. The evidence is clear that improving
outcomes for people with mental health problems supports them to achieve greater wellbeing,
build resilience and independence and optimise life chances, as well as reducing premature
mortality.
But moreover, the evidence is equally clear on the potential gain for the NHS and wider public
sector from intervening earlier, investing in effective, evidence-based care, and integrating the
care for peoples mental and physical health. The case in the Five Year Forward View for
Mental Health, therefore, is about moving beyond the moral imperative and the clear clinical and
individual benefits, and recognising this as a financial necessity to manage the challenges of the
years ahead.
Implementing this plan will benefit people of all ages, reflecting the specific needs of all groups,
from children and young people through to older people. As such, our aim to improve mental
health and wellbeing cannot solely be achieved by the NHS, but must be delivered in
partnership with other local organisations including local government, housing, education,
employment and the private, independent and voluntary sectors.
HEE is responsible for developing and delivering 8 specific Taskforce recommendations in
addition to working in partnership with other NHS Arms Lengths Bodies (ALBs) to deliver the
full suite of NHS recommendations; HEE has a central role to play in ensuring that the vision set
out is achieved.
1
2
http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted
https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf
Introduction
The Five Year Forward View for Mental Health sets out ambitious plans
to extend and improve the provision of mental health services across
England. It sets out a programme of improvement and associated
investment which will lead to an increase in CCG baselines to deliver
expanded services across a number of treatment pathways: psychiatric
liaison; community crisis care; early intervention in psychosis; specialist
perinatal mental health; Improving Access to Psychological Therapies;
liaison and diversion; community eating disorder services and Child and
Adolescent Mental Health Services. This mental health workforce
strategy describes the actions that need to be taken to address the
capability and capacity needs of the workforce to deliver this expansion
as well as the needs of the wider mental health workforce, including in
primary care and the private, independent and voluntary sector. This
workforce strategy is designed to be a living document. The landscape
is changing rapidly and workforce interventions must be receptive to
this fact, adapting as needed to deliver the best possible care for those
suffering mental ill health and their friends and families.
Delivering the recommendations in the Five Year Forward for Mental Health means an increase
in demand for all core professional groups: psychiatry, mental health nurses, allied health
professionals, clinical psychologist and therapists, or those with therapy skills.
This workforce strategy looks sets out the workforce gap that exists across the system and in
the pathways receiving investment to drive transformation. It lays out a five themes or pillars
pertaining to a range of interventions and actions that will need to be made by system partners
to ensure a sufficient workforce is in place for 2020 and beyond and that this workforce has the
right skills, in the right place, at the right time. The strategy also describes in more detail the
actions that Health Education England will take and recommends the actions that other system
partners will need to take.
The FYFV MH describes a flexible and sustainable workforce of the future caring for more
people, in the right settings at the right time. HEEs workforce strategy lays out the enabling
actions, process and infrastructure that can make it a reality. It operates on multiple levels; a
national strategy provides clarity and consistency but local areas and health economies are
encouraged to innovate and adapt.
Mental Health Taskforce Public Consultation Feedback

The project team will launch the workforce strategy consultation from 25 October 30
November 2016. The feedback will be reviewed and included into the strategy as applicable. As
patient and public consultation was undertaken only a year ago as part of the consultation for
the Five Year Forward View for Mental Health Taskforce, we have successfully sought approval
to re-use this recent and extensive feedback to represent the views of patients and the public.
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Three clear themes emerged from the patient and public engagement; prevention, access and
quality. The importance of integrating care and support was also identified as a critical factor to
the successful delivery of equitable access and improved outcomes. The need to prioritise
equality, particularly for BAME groups, older and younger people also came out strongly across
each of these themes. The full report can be found on the NHS England website3.
https://www.england.nhs.uk/mentalhealth/wp-content/uploads/sites/29/2015/09/fyfv-mental-hlth-taskforce.pdf

Five Year Forward View Workforce Strategy Objectives
HEE should work with NHS England, PHE, professional bodies, charities, expertsby-experience and others to develop a costed, multi-disciplinary workforce
strategy for the future shape and skill mix of the workforce required to deliver both
this strategy and the workforce recommendations set out in Future in Mind. This
review should address training needs for both new and existing NHS-funded staff
and should report by no later than the end of 2016. This workforce strategy should
include:
Clear projections for required staff numbers to 2020/21 and what action will
be taken to plug any gaps
Core training in basic mental health awareness and knowledge,
understanding of mental health law, public mental health, compassion and
communication skills
For professions involved in the care and support of people with mental
health problems, tailored curricula with competencies in dealing with the
common physical health problems people may present with, shared
decision-making, mental health prevention (including suicide), empowering
people to understand their own strengths and self-manage, carer
involvement and information sharing. Drawing on the best available
evidence, this should also ensure that professionals are equipped to provide
age-appropriate care and reduce inequalities. HEE and PHE should develop
an action plan so that by 2020/21 validated courses are available in mental
health promotion and prevention for the public health workforce (including
primary care).
Implement local plans to transform children and young peoples mental health, ensuring that
70,000 more receive highquality evidencebased care each year by 2020/21. Ensure full roll
out of the CYP IAPT development programme across England by 2018/19
Provide for a further expansion of access to integrated psychological therapies for adults with
anxiety and depression to reach 25% of need, with a focus on those with longterm physical
health conditions and people who are out of work
Ensure Crisis Resolution and Home Treatment Teams (CRHTTs) are providing a 24/7
communitybased mental health crisis response as an alternative to acute inpatient admission
for adults in all areas across England, with equivalent provision for children and young people
Ensuring acute hospitals have mental health liaison services available in emergency
departments and inpatient wards, with at least 50 per cent meeting the core 24 service standard
as a minimum
Expand the Early Intervention in Psychosis (EIP) standard so that 60% of those who are
referred for treatment receive NICEconcordant care within two weeks of referral
8
Put in place evidencebased screening and interventions to meet the physical health needs of
at least 60% of adults with severe mental illness, in accordance with NICE guidelines
Ensure that up to 29,000 more people per year living with mental health problems should be
supported to find or stay in work through increasing access to psychological therapies for
common mental health problems and doubling the reach of Individual Placement and
Support (IPS).
These recommendations are being developed and delivered according to their broad treatment
pathway. The table below shows the proposed mental health pathway and infrastructure
development programme:
Figure xx: Proposed treatment pathways (Five Year Forward View for Mental Health, p.36)
Current and Future Mental Health Workforce

Delivering the Mental Health Workforce Plan in response to the Five
Year Forward View for Mental Health (NHS England 2016) and Future
in Mind (NHS England 2015) relies heavily on good quality workforce
data as its starting point. Identifying suitable baselines for both current
supply and anticipated/projected demand must be the first step towards
developing this workforce strategy to bridge any gaps (either in terms of
workforce numbers or skills) or develop the workforce into one fit to fulfil
the ambitions of those documents and fulfil the recommendations of the
Five Year Forward View for Mental Health.
The current workforce picture
Creating a true picture of how many staff are required to deliver the recommendations
enhanced and expanded services is complex. There are a large number of data sources,
reports, collections, censuses and audits about mental health workforce numbers and skills,
capacity and capability. A large number of both quantitative and qualitative sources have been
gathered together to inform this workforce strategy.
Figure xx: Current staff (FTE) employed in Mental Health Trusts

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Supply data in mental health is complex, due to the amount of service provision that takes place
outside the NHS (very little is known about the non-NHS employed workforce). Even for staff
employed by NHS providers (and therefore recorded on the NHS Electronic Staff Record), the
data shows how many psychiatrists, mental health nurses and clinical psychologists are
employed but it is not possible to determine where these staff work (i.e. in which service or
team). While one can assume that the majority of psychiatrists or mental health nurses recorded
on ESR are working in mental health, it is not apparent from the data whether they are working
for CAMHS, services, Early Intervention in Psychosis teams or in a Perinatal MH Mother and
Baby Unit. This difficulty in accurately mapping the current workforce is exacerbated when
looking at Allied Health Professionals, support to clinical staff or administrative and
infrastructure staff. It may seem obvious that Clinical Psychologists are mainly employed in
mental health areas, but for staff such as Occupational Therapists, Speech and Language
Therapists and Social Workers, and Healthcare Assistants, Medical Summarisers and
Receptionists, it is not clear whether they spend some or all of their time working in/with a
mental health team.
For this reason, the accurate identification of current workforce normally takes place through
individual, subject area audits or censuses. These are normally undertaken by professional or
academic groups with an interest in a particular area (for example the Royal College of
Psychiatrists Faculty of Liaison Psychiatry commissioned the 1st and 2nd annual census of
liaison psychiatry teams, which were carried out by the University of Plymouth (2014, 2015)).
However, in some cases audits may be commissioned by one of the ALBs for historical or
budgetary reasons (for example, NHS England has traditionally carried out the adult IAPT
census (NHS England, HEE 2016). A full list of data sources is available in Appendix xx.
Figure xx: Total adopted current workforce (FTE) by expansion area
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The chart above shows that CAMHS and Adult IAPT are the largest areas (by staff FTE) in the
expansion areas. Some areas only show minimal current staffing, for example perinatal or
Children and Young Peoples crisis teams (the latter has never had a specific workforce
collection, however it is likely that there are dedicated CYP teams working within CHRTTs or
Liaison MH services).
However, it is important to recognise the contribution of core mental health services, which
provide the majority of patient care and employ the majority of staff, when compared with the
areas that are specifically recommended as expansion areas in the Five Year Forward View for
Mental Health. The relative size of the expansion areas in comparison to all staff employed in
Mental Health and Community Trusts can be seen below. Mental Health Trusts themselves
account for 14% of the NHS-employed workforce and employ approximately 150,00 FTE staff.
Figure xx: Relative size of core and expansion workforces
Skills for Care estimate that there are 47,000 nurses working in the adult social care sector in
2015, a 4% decrease from 20114. Of these, they estimate that 8% were registered with the
Nursing and Midwifery Council as a mental health nurse. In addition, there are approximately
1300FTE qualified social workers employed by Mental Health Trusts (just over half of all social
workers employed by the NHS).
Skills for Care The state of the adult social care sector and workforce in England (https://www.nmds-sconline.org.uk/Get.aspx?id=980099)
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The future workforce
There are a number of sources of evidence and data sources (see Figure xx below).
Populations sources include official forecasts on how the population is expected to change; for
example, the number of people over the age of 65 is anticipate to rise significantly in the next
few years and also include information on the prevalence or incidence rates of a particular type
of mental health diagnosis; for example how many women have required treatment for perinatal
mental health issues, including post-partum psychosis? The population quadrant (see Figure xx
below) tells us how many people are likely to require care and the next two quadrants tell us
how many health care professionals may be required to deliver that care. These guidelines may
come from professional bodies such as NICE or the Medical Royal Colleges or be rooted in a
politically-set target such as the Access and Waiting Time/Evidence-based Treatment
Pathways. Finally, HEE asks services themselves to articulate how many staff they both
(currently) have and need (now and in the future) to deliver care.
ONS population
forecasts
Activity (MHDS and
POPPI/HES)
Prevalence (PHE
fingertips tool)
RCPCH
RCPsych
NICE
Best practice
Population
Clinical
Provider
demand
Policy
targets
HEE annual collection

NHS Benchmarking
audit
Productivity
assumptions
5YFVMH
Future in Mind
Commissioning
guidelines
Figure xx: Four quadrant model of demand articulation
For the purpose of the mental health strategy, an internal model (Figure xx above) was
developed to bring together the need and demand aspects of each expansion area to enable
them to be mapped against each other, compared and one aspect to be agreed as the true
(although not necessarily right) measure of demand for that area. This approach was
necessary as HEE cannot, itself, determine appropriate demand lines for any individual service
or for the sector as a whole, as the organisation does not provide clinical interpretation of
epidemiology or clinical treatment guidelines published by other bodies, the political levers to
create policy targets different from those already published by government or the technical or
moral authority to contradict the annual collection of provider-expressed demand. Therefore, the
reliance on other primary sources must be acknowledged and assessed.
Each expansion area had charts populated with all of the possible demand lines that had been
harvested from external sources. Then, a series of confirm and challenge meetings were held
with internal and external stakeholder to adopt a single definition/source of demand, i.e. to
declare one true. In nearly every case, the political target was adopted as the primary target.
HEE acknowledges the increasing bias towards alignment with political objectives, however
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through this open process, hopes to mitigate against unconscious bias by making the adoptive
process and co-produced outcomes explicit.
Workforce supply
Due to the strategic nature of the project, a three dimensional model was chosen to display the
current supply of the workforce. The segmentation by staff group, clinical care/expansion area
and estimated skill/seniority level as a proxy for competency are all required to view the
workforce holistically. A key issue facing mental health is that each of the expansion areas in
the Five Years Forward View for Mental Health was developed by NHS England and the
NCCMH and proposed expansions and team models are based on available best practice. This
strategy begins the process of mapping these expansion goals to available workforce supply,
however further work will need to be undertaken in some professions where (due to length of
training) the forecast future supply is largely fixed for the next five years (for example
psychiatry).
Figure xx: Model of current workforce (FTE), by staff group, expansional area and levels
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Figure xx: Model of current workforce (FTE), by staff group, expansional area and levels
While the future workforce forms a key part of the strategy, it is vital to note that the bulk of
patient care up to 2020 to be delivered by the already existing services and workforce HEE
anticipates that more than 80% of staff currently providing mental health services will still be
providing those services in 2020.
Psychiatry
Psychiatrists (medically qualified doctors) look after patients with mental health problems such
as depression, bipolar affective disorder, anxiety disorders, learning disabilities, eating
disorders, schizophrenia, dementia, and drug and alcohol abuse.
After completing foundation, doctors will study core psychiatry for three years (CT1 - CT3),
before choosing one of the following six specialties within psychiatry:
general psychiatry - this is the largest group of psychiatrists and they look after psychiatric
patients aged 18-65 in inpatient and outpatient settings
child and adolescent psychiatry - these doctors specialise in managing psychiatric patients
under the age of 18
old age psychiatry - these are psychiatrists who deal with adults over the age of 65.
Psychiatric problems are more common in this age group, especially depression and
dementia
psychiatry of intellectual disability - psychiatric illness is common in people that have a
learning disability
15
forensic psychiatry - these doctors provide psychiatric care to prison inmates and those in
secure hospitals. They often act as expert witnesses in trials
medical psychotherapy - this group of psychiatrists specialise in the diagnosis and treatment
of psychiatric disorders through psychotherapy
Psychiatry has historically suffered from poor fill rates at core level, which has subsequently led
to a lack of available applicants to attract into higher specialty training. However, significant
programmes of work by HEE and the Royal College of Psychiatrists has led to steady increases
in the numbers of doctors choosing psychiatry training schemes.
Figure xx: Forecast Psychiatry (all branches) CCT outturn from education
The chart shows forecast growth for the aggregate of all psychiatry specialties based on:
- numbers in training currently (April 2016 Stocktake)
- estimated attrition from training and transition to employment (both based on observed data
over three years)
- and observed age-gender related retirement rates.
The forecasts indicates output from training will barely sustain very modest workforce growth.
In fact if past patterns of net outflow under 55 pertain, the workforce is likely to decline
marginally.
The current shortfall is unlikely to be is highly addressed over the next five years and even with
the modest decline in provider expressed demand from the 2015 data collection. HEE is
forecasting under supply through and beyond the period. This will be felt in most areas and will
be most acute in the north of England.
One of the distinguishing features of the psychiatry workforce is the reliance on EU and wider
overseas staff. The proportion of Consultants aged under 55 with non-UK Primary Medical
Qualifications grew from 42% to 45% in the period 2012-2015. This dependency is reducing
16

slowly- trainees with non-UK PMQs represent 34% in 2015 compared with 47% in 2012..
Amongst non-training, non-consultant grades two thirds have non-UK PMQs, and this has not
changed over the last four years. Overseas doctors from outside the EU/EEA outnumber those
from European countries significantly.
Mentalhealthnursing
HEE has sustained its investment and increased the number of mental health nursing
commissions each year since 2013/14. However, despite this consistent investment, the
numbers of mental health nurses employed in the NHS has reduced in recent years. Some of
this reduction is likely to be a reflection of the increasing variety of settings in which mental
health care is delivered, and HEE is working with NHS Digital to develop ways to identify the
valuable service that non-NHS staff provide to patients across England.
Figure xx: Forecast MH nursing (FTE) outturn from education
The available supply of mental health nursing is expected to grow significantly over the next five
years. However, outturn from education has not historically translated into rising employment
rates; the chart above shows a decline in mental health nurses in the NHS over the last several
years, despite the availability of qualified mental health nurses.
This may indicate that further work needs to be done to support staff, especially early in their
careers to encourage NHS employment and prevent burnout.
HEE is currently working with the Nursing and Midwifery Council to encourage nurses to return
to practice. So far, this scheme has produced 111 registrants who have returned to full
registration with the NMC.
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ClinicalPsychology
Figure xx: Forecast Clinical Psychologists (FTE) outturn from education
Clinical psychology is expected to see modest growth in available workforce supply, however
this is unlikely to meet current demand from services before 2020 (and may not factor in the
expansion areas of the Five Year Forward View for Mental Health).
HEE continues to support the psychological workforce through the training of CBT and
In addition to the three professional groups above, HEE has previously commissioned (and in
some cases, continues to commission) training programmes for Child Psychotherapists, Hit
Intensity Therapists and Psychological Wellbeing Practitioners in IAPT services, as well as
other modality IAPT therapists for children and adults. Mental health teams also include a range
of other professionals such as learning disability nurses, occupational therapists and other allied
health professionals who are supported through HEE training programmes.
HEE have developed training programmes that will enable health and care employers to ensure
that all staff have an awareness of mental health problems and how they may affect their
patients. These programmes include an awareness of the links between patients mental and
physical health and the impact of co-morbidity and the importance of work to health and health
outcomes as well as the actions they can take to ensure that patients receive appropriate
support.
The workforce gap

The difference between the identified supply and the adopted demand varies significantly
between areas facing extremely significant shortfall (perinatal and liaison services in particular)
18

and those with only minimal, or no, gaps (such as CHRTTs). In the charts below, the expansion
areas are shown separately from the total provider-expressed demand in eWorkforce.
The charts below show the extent of the recommended expansion in specific staff groups,
especially psychiatry and mental health nursing (see Figure xx below). The proposed
expansions are also disproportionately spread across areas, with CAMHS, EIP and Adult IAPT
facing particularly rapid expansion (see Figure xx overleaf).
Figure xx: Current workforce (FTE) and workforce required by 2020 (FTE)
These areas of expansion are particularly challenging as the strategys timeframe is only five
years; this means that there is limited opportunity to expand these professional groups through
training new staff. The supply forecasts previously described show that psychiatry and clinical
psychology are unlikely to meet existing service gaps by 2020, and will certainly not be able to
meet agreed expansion targets. MH nursing supply may meet nursing demand; however
historic trend data shows that nurses are leaving the system at an accelerated rate (not through
retirement), leading to a downward trend in staff in post.
Based on the current and future staff projected in the graph above, HEE estimates that the total
staff spend in MH services will rise from 8.3bn to 9.8bn by 2020.
Staff Group
Medical
Nursing and Midwifery
AHP/ST&T
Support to clinical staff
Infrastructure support
2016
1,000,000,000
2,400,000,000
2,500,000,000
1,400,000,000
1,000,000,000
8,400,000,000
2020
1,200,000,000
2,900,000,000
2,900,000,000
1,600,000,000
1,100,000,000
9,800,000,000
Total
Table xx: Estimated total paybill cost 2016 to 2020
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Change
20%
21%
16%
14%
10%
17%
However, all of these gaps assume that the NHS continues to provide mental health care in the
same way, by the same professional as now. While there have been some attempts to shift
from planning for professional roles to planning for skills hours or similar metrics (CfWI 2015),
many of the targets are still expressed in traditional professions-based roles. HEE is working
with system partners to develop core competency frameworks across mental health.
It should be noted that the future supply of the regulated workforce roles above, will turn out
from education as newly qualified staff and will require significant support initially. Any additional
new supply will be an unregulated workforce, which will support the existing workforce. The
professional development of both qualified and unqualified staff remains an employer
responsibility.
More granular data is required to fully the understand all the flows within the mental health
workforce, for example from junior to senior roles, between clinical areas or teams, or from
acute to community roles. There is anecdotal evidence to suggest that some of these flows are
viewed as inevitable (for example the high proportion of band 5 nurses in acute settings and
higher banded nurses in community settings), however this may give teams space to explore
new ways of working to recruit, train and retain staff.
The NHS England new models of care programme5 will lead to the development of new ways of
working which best enable service providers to deliver care or to make improvements in
prevention of illness. These vanguards, as well as the countless examples of local innovation
across the NHS, may well have a profound impact on the type of workforce required to deliver
high quality care to patients; this may result in a different skill mix or structure needed for
service delivery.
https://www.england.nhs.uk/ourwork/futurenhs/new-care-models/
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Cross-system strategic solutions- Five Pillars

This strategy will describe five overarching pillars that when implemented together can provide
a blueprint towards meeting the workforce gap. The five pillars are themselves rested on the
need to evolve a different approach to workforce planning, moving from planning to traditional
roles towards planning against competences needed to deliver care. This does not preclude the
need to ensure certain roles are filled but will enable the available workforce to be utilised more
effectively.
A key component for success will be the ability for stakeholders to know when to align with a
common approach to enable transformation to occur at scale and when possible at pace; and
when to develop workforce solutions to solve idiosyncratic problems.
Sustainability and Transformation Planning
Competency based workforce planning

These five pillars describe the means as to which the workforce gap can be closed and the
5YFV-MH ambitions can be realised. Each pillar represents a range of interventions that will
need to be led by different agencies but with shared responsibility or the need for high levels of
collaboration. These interventions will not be alone sufficient to address the workforce capacity
gap. Commissioners and employers will be advised to take a flexible approach to workforce
planning and service development. This will require balancing the need for specific roles to be
filled by relevant professional groups as well as recruiting to the competences required to
deliver care. We need to change the shape of the workforce to become more flexible, more
affordable and also to be better equipped with skills and competencies to deliver NICE
concordant care. In addition, the development s in place based planning through the
Sustainability and Transformation Planning process will help realise positive implication for the
workforce. A focus on for instance, prevention and early intervention, on the use of third sector,
education and primary care may lead to a distribution of demand around the system. This
approach to planning will also enable a way of utilising the workforce in smarter working, such
as through co-located services.
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Figure xx: Current and future supply with changes (FTE) 2016-2021
Importance of managing workforce stability

A significant level of expansion can be achieved through the investment being made available
to mental health for the pathways yet these pathways are but a portion of all mental health
services. The creation of new jobs will lead to an increased mobility of the workforce as existing
staff move to new opportunities. This may entail staff moving horizontally at their existing band
or grade, or moving vertically as new, more senior opportunities arise. This will to a degree be
offset by utilising new roles, yet the impact these can make by 2020 will be limited. Therefore,
there will be the need to minimise unintended negative consequences. These may include
depleting community mental health services and inpatient services of experienced staff without
a plan to ensure that quality is not reduced as they leave.
A new approach to workforce planning
The workforce of the future requires flexibility and a competency based approach. This may
mean a different skill mix for teams or the freedom to allow local innovation to develop new
services for patients.
This strategy addresses workforce issues from support worker to director level.
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Specialist
Advanced
Practitioner
Practitioner
Associate Practitioner
Pillar One- Increasing Productivity

The drive towards gaining efficiencies through increasing productivity in the delivery of care can
provide direct impact on the level of workforce required. Productivity targets have not yet been
set for Mental Health and Community Trusts, however it is expected that similar targets as the
acute sector will be set after Lord Carter finishes his review in 2017. In the meantime, it is
expected that Mental Health and Community Trusts, as part of their STPs may be subject to
whole health economy productivity increases and efficiency gains. This may lead to a reduction
in the workforce required to deliver care at the same level of quality. Increasing productivity is
high priority for service providers and this strategy will not set out further guidance on this.
Services providers will need to engage in ambitious productivity programmes in order to meet
this and will need to be supported by commissioners and regulators. Key outcomes of
productivity improvements need to lead to support the effective utilisation of staff, including
enabling staff to operate at the top of their competences and utilisation of support/ assistant
workforce; greater clinical capacity and better utilisation of community resources. This may be
addressed through investment in technology such as early awareness and sign-posting, as well
as self-care and digitally delivered therapies, as well as through systems of management and
supervision and relationships with third sector organisations.
Productivity and efficiency gains may not be possible in all pathways of care yet gains made
elsewhere can enable staff to be freed up to be available where services are expanding. In
addition, place based planning may lead to further rationalisation of care between organisations,
opening up opportunities for staff to move to areas of expansion between organisations.
It will be important to enable efficient use of professional groups which will experience a
sustained shortage in the short to medium term. This includes the effective utilisation of
psychiatry, both at junior or non-training grade and at consultant level.
HEE, through this strategy will seek commitment from system partners to engage in a range of activities
to improve productivity and to establish its effect of workforce needs.
Cross- system solutions
23

Health Education England
Placement/training quality
Supporting wider system to access education and training
including through: competence frameworks and e-learning
NHS England
Commissioning- moving away from block contracts

Specialised commissioning
New models of care, Vanguards, PMCF, BCF
Outcomes based commissioning
NHS Improvement
Financial/workforce monitoring
Implementing Carter
Intensive Support teams
Regional support structures
NHS Employers
2%
Implement outcome of Carter review
Productivity and efficiency
Embracing new care models
Innovative ways of working
Utilisation of digital technologies, eg comms, e-rostering and
digitally delivered therapies/interaction
Management and clinical supervision, adequate support services
(top and tail quals)
Supporting individuals to work at the top of their competence
Private, voluntary and

independent sector employers
As above
Royal Colleges and professional

bodies
New care models support, innovation, etc
Regulators GMC and NMC
Supporting new models and new roles
Other government agencies
Supporting staff to develop relevant competence in mental

health, including in education, criminal justice, employment
services
Pillar Two- Increasing Attractiveness and Reducing Attrition

In addition to increasing productivity, there will need to be a concerted effort to increase
attractiveness to careers in mental health and to reduce attrition from training as well as from
the existing workforce. Any actions taken to address the workforce gap by 2020 will need to
occur in parallel with actions to support the longer term workforce supply. Increasing
24

attractiveness to careers needs to include attracting potential staff at all levels, however in
particular at the entry level. As the bulk of care in the next five years will provided by the existing
workforce or those currently in training there is a fundamental need to ensure these staff are
retained and find employment.
Increasing Attractiveness
This includes growing new entrants to the workforce as well as supporting the existing
workforce in their career aspirations. A central tenant of attractiveness is to ensure that there is a
coherent and well-articulated vision as to the careers available in mental health. This vision needs to
include the roles available across metal health services, whether in NHS settings or as mental health
workers in the third sector, in education or in other settings. The vision needs to articulate opportunities
for advancing in careers if so desired as well as the qualification required for such roles. This would
enable individuals to plan their careers as well as employers to support professional development. HEE,
through this strategy, will seek commitment from system partners to engage in a coordinated range of
activities to improve attractiveness to mental health careers.
Articulating a coherent unified narrative around careers in

mental health including in third sector and social care
Career campaigns (Health Careers)
Support with addressing regional recruitment to training
issues
Supporting professional groups to attract future workforce
Talent for Care programme to develop support workforce
RePaIR- programme to reduce attrition from training
Local Workforce Action Board interventions
Engagement with providers outside of NHS Trusts
NHS England
Communication of mental health systemwide transformation and

its impact on improving outcomes for patients
NHS Improvement
Working with/supporting employers to
CCGs
Reduce agency use
Reduce turnover
Develop of clinical leadership
Investment, job creation

Adequate funding for teams
Flexible approach to commissioning, workforce planning, team
25

delivery
NHS Employers
Good HR policy
Bullying/harassment statistics
Staff retention programmes
Training/development opportunities supported
Backfill and release of staff to training
First year attrition addressed- mentorship, preceptorship,
buddying schemes etc
Skill mix MDTs, working across organisation boundaries, settings
Engage in widening participation programmes

Support for staff development

bodies
Attractiveness of professions
CPD opportunities
Networking and knowledge share/transfer
Regulators GMC and NMC
Recognition of skills, credentialling

Public perception
Higher Education Institutions
Ensure effective communications potential students

Ensure support for widening participation
Schools, colleges and further

education institutions
Support campaigns to increase interest in mental health careers

Develop courses to support mental health workforce
Reducing Attrition
Attrition of staff can occur at a number of points in an individuals career. This may be during training,
between qualification from training and gaining employment and out of employment. Interventions need
to be put in place to address attrition at each of these points. Many reasons for attrition are unavoidable,
such as leaving due to ill health and retirement; however some of them can be avoided. Avoidable
reason from training include poor experiences during clinical placements or poor learning experiences in
college. Reasons for failure to transition from training to employment may be due to employer
recruitment practices or due to newly qualified staff being unprepared for employment. Reasons for
attrition from service are many but they may be due to everything from stressful work practices leading to
burnout, to lack of flexible work practices.
Actions need to be taken to minimise attrition from these three sources. This will be of even greater
importance due to the effect that rapid expansion may have on the workforce. The increased movement
of staff may lead to increased pressure at both senior and junior levels, due to both meeting higher
26

demand or having to learn to operate in a new environment or new model of service delivery and work at
the top of their level of competence.
The need to address attrition can include ensuring that training is fit for purpose and delivering the
quality required, ensuring that employment practices and workforce planning supports service delivery
and ensuring that there are good staff welfare and HR policies in place. All of this will require system
leaders in education and in service provision and service managers ensure a continued focus on looking
after their staff or the training of such individuals. HEE, through this strategy will seek commitment from
system partners to engage in a coordinated range of activities to reduce attrition.
Quality Framework for training placements

Competence Frameworks
Workforce planning tools: Generic role templates, team
templates
Leadership Academy
RePAIR Programme
Local initiatives e.g. Capital Nursing Programme in London
NHS England
CQUIN for staff welfare

Implementation of Occupational health standards
NHS Improvement
Organisational Development and leadership development.

Reduction in use of locum staff and short term contracts
Employers
Value of Portfolio: Working in inpatient and community and

exchange programmes [cross-skilling]
Propose to employers to develop a project to pilot a flexible
workforce between acute and community settings to potentially
address retention?
Research feasibility of newly qualified nurses [AfC Bands 5+6]
practicing straight into the community to as there will be less
acute beds as healthcare becomes based on prevention.
Develop a placement infrastructure to provide early experience
in community care settings for AHPs and Nurses [preregistration]
Develop mentorship training into community care.
Ensure highest standards of training to ensure transition to

employment
27

Ensure effective mechanisms to manage student welfare
Pillar Three - New Staff

New staff expected to complete training over the course of the next five years will make an extremely
important contribution to developing the workforce needed. These need most importantly to be available
to take up employment in addition to new starters into support and assistant practitioner roles. Due to the
length of time it takes to train newly qualified staff, there is a fixed supply of newly qualified regulated
workforce that will be available to employers in the next few years. The existing HEE training pipeline will
continue to produce new staff who will be available to the system, however actions need to continue be
taken to ensure that jobs are available and people are attracted to roles. HEE, through this strategy will
seek commitment from system partners to engage in a range of activities to ensure that newly qualified
practitioners find employment and that the support and assistant workforce is grown accordingly to meet
expanded demand.
Quality framework to ensure quality of training and training

environment
Continue to output professionally qualified staff as detailed in
chart below
Working with HEIs
Good supervision
Reducing avoidable attrition
Coordination to ensure effective use of apprenticeships
Talent for Care to grow un regulated workforce and widening
participation
Engaging with Private, voluntary and independent sector
employers
NHS England
Monitor increased investment by CCGs
NHS Improvement
Conversion of bank/agency into substantive
HEFCE
Teaching Experience Framework
HEIs
Ensure continued inflow of new trainees- esp nurses, AHPs

Values based recruitment
NHS Employers
Creating posts and making them attractive

Developing own workforce through new roles Good HR policy
Supporting junior staff- refer to above

Attracting qualified regulated professionals

Utilising apprenticeship route
Supporting training through clinical placements
CCGs
Invest to create posts

Ensuring funds are available for new roles, inc utilising
28

apprenticeship route
Prof. Regulators
Prompt entry to registers

Light touch regulation
Figure xx: New staff (FTE) 2016-2021
Pillar Four- New Roles

Despite the potential impact of increasing productivity, reducing attrition and employing new staff, it is
unlikely that this will enable service providers to close the sizable workforce gap. New roles will be
required which will support an expansion of the available workforce in real terms. The new roles
proposed here include ones that have been developed recently as well as roles that have been available
for some time but have been historically underutilised in mental health, namely nursing associates and
physicians associates respectively. Supply for these two roles is expected to increase over the next five
years with regulation and funding for training expected to be agreed in the near future.
In addition to these, there is also a need to develop new support roles. HEE recommends that a
coordinated national approach is taken to this to support sustainability, transferability and career
progression. This should include the employment of users by experience and peer support workers. An
example of this will be in the use of support time workers in liaison and diversion services.
HEE, through this strategy, will seek commitment from system partners to identify how to integrate new
roles into care and ensure consistent approaches to this drive training demand to support sustainability.
29

Career pathways
Widening access
Workforce planning tools
Core skills framework
Cross system coordination
NHS England
Commissioning guidance
CCGs
Flexible funding to allow for skill mix innovation

Widening access
Ensuring funds are available for new roles, including utilising
apprenticeship route
NHS Employers
Accommodate new roles, appropriate supervision and support

Invest in CPD to create new opportunities
Developing the Assistant practitioner and support roles in line
with coordinated approach
Widening participation
Collaborate with other providers to ensure sufficient demand in
place for sustainable training pipeline and training fit for purpose
Innovation in roles and service delivery
Encourage use of competence frameworks to map against CPD
and team development

Developing new roles in line with coordinated approach and

collaborating with training institutions
Encourage use of competence frameworks to map against CPD
and team development

bodies
Support introduction of new roles and socialise with existing

members
Accreditation of new role training
Regulators
Providing regulation/course accreditation
Deliver the training for new roles and collaborate with service
providers

Support the development of support worker and assistant

practitioner roles through delivery of training and education
Collaborating with service providers to ensure workforce fit for
purpose
30
Figure xx: New roles (FTE) 2016-2021
Pillar Five- New Skills

The final theme of this strategy is the development of new skills into the workforce that will support
individuals moving into new roles or the accommodation of existing roles such as qualified social
workers or psychological therapists within multidisciplinary teams. New skills may include the upskilling
of staff to deliver psychological therapies, leading to extending capacity to deliver NICE concordant care.
It may also include the development of staff with other clinical skills such as non-medical prescribing and
in leadership that will expand capacity for clinical leadership and management. New skills also include
supporting team development or individual professional development that does not necessarily require
post-graduate qualifications. This will entail utilising existing training resources, such as e-learning, and
where available, innovations such as simulation training. In order to support the development of new
skills, training will need to be available and funding identified, employees will need to be available to
training and then use the skills on qualification. HEE, through this strategy will seek commitment from
system partners to engage in a coordinated range of activities increase relevant skills into the workforce.
HEE
eLearning developed for specialist ahnd universal skills and

made widely available
Supporting providers to discharge their own responsibility to staff
Workforce planning tools e-learning
Support access to education and training, including simulation
training and short courses (not necessarily HEE funded)
NHS Leadership Academy programme to support leadership
31

development across health system
Support the development of the clinical academic workforce
NHS England
Support the development of clinical leadership

Commissioning for outcomes across pathways and supporting
new models of care
NHS Improvement
Ensuring quality of care

Development of effective clinical leadership
NHS Employers
Providers to support staff to develop their career.
Utilise career framework, competence frameworks and

workforce development tools to guide staff development
Ensuring that Trusts demonstrate clinical leadership and
encourage Continuing Professional Development [CPD] of
post registration staff during their preceptorship year to
provide a better working environment. In addition to
signposting various specialties and offering peer support
and networking opportunities.

Making space in teams

CPD/training
Recruit for skills rather than professions
Making roles attractive
Utilise career framework, competence frameworks and
workforce development tools to guide staff development as
well as the commissioning of education and training
Utilise competence frameworks to map against course curricula
Deliver the training for new skills in collaboration with service
providers
Work with service providers to develop clinical academic skills

Utilise competence frameworks to map against course curricula

Deliver the training for new skills in collaboration with service
providers
Other government agencies
Utilise competence frameworks to guide staff development

32

and commissioning of education and training
Prof. Regulators
Accreditation/ credentialing of new skills
Figure xx: New skills (FTE) 2016-2021
Measurement and evaluation and data strategy

Metrics will be established between Health Education England, NHS England and NHS
Improvement to enable the progress and milestones within the five pillars to be measured to
develop capacity in the workforce. Measurement will support future decision making and
allocations of resource.
In order to support this HEE will work with NHS Digital on a strategy to improve the data held on
the workforce through the existing mechanism of the Minimum Workforce Data Set and the
electronic staff record. This will include working with providers in the NHS, third sector and
independent sector to enhance the level of information held on the work force and to preclude
the need for additional workforce collections.
HEE Support Offer

HEE recognises that it has a central role to play in the delivery of this strategy. In addition to
working with system partners to ensure a coordinated delivery of the strategy, HEE will be
delivering its responsibilities as detailed within. There are within this a range of responsibilities
that address the while workforce or are pertinent across all pathways. The support offered by
HEE will both enable NHS providers to develop the capacity and capability required as well as
33

to support in collaboration the private, voluntary and independent sector and sectors managed
by other government agencies.
HEE organisational structure

In order to hardwire the workforce in mental health as described in the FYFV-MH at the pace
and scale required to meet ambitions, HEE is developing its governance and organisational
infrastructure across the local, regional and nation levels
HEE will work with, NHSE, NHSI, NHS and LA providers, NHSE clinical networks,
commissioners, AHSNs and training providers collaborate to address the needs of the mental
health workforce at a local and regional level. This will include support for workforce planning,
workforce data collection, workforce upskilling and reskilling, as well as managing local supply
issues. It will facilitate a forum for addressing local challenges to recruitment and retention.
Regional forums will be created to support investment decisions for HEE transformation monies
or other national level funding in to training; new role development or routes into clinical
practice, such as physicians associates and apprenticeships.
Local, regional and national leadership on mental health workforce will support the Local Action
Workforce Boards to deliver the workforce needed with the sustainability and transformation
planning footprints.
Patient and Public Engagement

HEE will work with patient and public advisors in the development of resources, including any
frameworks and learning materials to ensure that their views and needs are appropriately and
adequately represented in the materials produced. This does not however preclude the need for
patient and public involvement at the local level of implementation. The participation of patients
and public in the development of the workforce needs to include the views or young people and
their families as well as views of the older person as well as, representatives of groups in a
minority such as with regards to ethnicity, religion, disability and sexuality.
Leadership Academy
The work of NHS Leadership Academy as a whole system resource will support the
transformation in leadership capacity and capability required to meet the objectives of the NHS.
The Academy will work with national and local stakeholders and partners to provide support
through a wide range of applied offers, programmes, development and leadership thinking and
advice. The Academys key role is to provide development that liberates leadership talent
across the NHS, develops highly innovative and effective leaders and increases the capacity
and capability of leaders to create high quality, continuously improving, compassionate care.
Technology Enhanced Learning

HEE has a very active programme developing the use of technology enhanced learning.
Technology such e-learning will be used to support the dissemination of knowledge and skills
across universal and specialist competences. Technology will also be developed through the
course of this strategy and beyond to further support the learner. It will also be utilised to
support career development and workforce planning. E-learning when developed should also
include educational needs of patients, families and carers. It should also be supported with
guidance on how to use the resource within blended learning. These resources will be free at
the point of access to support both health and care sectors.
The use of technology and digital care innovations will also require a focus on the digital
educational needs of the workforce. The use of technology and also the development of
34

technology to solve workforce issues will be a focus within this programme. This will include the
implication of human factors in the design and use of this technology.
This will also include online tools to support other workforce issues such as recruitment, an
example is the skills passport. This is an online tool which can be used to assist in the process
of recruiting new staff. Individuals create a Skills Passport profile which houses CVs,
qualifications and references all in one place which prospective employers can then review. In
order to verify and track employee skills, competencies and training compliance, the passports
need to be linked to an online Skills Register tool.
Sustainability and Transformation Plans

Sustainability and Transformation Plans [STPs] provide the local vehicle for strategic planning,
implementation at scale and collaboration between partners. Implementing the commitments of
this plan will improve access and outcomes, deliver seven-day services, reduce inequality and
realise efficiencies across the local health and care economy and wider society. Mental health
should be an intrinsic element of every STP threaded throughout and not an afterthought.
Joint working with Local Government, housing, employment and voluntary sector will be a
particular focus of the STPs
Local Workforce Action Boards (LWABs)
As of August 2016 Health Education England established across the country Local Workforce
Action Boards in order to develop and implement workforce plans as part of the Sustainable
Transformation Planning. The entities are co-chaired by a senior HEE staff member and a chief
executive within the STP footprint. The LWABs will have a line of accountability to the national
Workforce Advisory Board (WAB) which is the cross-NHS board accountable for workforce
aspects in view of the Five Year Forward View. Membership will be drawn from health and
social care organisations within the STP and the LWABs will act as delivery groups alongside
other relevant enabling functions within the STP governance arrangements. They are tasked
with produce a Five-Year Workforce Strategy for the local health and social care workforce
delivering care to the population of the STP. This national mental health strategy will support the
development of these LWAB workforce strategies.
Through this process the LWABs will create a workforce development plan based on robust
commissioner intentions and provider plans. Use the workforce strategy and development plans
as the basis for decisions about investment in education and training locally and to advise the
investment decisions of the transformation funds, vanguard funds and HEE funds.
They will at the local level, ensure appropriate governance and infrastructure arrangements are
in place to hold the system to account for workforce development. Work in partnership with
universities, other education providers and research and innovation organisations to develop
responsive provision & disseminate best practice. Work with local authorities and health and
well-being boards in taking a joined-up approach across the local health, public health and care
workforce, considering the wider non-traditional workforce of volunteers, carers and self-care.
Workforce transformation through the LWABs will be deliver in line with the components of the
following model. This model aligns with the objectives of this strategy.
35
Workforce and Career Planning

In order to support the improving the attractiveness of careers in mental health, to facilitate
career development and a competence based approach to workforce planning and recruitment,
a number of tools and resources will be created. These tools will support individuals looking to
work or progress in mental health careers as well as employers and commissioners when
planning their workforce.
Career and Education Framework

Central to attractiveness and also supporting future workforce supply, including new roles is the
well-articulated vision. HEE will commission the development, collaboration with system
partners, career frameworks which will describe career pathways across professional groups
and speciality areas.
A well-articulated career needs to be well communicated through a number of channels. HEE
will achieve this by working with Health Careers, running focussed campaigns and through the
use of the internet, including social media. HEE will also work with system partners with this
such as the royal colleges and professional bodies and third sector organisation, as well to
communicate the vision across all professional groups.
Competency frameworks for specialist pathways and universal skills
In addition to the development of a career and education framework, HEE will work with experts
and system partners to either collate or develop when needed competence frameworks that
encompass the skills needed to deliver care in mental health, in line with NICE concordant
levels of care and commissioning guidance. These frameworks will link to the career and
education framework. HEE will seek to host these or provide access to them from a central
location on the internet.
36

These frameworks will enable individuals to establish their own continuing professional
development needs, as well as employer to do the same at a team level. They can enable
decisions to be made with regards to team planning and recruitment to posts, including on
decision about upskilling and reskilling.
Frameworks will cover the full range of care pathways where possible, an example of this the
perinatal mental health competence framework. They will also cover a range of generic
competences that are relevant across pathways. The frameworks developed will extend beyond
the Mental Health Core Skills and Knowledge Competence Framework (HEE, Skills for Health
and Skills for Care). This framework sets out the core skills required from people who come in
contact with individuals with mental health problems and their families across all ages. A
timetable of the development of proposed frameworks is described below. The frameworks
included in this strategy does not preclude the construction of additional frameworks or curricula
if so required to support further skills being developed into the system. Where possible key
learning resources will be identified that can be mapped to the competences described in the
framework (not necessarily endorsed by HEE). All frameworks where possible will be hosted on
the internet at the HEE website and a timetable of review will be published.
There will be additional frameworks that will be developed that comprise skills and knowledge
needed across all of health care. An example of the is the developments in Human Factors and
team work and decision making in clinical setting as driven by the Human Factors Concordat
and HEEs role in this. Another example will be in the development of competences in person
centred care, end of life care and dementia care.
Role and Team Templates
In order to support the planning of a workforce both based on the competences required as well
as with the compliment of staff from the right professional groups, HEE will develop a suite of
tools and guidance to support this. Tools will enable providers and commissioners to workforce
plan to meet the outcomes and performance targets expected within a pathway. The tools will
support the development of an affordable workforce. They will also support the process of
moving staff between areas of working and when used with the competence and career
framework, identify any need to upskill or reskill. HEE will work with service providers and
system stakeholders in their production.
Team Template
- Based on competence by
population need
- Recommended Team
- Develop Workforce Planning
Guidance
Role Template
- Advanced Clinical Practitioner
- Service Manager
- Practitioner
- Associate Practitioner
- Assistant Practitioner
37
2016/ 17
Career and Education
Frameworks
Role and Team
Templates
Universal Frameworks
2017/18
Support/ Assistant roles in NHS
and third sector roles
Regulated NHS
Pathway Specific Role and Team Templates
Core Skills and

Knowledge
Psychological Skills and
Knowledge for SMI
Care Coordination
Suicide and selfharm prevention

Core physical health
management in MH
Equality and Diversity: cultural
sensitivity in practice
Mental Health Law/
Mental Capacity Act
Medication Management
and prescribing in MH
Pathway Specific
Frameworks
IAPT (UCL)
Child and Adolescent Mental Health: inc.

CYP IAPT & eating disorder (UCL)
Perinatal Mental Health
Early Intervention in
Psychosis
Liaison Mental Health
(City)
Community Crisis
Care (City)
Liaison & Diversion
(OHC)
38
2018/19

New Staff
Over the course of the next five years in the region of 24,000 FTE professionally qualified
workers will be available to work in mental health; including from psychiatrists to psychological
therapist, mental health nurses and allied health professionals. In addition, individuals will be
starting new training courses, training to be the future workforce. HEE will ensure that there is a
system of support in place to support the development of this workforce whilst in training and
the recruitment of the workforce into training, as well as encouraging new entrants to the
workforce. Equally importantly, unregistered new staff will also be joining mental health teams,
including support staff in clinical roles and administrative and infrastructure staff.
Health Careers
Health Careers is part of HEE and its role is to provide support for individuals looking to find a
career in healthcare, as well as to commission campaigns to encourage recruitment and to
provide guidance and advice to schools and colleges to support career planning. Health
Careers will continue to develop the resources available for careers in mental health, as well as
manage campaigns to support recruitment into expanding roles.
Health Careers will support work that HEE is developing with schools and further education
colleges, as well as with higher education institutions to encourage interest and enthusiasm to
take up roles in mental health.
Quality Assurance of Training
HEE has an evolving role in how it delivers its responsibilities for the supply of the healthcare
workforce. Following the governments reforms to education funding announced in 2016, HEE
will no longer directly commission the training for nursing and allied health professionals, with
these course being funded through the student loan system. HEE retains its role in medical
training and a role in commissioning a range of other courses. It also retains a role in managing
clinical placements within the nursing and allied health professional training courses, as well as
those it retains commissioning responsibility for. In terms of the prior courses, HEE will have at
its disposal the placement tariff funding that will be used to support providers in deliver high
quality clinical placements within the courses now supported through student loans. This will in
part help ensure that students are learning across the range of clinical settings to deliver a
workforce with the required experience.
Across all training where HEE manages clinical placements, it is evolving its approach to quality
assurance. As of 2017 HEE will be implementing its Quality Framework. This will set
expectations for service providers and training bodies in the delivery of the highest quality
training experience.
Developing the future workforce at support and assistant levels
The Talent for Care programme partnership and the national Talent for Care strategic
framework is published by Health Education England (HEE) on behalf of the Talent for Care
programme partnership, which includes: Health Education England, National Skills Academy for
Health, NHS Employers, Skills for Health, Social Partnership Forums and/ Trade unions. The
programme aims to broaden the ways into training and employment in the NHS, especially to
attract more young people and improve diversity within the workforce Challenge and support
every NHS employer and contractor to implement a development programme for all support
staff that is over and above annual appraisals and mandatory training. All new Healthcare
Support Workers and Adult Social Care Workers to achieve the new Care Certificate. The Care
Certificate is a set of standards that non-regulated health and social care workers stick to in
their daily working life. It is the minimum standards that should be covered as part of induction
39

training of new care workers and also offers opportunities for existing staff to refresh or improve
their knowledge. It includes mental health awareness
Widening Participation
HEE engages in a range of activities that seek to widen participation into roles in healthcare,
seeking to ensure a workforce that is representative of the populations it serves. This is as
important for mental health as it is for other areas of healthcare and HEE will focus activities into
widening participation into a range of roles. This will involve developing a plan with relevant
service providers and training providers where greater diversity in the workforce is required.
HEE will also promote the Health Ambassadors scheme. This where a service provider agrees
to pledge the time of five staff members from a variety of roles to attend careers events and to
engage in other activities seeking to promote careers in health to schools, colleges and local
communities.
Reducing Pre-registration Attrition and Improving Retention (RePAIR)
In March, 2015 HEE was mandated by the Department of Health to develop a programme of
work to address attrition from pre-registration training and the RePAIR programme was
developed. This aims to understand the factors that lead to attrition from training and to identify
best practice and to promote this across England, leading to a nationally agreed approach.
Training to develop mental health professionals are included within this programme.
Working with Royal Colleges and Professional Bodies
HEE will work with, workforce regulators the professional groups whose members comprise the
range of regulated or accredited mental health professionals that make up the largest proportion
of the workforce. That includes bodies representing: doctors, nurses, allied health professional,
therapists and pharmacists. HEE will work with the National Midwifery Council, General Medical
Council and the Health and Care Professions Council to ensure that education standards and
re-validation are supporting the needs of service users of the future.
Return to Practice
HEE has an active return to practice programme for nursing in collaboration with Nursing
Midwifery Council, providers and higher education institutions. This has facilitated 111 mental
health nurses back into practice since 2013. This will continue to be active in bring nurses back
into practice and facilitate movement (and learning) across sectors.
New Roles
As previously described the mental health workforce will need to expand to ensure that
sufficient capacity is available to deliver the ambitions of the 5YFV-MH. New roles that can be
trained to deliver high quality levels of care and to be available to employers within short periods
of time will enable such expansion. HEE have invested in three such roles which would provide
significant benefits if integrated into mental health provision. These roles are not as an
alternative to other regulated or accredited staff but would enable that fixed commodity to be
better utilised as well as provide new routes into potential careers.
Nursing Associates
The nursing associate is a new role that fits in between a health assistant with a care certificate
and a registered nurse. They will support registered workforce in the delivery of care and at the
same time complete a foundation degree. This role can be a step towards pre-registration
training and will support widening participation within the nursing profession.
40

Physicians Associates
The physicians associate is trained to be a generalist who can operate across a range of
settings. This role has been in existence for over a decade but has not yet had much presence
in mental health settings. Training can be modulated to include significant levels of mental
health and people with these skills can assess, diagnose, analyse results and develop
management plans. They operate under the supervision of a qualified doctor
Psychological Wellbeing Practitioners in Childrens Mental Health
In order to support the expansion of the therapy workforce delivering care for children in child
and adolescent mental health services HEE, in collaboration with other system partners has
developed a low intensity therapist role. Individuals will be trained to deliver a range of low
intensity interventions expanding the capacity of teams to offer NICE supported interventions.
These individuals will also be available in the longer term to grow the high intensity level
therapist workforce.
New Skills
HEE will support the acquisition of new skills which will enable the upskilling and reskilling of
staff. This will support the capability to deliver care and also enable vertical and horizontal
movement of staff. This will be achieved through a number of sources, and will supplement how
individuals and service providers conduct continued professional development. HEE will support
this through providing free to use e-learning resources, guidance for blended learning, access to
funded short courses and access to funded/ self-funded long courses. Training and education
will be pathway specific or may be universally applicable. Pathway specific roles such as in the
psychological therapies will be described within the pathway specific sections below. It will be
important to support access to education and training both within the health workforce as well
as in other settings such as social care and education. Competence frameworks provide
guidance for employers and commissioners in any setting to develop training or commission
training that will be in line with expert guidance.
Technology Enhanced Learning
E-learning offers the ability to disseminate knowledge and skills to large populations. However,
it is important that the learning is accurate, trust worthy and up to date. Health Education
England has invested in developing e-learning for health learning hub as a central source for
such materials. HEE will review its existing portfolio and will develop new material for each
expansion pathway; to be hosted either on the eLfH or MindEd learning hubs. HEE will support
the development of (learning modules for carers and families for supporting the wider workforce.
Along with the e-learning modules, HEE will commission the development of blended learning
or simulation guidance. This guidance can be utilised by providers to support team
development.
Credentialing Pilots
HEE is working with the Department of Health, NHSE and the Royal College of Psychiatrists on
two pilots to credential psychiatrists into liaison psychiatry and perinatal mental health. It is
hoped that these pilots support the attainment of specialist skills within these areas, growing
capacity in specialised consultants and where possible for other doctors, in training or not.
Sources of Funding for Training and Education
Sources of funding for the pre-registration training in the regulated professions into mental
health have been allocated to HEE, however many of these routes are now being liberalised to
provide greater access to students. Sources of funding for the reskilling and continued
development of the workforce will depend upon the education and training to be completed. The
following sources of funding will need to be utilised to ensure sufficient skills are established in
41

the workforce. Funding will be available at the national level from HEE and NHSE for defined
period of time to support the development of the workforce in a number of pathways; including,
IAPT and CYP IAPT therapists.
Funding for training will also be available from local transformation funding at HEE and NHSE
and other locally held funding, however some of these will need to cover the whole health
system and thus not limited to mental health. Commissioners will need to ensure that sufficient
funding is available to service providers where needed to increase capability to deliver care,
such as when building new services or transformation at pace and scale to accommodate new
models of care.
Providers retain the responsibility for the professional development of their staff and will need
utilise funding available for this to ensure that training required achieved and are encourage to
discuss this with their commissioners to manage funding flows.
Regulated and accredited individuals are also responsible for their own continued professional
development. Many sources of education are free to access, including high quality e-learning,
articles and books and the use of these should be encouraged by employers and linked to from
learning and development resources. Colleges and professional bodies develop learning
resources for their members and these should also be utilised to ensure skills are updated.
Some short courses such as those to develop support and assistant practitioner roles as well
as, long courses such as degrees, diplomas, masters degrees will be funded through additional
relevant sources. Self- funded courses allow access for some to acquire new skills as well as
will accessing student loans where possible. Apprenticeships will be an important source of
funding for short and long courses and the apprenticeship levy (from April 2017) will enable
service providers build the skills needed in their workforce and to encourage recruitment into
roles.
In addition to funded or free to access materials, education and training is also achieved
through mentoring, placement opportunities and clinical supervision. Learning and development
departments or relevant managers in organisations should develop learning plans for teams
working within clinical pathways around the competence frameworks and the resources and
training opportunities available.
National Mental Health Training Contract
HEE have a contract with the Tavistock and Portman Foundation Trust to deliver the Mental
Health National Training Contract for England. Through this contract HEE provides subsides
courses across a range of topics in health and social care and enables these to be delivered
across the country. The contract also brings additional resources which will support activity in
transforming the workforce and to deliver education and training.
Other Activities
HEE are currently reviewing the possibility to include mental health into the NHS mandatory
training to enable the whole workforce to obtain, at the very least, a basic introduction to mental
health. HEE also supports the development of clinical academic careers working with the
National Institute for Health Research.
42

HEE will establish a project of work with stakeholders that addresses the prescribing standards
for mental health in line with the recommendation made in the 5YFV-MH. This will build upon
framework produced by the Royal Pharmaceutical Society (published July 2016), to be
completed by April 2017.
In line with the recommendation made in the 5YFV-MH, HEE is working with Public Health
England and to establish access to an accredited mental health awareness training programme.
Within scope of this work is a review of the Public Mental Health core curricula framework,
identification of mental health public health training programmes, the development of the
accredited programme, and evaluation of cascading this training and its impact. In addition to
this, the development of relevant e-learning materials, including in mental health promotion and
prevention, Making Every Contact Count (MECC)6 best practice materials and the creation of a
network of public health nurse suicide prevention champions.
In line with the recommendation made in the 5YFV-MH, HEE is working with system partners to
support the primary care workforce. It is working with system partners implementing the Primary
Care 2020 strategy. It is also working the Royal College of General Practice in terms of training
GP receive both during training and after qualification; including the development of GP with
extended roles. In addition, it is ensuring that mental health is a component of its practice nurse
development strategy.
Social care and the education workforce are also considered within this strategy. It is envisaged
that their knowledge and skills will be supported by the competence frameworks published as
well as through access to e-learning and blended learning guidance on learning hubs such as
MindEd. Staff will have access to gain qualifications in the psychological therapies across adult
and child pathways dependent on meeting entry criteria and funding availability.
MECC encourages conversations based on behaviour change methodologies (ranging

from brief advice, to more advanced behaviour change techniques), empowering healthier
lifestyle choices and exploring the wider social determinants that influence all of our health.
43
Transformation across key pathways

Children and young peoples mental health
Implement local plans to transform children and young peoples mental health,
ensuring that 70,000 more children to receive high-quality evidence-based care
each year by 2020/21. Ensure full roll out of the CYP IAPT development
programme across England by 2018/19.
In order to develop the work force for this pathway all of the five pillars will need to be
implemented. This work will also need to be completed in collaboration between partners at a
local level, implementing revised Local Transformation Plans. HEE in 2016 commissioned the
most comprehensive census of the CAMHS workforce to date, which identified 9000FTE staff in
NHS-provided CAMHS services and an additional 2100FTE staff (including 1000FTE in Youth
Offending Teams who may not be CAMHS specialists). Further details on this workforce can be
found in appendix xx.
Figure xx: NHS-employed CAMHS workforce summary
The Five Year Forward View for Mental Health Implementation Plan recommends that at least
3,400 existing CAMHS staff be upskilled in CYP IAPT therapies. HEE is delivering this with
central funding until 2018/19 and will work with the system to ensure the sustainability of
psychological therapies workforce beyond this point.
44
Figure xx: Forecast trajectory of available CAMHS staff
HEE has identified resources to develop a new role into the delivery of therapies in children and
young peoples mental health. Training for this new role - Children and Young Peoples
Psychological Wellbeing Practitioner (PWP) will commence in January 2017 via a 1 year fully
salary supported training position. From 2018 (when the current central funding terminates),
HEE are looking at ongoing funding arrangements.
To address the current vacancies and proposed expansion of the pathway, HEE will develop
and implement a range of new routes into the CYP Therapist workforce roles. HEE is continuing
to support the roll-out of the CYP IAPT programme through the training of existing CAMHS
workforce through the CYP IAPT curricula. In addition, HEE is expected to receive 115 million;
this is expected to pay for the following training:
Supervisors
Recruit to
Train
CYP PWPs
Upskilling of
existing staff
2016/17
157
350
2017/18
157
350
2018/19
157
350
2019/20
157
350
2020/21
157
350
280
680
280
680
280
680
280
680
280
680
In addition to the education commissions above, this funding will also be used for investing in
the following areas:
HEE have commissioned training for Community Eating Disorders Teams to support the
introduction of access and waiting time standards in April 2016.
HEE is working with RCPsych to encourage more applicants into child and adolescent
psychiatry training.
45
Developing the MindEd learning hub
HEE estimates that the total paybill in CAMHS services will rise by 22% (111m), with the
largest area of growth being psychological therapy staff to deliver the Taskforce
recommendation of treating 70,000 more children annually.
CAMHS
StaffGroup
Medical
AHP/ST&T
2020 Difference
2016
81,000,000
114,000,000
222,000,000
37,000,000
48,000,000
99,000,000
138,000,000
279,000,000
44,000,000
54,000,000
18,000,000
24,000,000
57,000,000
7,000,000
5,000,000
Total
502,000,000
614,000,000 111,000,000
Table xx: Estimated paybill costs in CAMHS services 2016 and 2020
Perinatal mental health

Provide timely, evidence-based specialist perinatal care for all women who need
it, to support an additional 30,000 women per year to access care.
Perinatal mental health services are highly specialist services covering significant geographical
areas. There are fifteen specialist inpatient units across England, which are supported by
community teams. To date, the workforce has been very small, drawing predominantly on
psychiatrists, mental health nurses and midwives, and support staff including health care
assistants and nursery nurses.
implemented.
Figure xx: Expansion trajectory in perinatal services
46

The proposed expansion of perinatal services will require a significant increase in the employed
workforce that cannot be met from new staff alone. This must therefore include attracting
existing professionals from other areas of mental health (e.g. psychiatrists, mental health
nurses, psychologists and support staff) or new staff groups such as nurse associates. There
may be other qualified professionals who would be suited to working in this care pathway, such
as health visitors, specialist midwives and social workers. In addition, the proposed significant
demand for psychiatrists cannot be met from existing training pipelines and commissioners and
service providers will need to develop alternative options for senior clinical leadership, for
example advanced clinical practitioners.
To deliver the recommendation HEE are currently undertaking the following:
Working in partnership with NHS England and the Royal College of Psychiatrists on a
project that will train 10 specialist perinatal mental health Psychiatrists in 2016 and upskill
general psychiatrists, Obstetricians and General Practitioners in PMH. The plans are in
place for the training to begin for 10 x psychiatrists.
Working in partnership with the Tavistock and Portman NHS trust, Royal Colleges and
other key stakeholders to develop an online Tiered Competency and skills Framework for
the multi professions across care pathway. An Expert Reference Group (ERG) has been
established to lead on the development of the competency framework and a workshop
took place in May 2016 to agree scope and draft skeleton of competencies. A writing
group has begun to develop the first draft of the competency framework which will then
be sent out to multi professionals as part of a consultation exercise due to complete by
March 2017. This will inform local training organisations as well as training opportunities,
which can be accessed through existing training relationships or develop these where
they do not already exist.
Working with HEE local teams to link in with NHSE clinical networks and service
providers to determine training requirements locally across care pathway for PMH and
agree what training should be available for local teams to access.
HEE estimates that the total paybill in perinatal services will rise by 710% (115m), with the
largest area of growth being nursing staff to deliver the Taskforce recommendation of treating
30,000 more women annually.
StaffGroup
Medical
AHP/ST&T
PerinatalMentalHealth
2016
5,000,000
5,000,000
3,000,000
300,000
3,000,000
2020 Difference
18,000,000
49,000,000
25,000,000
19,000,000
21,000,000
13,000,000
44,000,000
22,000,000
18,700,000
18,000,000
Total
16,300,000
132,000,000 115,700,000
Table xx: Estimated paybill costs in perinatal mental health services 2016 and 2020
Adult mental health: common mental health problems

Provide for a further expansion of access to integrated psychological therapies for
adults with anxiety and depression to reach 25% of need, with a focus on those
with long-term physical health conditions and people who are out of work.
47

Trial new models for delivering psychological therapies and building a robust
invest-to-save case for integrating psychological therapies into primary care and
secondary acute specialist teams to support the wider expansion programme and
to increase access for adults with psychosis, bipolar disorder and personality
disorder.
The IAPT workforce accounts for one of the larger expansion pathways in the Five Year
Forward View for Mental Health. The most recent IAPT census7 identified Nearly 7000 FTE staff
in post providing psychological therapies. This workforce consists predominantly of high
intensity CBT therapists, therapists qualified in other modalities and Psychological Wellbeing
Practitioners. There are also a small number of employment advisers in IAPT teams, although
many services refer their clients out to Job Centres or other external organisations. This census
identified high levels of movement of staff between services. The 2016 census (due to report in
early 2017) will provide more detail about the reasons for this movement and the destinations of
staff.
HEE has made a strong commitment to IAPT since the beginning of the programme and has
now commissioned more than 7700 training opportunities.
Figure xx: Expansion trajectory in Adult IAPT services
HEE is working with NHSE to support the delivery of the Five Year Forward View Independent
Taskforce Report objectives of providing for a further expansion of access to integrated
psychological therapies for adults with anxiety and depression to reach 25% of need, with a
focus on those with long-term physical health conditions and people who are out of work.
There is an emphasis on developing the expanded workforce to work in new integrated long
term conditions (LTCs) and medically unexplained symptoms (MUS) IAPT pathways.
7
https://www.england.nhs.uk/mentalhealth/wp-content/uploads/sites/29/2016/09/adult-iapt-workforce-censusreport-15.pdf
48
This involves collaboration on detailed workforce planning and education commissioning to

support NHSE to utilise ring-fenced funding that has been made available through the CSR to
expand and upskill the existing IAPT workforce to increase access, develop robust integrated
models for delivering psychological therapies and develop a sustainable plan for growth and
further development of the IAPT workforce over the next five years.
During 2016/17 it is anticipated new therapists will be trained to develop co-located IAPT
services for people living with long term physical health conditions and medically unexplained
symptoms. The IAPT expansion programme will accelerate with additional investment in
2017/18 in order for NHSE to build the case further investment through CCGs up to 2021.
Replacement High Intensity

(based on
Therapists
15%)
Replacement Psychological
Wellbeing
Practitioners
Expansion
High Intensity
Therapists
Expansion
Psychological
Wellbeing
Practitioners
LTC
High Intensity
Therapists
LTC
Psychological
Wellbeing
Practitioners
2016/17
367
2017/18
367
2018/19
367
2019/20
367
2020/21
367
579
579
579
579
579
360
240
165
58
125
60
In addition to the above HEE are:

Support recruitment into training
Improving Recruitment Access to IAPT training
Support NHS England in ensuring a choice of therapies in IAPT
HEE estimates that the total paybill in IAPT services will rise by 710% (115m), with the largest
area of growth being High Intensity Therapists and other modality therapist staff to deliver the
Taskforce recommendation of increasing the access rate for services to 25% annually.
AdultIAPT
StaffGroup
Medical
AHP/ST&T
2016
0
0
344,000,000
62,000,000
71,000,000
2020 Difference
0
0
580,000,000
99,000,000
71,000,000
0
0
236,000,000
37,000,000
0
273,000,000
Total
477,000,000
750,000,000
Table xx: Estimated paybill costs in adult IAPT services 2016 and 2020
49

Adult mental health: community, acute and crisis care
Expand the Early Intervention in Psychosis (EIP) standard so that 60% of those
who are referred for treatment receive NICE-concordant care within two weeks of
referral
implemented.
Work is ongoing to identify existing competencies and any resulting skills gap analysis. HEE
continue to offer eLearning opportunities to all staff including EIP teams. HEE will work with
system partners to identify unmet training needs in order to commission courses for advance
practitioners and work with regulators/professional bodies to recognise the new courses.
Figure xx: Expansion trajectory in Early Intervention in Psychosis services
In 2017/18 there will be an aim to begin a programme of expanding CORE 24

crisis care and improved psychiatric liaison in acute hospitals. (50% by 2021).
There will be a plan in place to address the education and training needs to
achieve this including commissioning products such as competence framework to
enable this.
A liaison psychiatry workforce (all ages) survey was conducted in autumn 2016, with the final
report due in November 2016. Up-skilling/re-skilling existing workforce plan will follow March
2017. These pieces of work will inform the further development of this expansion pathway.
50
Figure xx: Expansion trajectory in liaison mental health services
There is an aim to begin a programme of expanding provision of crisis resolution home

treatment teams.
A survey of all age Crisis Resolution and Home Treatment Team (CRHTT) is being conducted,
with the final report due in December 2016. This work will inform the further development of
this treatment pathway.
Adult mental health: secure care pathway and health and justice
To support the objective to transform pathways in and out of secure care, a workforce strategy
setting out multi-disciplinary skills and capacity requirements will be produced based on
development of community service models, and demand modelling.
A Skills and Competency Survey is ongoing and is expected to be completed by October. This
will be presented to the NHS England Steering Group by December, which will inform the
further development of this area.
New pathway transformation

The Five Year Forward View for Mental Health sets out a timetable of additional clinical
pathways over and above those mentioned so far in this strategy. Please see the full pathway
chart in the introduction above on page xx.
51
Beyond the Recommendations from the Five Year

Forward View for Mental Health
Throughout the process of developing the mental health workforce strategy to respond to the
recommendations, it has become clear there is a need to reform higher education systems to
develop the future workforce to be more skilled and flexible to meet future demands on the
NHS. This aspiration would take substantially longer to achieve than 5 years but will continue
the legacy of the 5 Year Forward View for Mental Health. Therefore, NHS Employers and HEE
have commissioned a project The Future of the Mental Health Workforce led by the Mental
Health Network of the NHS Confederation to look into longer-term mental health workforce
transformation. The report is due to be published by April 2017 and will include further
recommendations for reform.
52

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Mental Health Workforce

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Mental Health Taskforce Public Consultation Feedback

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Current and Future Mental Health Workforce

Figure xx: Current staff (FTE) employed in Mental Health Trusts

Mental Health Workforce Strategy

Figure xx: Total adopted current workforce (FTE) by expansion area

Mental Health Workforce Strategy

Figure xx: Relative size of core and expansion workforces

Mental Health Workforce Strategy

HEE annual collection

Figure xx: Four quadrant model of demand articulation

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Figure xx: Forecast MH nursing (FTE) outturn from education

Mental Health Workforce Strategy

Figure xx: Forecast Clinical Psychologists (FTE) outturn from education

The workforce gap

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Mental Health Workforce Strategy

Cross-system strategic solutions- Five Pillars

Sustainability and Transformation Planning

Competency based workforce planning

Mental Health Workforce Strategy

Importance of managing workforce stability

Mental Health Workforce Strategy

Pillar One- Increasing Productivity

Mental Health Workforce Strategy

Commissioning- moving away from block contracts

Private, voluntary and

Royal Colleges and professional

New care models support, innovation, etc

Regulators GMC and NMC

Supporting new models and new roles

Other government agencies

Supporting staff to develop relevant competence in mental

Pillar Two- Increasing Attractiveness and Reducing Attrition

Mental Health Workforce Strategy

Articulating a coherent unified narrative around careers in

Communication of mental health systemwide transformation and

Working with/supporting employers to

Reduce agency use

Develop of clinical leadership

Investment, job creation

Mental Health Workforce Strategy

Private, voluntary and

Support for staff development

Royal Colleges and professional

Regulators GMC and NMC

Recognition of skills, credentialling

Higher Education Institutions

Ensure effective communications potential students

Schools, colleges and further