Written evidence submitted by The Association of Mental Health (RTR0113)

About The Association

Association of Mental Health Providers is the only national representative organisation for voluntary and community sector providers of mental health and wellbeing services in England and Wales, and focuses on supporting the delivery of services, which make a positive and demonstrable difference to people with mental health needs. The Association promotes the crucial role of the voluntary and community sector as a planning and delivery partner to improving mental health and transforming mental health provision.  

This submission has been developed following engagement with, and is on behalf of, our membership of voluntary and community sector mental health service providers.

Q: What are the main steps that must be taken to recruit the extra staff that are needed across the health and social care sectors in the short, medium, and long-term?

In the short term our need is urgent and growing daily. Seeing increased acuity within services (either need on referral or becoming more unwell in service) impacted by the lack of access to other professionals / services. What you can see across health and social care services is a perfect storm of acuity / demand / capacity.

In its 2019 position paper, Adult social care funding and eligibility: our position, the King’s Fund noted that in the past 20 years there have been 12 White Papers, Green Papers, and other consultations on social care in England as well as five independent reviews and commissions. Despite this, no lasting workforce solutions to the problems in mental health services have been implemented. This is in principal because the model of funding is no longer fit for person centred services we provide.

Our ask would be to bring forward a workforce plan co-created by providers of care and support services plus the people who draw on services themselves – A plan that delivers a consistent approach across NHS and LA commissioning practices yet recognises the placed-based needs within our community delivery models.

One such example of how this would work in practice: workforce retention fund nationally and ICF money distributed by staff headcount (no residential beds) should be provided with grant conditions to be used flexibly across the provider operations.

Q: What is the best way to ensure that current plans for recruitment, training and retention are able to adapt as models for providing future care change?

We would welcome central government support in terms of a national workforce plan that ensures the care and support sector is as attractive as the NHS. Furthermore we would hope there is autonomy provided to our members so that they can ensure that they have the right mix of staff in terms of skills, experience, attitudes, and values.

We would encourage government to work with us to consider staffing solutions for winter pressures and crisis management so we can weather these storms each year and step up and step down the workforce requirements within services.

The Association’s members share their issues and challenges in terms of staff retention and recruitment in mental health social care and support services are not about the skills, experience, knowledge and abilities of the leaders and managers in the sector.

The issues are about the low value that society places on social care work which is reflected in the terms and conditions employers can offer. The ambition to Build Back Better and create healthy communities cannot be delivered if we are unable to encourage people with the right values to make their career within social care. This starts with making the roles they apply for competitive.

The last 10 years of cuts in Local Authority budgets, have compounded the immediate workforce shortage we face now. Social care has been significantly underpaid given the levels of responsibility associated with the work is now very much at the bottom of the pile in terms of the desirability of care work.

Q: What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium, and long term?

The balance must be to develop and strengthen our domestic workforce as much as possible. However, providers should be able to attract candidates from the widest possible range of sources. Restricting recruitment from overseas without a clear plan to motivate and upskill the UK citizens who, it is presumed, were expected to fill the roles made vacant by the policy was always going to lead to staff shortages. Long term, we must develop a workforce plan for both business-as-usual and to manage the seasonal pressures and crisis we will face. There is no flexibility within the workforce supply if we do not use all avenues open to us. Furthermore, we should encourage cross skilling between health and social care staff to ensure we can work across the networks and share professional knowledge for the long term integration plans to succeed.

Q: What can the Government do to make it easier for staff to be recruited from countries from which it is ethically acceptable to recruit, with trusted training programmes?

It is for the provider to determine the skills required for the role and to support and develop candidates who do not initially meet the criteria.

Q: What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?

At The Association, our members have shared with us that care and support workers leave primarily because they and what they do every day is not valued by society. Furthermore the attractiveness of another role, for example within the retail or hospitality sector that pays nearly double the starting salary the sector can offer for less responsibility is a welcome change when you have been fire fighting for more than two years on the “frontline” of the Covid pandemic.

This is compounded by a decade of unprecedented cuts in Local Authority budgets, what was already a sector in which people were significantly underpaid given the levels of responsibility associated with the work is now very much at the bottom of the pile in terms of the desirability of care work.

To address this, we must fix the fee rates paid to providers clearly outlined in Health Select Committee report: “a funding increase of £7.7bn would increase access to social care and would have a potentially positive impact on workforce numbers and pay, provider sustainability, and the quality of care. This is slightly lower than, but broadly comparable to, the estimates put forward both by the Lords Economic Affairs Committee, and by the Local Government Association.”

https://committees.parliament.uk/publications/3120/documents/29193/default/ 

This will ensure we can operate on a financially sustainable basis and providers will be able to make sure that their staff feel valued by ensuring that they have an appropriate degree of autonomy in the role, that they are properly trained developed and supported and that the work they do is recognised and valued.

Q: Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this?

Yes – for example, registered managers, ultra-rural and major urban conurbations. The gaps are everywhere across our country. Historically, these were locations where social care operators were competing with the hospitality and tourism industries. Now, it includes all low-pay work such as warehouse / fulfilment operations.

Q: What should be in the next iteration of the NHS People Plan, and a people plan for the social care sector, to address the recruitment, training and retention of staff?

Latest Skills for Care workforce survey data shows vacancy pressures particularly in the registered managers and nursing categories meaning the most skilled roles in services are becoming woefully understaffed.

The next People Plan should include integrated training placements in both healthcare and social care settings including hospitals, residential care homes and home care,

Q: To what extent are the contractual and employment models used in the health and social care sectors fit for the purpose of attracting, training, and retaining the right numbers of staff with the right skills?

Support the improvement of employment conditions in the sector, including reducing the over-reliance on zero hours contracts and improving the provision of sick pay

The market oversight role that the Care Act requires Local Authorities to undertake is often not being fulfilled. This is a market that is poorly understood by Ministers. Much greater scrutiny and regulation of the market is needed to prevent a continuing race to the bottom.

Q: What is the role of integrated care systems in ensuring that local health and care organisations attract and retain staff with the right mix of skills?

This will depend on whether these are genuinely a partnership of equals or whether, as they seem to be now, is an NHS-led initiative to which social care is invited to attend but at which it does not enjoy parity of esteem or equality in terms of decision-making, influence, and power. There are many care and support staff who have developed clinical skills in their roles akin to healthcare assistants. We need to have a greater number of care and support voices around the table ensuring our staff are recognised for their skill and we can co-produce career development and training pathways to maintain good levels of retention.

We welcome the expectation in NHSE operational priorities and planning guidance for 2022 that, in the context of the anticipated growth and improvement of mental health services, “systems are asked to develop a mental health workforce plan to 2023/24 in collaboration with mental health providers, HEE and partners in the voluntary, community and social enterprise (VCSE) and education sector”.

This is significant signal to local health and care systems about the strategic and operational importance the VCSE mental health sector and its social care workforce, particularly given Integrated Care Systems are now moving toward their legal status on 1 July 2022.

Collaboration between the VCSE sector and ICSs will ensure effective workforce planning in the future.

Please also see The Association’s report on Developing the Mental Health Social Care Workforce which was developed through our Mental Health and Wellbeing Policy and Oversight Advisory Group - attached to this response.

For further information on this submission, please contact Victoria Buyer, Associate Social Care Policy Lead, Association of Mental Health Providers

Jan 2022