Written evidence submitted by The UK Council for Psychotherapy (UKCP) and British Association for Counselling and Psychotherapy (BACP) (RTR0119)

The UK Council for Psychotherapy (UKCP) and the British Association for Counselling and Psychotherapy (BACP) welcome the opportunity to respond to the Health and Social Care Select Committee’s Inquiry on workforce recruitment, training and retention in health and social care. Collectively our two organisations represent over 70,000 psychotherapists and counsellors working for the NHS, privately, and in third sector organisations. We support the highest possible standards, quality of care and public protection for the practice of psychotherapy and counselling through our regulatory function, and each hold registers of practitioners accredited through the Professional Standards Authority’s (PSA) Accredited Registers programme.

As the UK’s two leading professional bodies representing psychotherapists and counsellors, we have excellent insight into our practitioner members’ experiences of recruitment, training, and retention in mental health roles within the NHS, as well as their potential to play a key role in the expansion of the mental health workforce.

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? 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?

Psychotherapists and counsellors have played a vitally important role throughout the coronavirus pandemic supporting vulnerable people in a wide variety of settings, as demand for therapy has grown in the wake of physical health challenges, lockdowns, financial insecurity, bereavement, isolation and many other mental health impacts felt over the past two years.

Following an initial lull in help-seeking across the NHS at the beginning of the coronavirus outbreak, the wider impacts of the pandemic have led to significant strain on NHS mental health services, with demand for both antidepressants (NHSBSA, 2021) and talking therapies (NHS England, 2021) reaching an all-time high in 2021 in England. Indeed, the Centre for Mental Health has estimated that up to 10 million people in England will need new or additional mental health support as a result of the pandemic (Centre for Mental Health, 2020), which will have a huge impact on demand for NHS support. 

Given this record-setting demand, and the already considerable waiting times for treatment in many parts of the UK, it has never been more important to ensure that evidence-based support is available to whoever needs it.

However, psychotherapists and counsellors continue to be an underutilised and undervalued workforce in the NHS context. Of the over 70,000 therapists UKCP and BACP represent, fewer than 5,000 work in the NHS, with even fewer working on a full-time equivalent (FTE) basis. Despite this, many of them are ready to step in to fill workforce gaps and support the NHS in meeting the growing demand for therapy.

For example, according to UKCP’s most recent all-member survey, only 21% of our qualified members work in an NHS-funded role and the vast majority of those work part-time. However, 45% of our members who don’t currently work in the NHS are interested in doing so and, more significantly, well over 80% of our student and trainee members are interested in working in the NHS in the future, highlighting the huge potential for future workforce growth (UKCP Member Survey, 2020).

There is a large and diverse pool of qualified and highly professional psychotherapists and counsellors ready to be recruited that could quickly be integrated across NHS mental health care to meet the growing need. In the Improving Access to Psychological Therapies (IAPT) programme, there was already a target to recruit 2,940 new therapists by 2023/24 before the pandemic hit (NHS Mental Health Implementation Plan, 2019) and, given the impact on IAPT of increased demand for support, this target will need to be increased in future workforce planning.

Removing barriers to entering the NHS workforce for psychotherapists and counsellors will be essential to ensuring that this target and any future expanded targets are met. This should include:

• A national campaign to recruit psychotherapists and counsellors into NHS roles in IAPT, primary and secondary care, led by Health Education England and coordinated with the national professional bodies, such as UKCP and BACP.
• Addressing financial barriers to recruitment and retention in mental health that disproportionately affect psychotherapists and counsellors, such as self-funded training and an over-reliance on unpaid trainee work.
• Expanding the fully funded high-intensity psychotherapeutic counsellor training following a successful pilot, increasing access to the psychological professions regardless of background and increasing supply to the IAPT workforce.
• The rapid expansion of paid training opportunities for qualified (and nearly qualified) psychotherapists and counsellors. There are tens of thousands of psychotherapists and counsellors who are already qualified, and therefore only require a short adaptive training to work in NHS settings – for example, a Dynamic Interpersonal Therapy training or a Counselling for Depression training. These trainings are considerably cheaper to the NHS than funding entire core trainings and these therapists are far easier to recruit than graduates without an established career path (e.g., see the recent heavy emphasis on recruiting psychology graduates).
• Targeted recruitment of psychotherapists and counsellors directly from non-NHS training programmes.
• Employing a more diverse range of practitioners in NHS leadership roles, including a far greater number psychotherapists and counsellors.
• Committing in the IAPT Manual to making all NICE-recommended therapies available in every IAPT service.

What changes could be made to the initial and ongoing training of staff in the health and social care sectors in order to help increase the number of staff working in these sectors?

Psychotherapists and counsellors frequently encounter financial barriers to accessing the necessary training to enter the NHS workforce. In comparison to other mental health professions in the NHS, there are few paid training opportunities available to psychotherapists and counsellors interested in joining the workforce. We welcomed the fully funded Level 7 pilot training programme in psychotherapeutic counselling recently launched by Health Education England (HEE) and encourage more paid training programmes to be available to reduce the barriers to entry for an otherwise valuable and qualified workforce – for example, see adaptive trainings listed above.

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

The National Vision for the Psychological Professions, developed before the Covid-19 pandemic by the Psychological Professions Workforce Group at NHS England / Improvement and Health Education England with input by eight professional bodies, including ours, confirmed that the transformation in mental health care requires not just a major expansion of the psychological professions, but also incentivising retention within the current workforce, with particular emphasis on career development opportunities, such as tailoring HEE’s advanced clinical practice initiative to the working context of psychological professionals.

As such, along with increasing recruitment of highly trained psychotherapists and counsellors into the NHS workforce to meet growing demand and planned workforce expansion, it is vital to also consider retention of this workforce. A report recently conducted by UKCP on barriers to entry and retention in the NHS for psychotherapists identified that systematic monetary undervaluation, limited career progression, and exclusion from eligibility for generic psychological therapist or leadership job roles, all limit retention of the psychotherapy and counselling workforce. More opportunities for pay and career progression, decreasing the prevalence of honorary work for psychotherapists and counsellors, and increasing the accessibility of new roles to psychotherapists and counsellors are all necessary steps to increase retention of these important members NHS mental health workforce.

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?

It is vital that the next iteration of the NHS People Plan includes an emphasis on viable career progression for psychotherapists and counsellors in the NHS, given that opportunities for career and pay advancement are vital for retention. Ensuring that leadership opportunities are available to psychotherapists and counsellors is also key.

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?

Currently, the contractual and employment models used are not fit for the purpose of attracting, training, and retaining psychotherapists and counsellors. The lack of paid training programmes, a high prevalence of honorary work, and low salaries as compared to experience and qualifications all contribute to low rates of entry and retention to the NHS workforce.

Contact

Adam Jones

Policy and Public Affairs Manager

UK Council for Psychotherapy

Jan 2022