Professor Lisa Bayliss-PrattChief Nurse and Interim

Regional Director for London Health Education England

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Mental Health WorkforceStepping Forward- Making it a Reality

Professor Lisa Bayliss-PrattDirector of Nursing

Deputy Director of Education & QualityHealth Education England

Lisa.bayliss-pratt@hee.nhs.uk@hee_lisaBP

We exist for one reason only

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 behaviours, at the right time and in the right place.

Stepping forward to 2020/21: The Five Year Forward Plan vision for the mental health workforce

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The Mental Health Workforce PlanStepping Forward

Sets out a high level road map

Reflects the additional staff required to deliver the transformation set out in the Five Year Forward View for Mental Health and the subsequent Implementation Plan

Is based on best evidence to date.

Chapters set outOur existing workforce – where are we now?Our future workforce – where do we need to be?How we will get there: agreed actionsThe Delivery Architecture

https://www.hee.nhs.uk/sites/default/files/documents/Stepping%20forward%20to%20202021%20-%20The%20mental%20health%20workforce%20plan%20for%20england.pdf

The Mental Health Workforce Plan is being implemented in partnership with all ALB partners

and DHSC through a number of interventions.

Delivery of Stepping Forward

These are broadly arranged

into 4 main areas:

• Reducing demand on the

mental health system

• Increasing headcount

(with new and returning

staff),

• Retention of existing

staff

• Improved, new and more

efficient, ways of working

– getting the best from

multi-disciplinary teams

and staff supporting

service users.

HEE CYP Mental Health Programme

@NHS_HealthEdEng

• Policy context and key drivers • Workforce expansion targets: Improving Access to

Psychological Therapies (IAPT) (5YFV MH)• Implementing the Government’s Green paper • Developing a wider Children and Young People’s MH

Framework• To include workforce transformation: new roles, new

ways of working and new service models

HEE CYP Mental Health Agenda

@NHS_HealthEdEng

• Workforce expansion and transformation - CYP initiatives within STP workforce plans - HEE leading workforce transformation at national level through New Roles workstream- how will

this link into the wider CYP delivery considerations?

• Implementation of national and local delivery framework- Additional resources have been secured within HEE to support delivery of the wider MH and

particularly CYP agenda - Roll out of CYP agenda via regional and local offices is underway to build relationships and support

improved engagement with stakeholders locally

• Scoping the CYP workforce - Working with NHS Benchmarking and NHS England to scope both the NHS and non-NHS sector CYP

workforces to understand implementation of new roles and workforce expansion.- A workshop session was held on 9th January2019 with support from ALBs and partner organisations

to develop a framework to support the wider CYP MH agenda

• Working with NHS Benchmarking and NHS England to scope both the NHS and non-NHS sector CYP workforces to understand implementation of new roles and workforce expansion.

• A workshop session was held on 9th January2019 with support from ALBs and partner organisations to develop a framework to support the wider CYP MH agenda

• Harnessing the value of the voluntary sector in CYPMH: CYP Education and Training fund supporting 26 projects led by voluntary sector organisations focussing on vulnerable groups (?)

• Successful sharing event on 14th November, where there was enthusiasm to create a network of voluntary sector organisations working in this space to share learning, good practice and support development of innovative workforce solutions.

Scoping the CYP Workforce

HEE CYP Mental Health Agenda: CYP IAPT

@NHS_HealthEdEng #insertcampaignhashtag

5YFV MH CYP IAPT targets: • Existing workforce target - 3,400• New staff target - 1,700

Progress to date: • 1,368 existing workforce have been trained in the principles of CYP IAPT • 717 new staff have been trained in CYP IAPT to date, with a further 532 to commence training in

January 2019. 620 further commissions will be let in 2019/20 in order to achieve the 1,700 target.

✓ HEE have worked closely with NHSE and DHSC to develop a recovery plan to deliver against targets in the remaining period from 2018/19 to 2020/21.

✓ Work will continue to deliver over the next 2 years with support from CYP collaboratives including service partnerships and other key stakeholders.

Green Paper Implementation

1. Incentivise every school and college to identify a Designated Senior Lead for Mental Health to oversee the approach to mental health and wellbeing. This will provide rapid advice, consultation and signposting to wider services.

2. Fund new Mental Health Support Teams to provide specific extra capacity for early intervention and ongoing help. These teams will be linked to groups of primary and secondary schools and to colleges, providing interventions to support those with mild to moderate needs and supporting the promotion of good mental health and wellbeing.

3. Trial a four week waiting time for access to specialist NHS children and young people’s mental health services. This builds on the expansion of specialist NHS services already underway.

Overarching Aims: Improving Access

HEE Adults and Older People MH Programme

Perinatal Mental Health Objectives

By 2021:Increase workforce capacity and capabilityto support 30,000 more women a year to receive evidence-based care in specialist perinatal mental health services

Adults and Older People Mental Health Objectives

Effective workforce planning to deliver

the right capacity and skills for service

expansion

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Regional Workforce Plans 1

42 STPs across the country have completed their workforce plans which have gone through comprehensive Quality Assurance process.

The four HEE Mental Health Regional Leads then amalgamated those plans into 4 regional plans that provide region-specific data indicating:

• a growth trajectory to March 2021;

• levels of engagement and alignment

• next steps, risks and issues.

These plans provided updated targets for six key expansion areas:

• Children & young people’s mental health

• Adult Improving Access to Psychological Therapies

• Perinatal mental health

• Crisis care

• Liaison mental health

• Early Intervention in Psychosis

Regional Workforce Plans 2

Analysis of June iteration of workforce plans indicates that workforce supply might grow sufficiently to meet the requirements set out in Stepping Forward to increase the Mental Health workforce

Expansion figures in all submissions are reflective of the changes that are locally sought to be delivered in any new service models. However; many STP plans highlighted difficulties in recruiting and retaining substantive mental health nurses and psychiatrists

Regional Workforce Plans 3

Monitoring of the Workforce Plans

The mental health workforce dashboard

It has been designed to capture upskilling, new roles, and new ways of working supporting activities as well as core posts and staffing in NHS providers.

Further development and use of new roles including:

• Physician Associates

• Pharmacy Professions

• Psychological Professions

• Peer Support Workers

• Nursing Associates

• Allied Health Professions

• and Social Work

Should ultimately contribute to enable us to achieve the required Mental Health workforce growth expansion as described in Stepping Forward.

Developing a longer term integrated

health and care workforce strategy

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Key Themes to consider for the future:

1. The changing profile of MH and population needs

2. Need for evidence base

3. Expanding New roles and ways of working to deliver on the new models of care

4. Supporting our workforce

5. Growing an informal ‘Support Force’

6. Transformative impact of Digital Medicine, Artificial Intelligence and Genomics over the next ten years

NHS Long Term Plan

CYP MH

• Funding for CYP MH will grow faster than both overall NHS funding and total MH spending. CYP MH services will time grow as a proportion of all mental health services.

• Expanding access to community-based mental health services via NHS funded MH services and Mental Health Support Teams working in schools and colleges to cover ¼ of the country by 2023…100% of CYP who need specialist care can access it ‘over the coming decade.’

• New waiting time standards for eating disorder services by 2020/21

• Green Paper MHSTs to be trained on supporting young people more likely to face mental health issues- e.g. how to support LGBT+ individuals and children in care

• Testing approaches to feasibly deliver 4 week waiting times for access to NHS support, ahead of new national standard

• Develop new services for children with complex needs, including those who experience sexual assault who are not reaching services. For 6,000 highly vulnerable children with complex trauma, this will provide consultation, advice, assessment, treatment and transition into integrated services.

• Extend current MH services to create comprehensive offer for 0-25 year olds

• New service model to deliver an integrated approaches, e.g. the evidenced based ‘iThrive’ model focusing on transitions for 18-25 yr olds to improve student welfare services and improve access to mental health services for the student population

• Expanding timely, age-appropriate crisis services (via NHS 111, A&E, paediatric, ambulance services)

• Develop specialist community teams for CYP

• Create a Children and Young People’s Transformation Programme

Perinatal

• Increasing access to high quality evidence based care for women with severe perinatal mental health difficulties and personality disorder diagnosis

• Develop Specialist perinatal MH services

• Improve access to Psychological Therapies within specialist perinatal MH services to include parent-infant, couple, co-parenting and Family Intervention therapies.

Putting training in place to develop a

highly skilled and flexible workforce

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New roles work: enabling clinicians across a range of settings with MH skill sets

HEE STAR re upskilling, new ways of working, leadership etc- clinicians working to the top of their license with varied skill sets that can be applied in a range of settings

Green paper practitioners working in education settings, providing care where/when it is needed and supporting improved access for CYP to MH services and signposting (Green paper slides included for information following)

Further Work

The EMHP training programmeCross ALB commitment

• Curriculum Development Group with specific expertise has developed the curriculum and job specification along with the job advertisement.

• Group consists of

• Department of Health and Social Care

• NHS England

• University training providers

• Education providers (Schools, Further Education, Voluntary Sector)

• Current service providers in healthcare

220 fully funded places in January 2019, c. 30 places with each of the 7 HEI’s to support the implementation of the trailblazers

• London & South East – University College London, King’s College London, Anna Freud Centre

• Central and South – University of Reading

• South West – University of Exeter

• Midlands – University of Derby, University of Northampton

• North West – Greater Manchester Mental Health NHS Foundation Trust

• North East – Northumbria University, Newcastle

HEE: Mental HealthSupport Teams

Delivery Overview Timeline

MHSTs operational from Dec

2018 2019

July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec

HEIs sign off MHST curriculum; MHST recruitment guide released to sites

Training for MHSTs runs Jan-Dec

Trailblazer CCGs recruit MHSTs (220 trainees expected) and prepare for 4-week waiting time rollout

Wave 1

Funding released to sites for wave 1

Funding released to sites for wave 2

2018 2019 2020

O N D J F M A M J J A S O N D J F M A M J J A

Design requirements and objectives for Wave 2, and nature of further rollout

Training for MHSTs runs Sept - Jul

Trailblazer CCGs recruit MHSTs (220 trainees expected) and prepare for 4-week waiting time rollout

HEE expand capacity across universities ahead of Wave 2

Wave 2

Sequencing for wave 1 is a pragmatic solution to extremely tight timescales for delivery. Timescales for wave 2 are currently in development and we would like to seek your views.

Design of objectives for wave 2 including nature and extent of rollout needs to take place early in order to begin set up and training in time for Wave 2 rollout in 2019/20.

Expansion may focus on: vulnerable groups, devolved systems, links to a place-based agenda and integrated practice.

EOI process

Development & Delivery

Maximising the Impact

•c. 30 trainees per cohort.

Immediately extending capacity

•2019/20 and 2020/21 will need bigger cohorts

•Meet the larger targets

•Ensure that there is provision across a wider geography.

Ensuring roles are new

•Complementary/additional to those that already exist OR being developed as part of the 5YFV deliverables.

Funding is directly tied to the training and delivery of this new workforce

•Aim is that they will add further benefit and value

•Providing direct support in an education setting,

•working in an integrated way across education, health, social care and the PVI sector.

•Providing early intervention and assessment.

Mental HealthSupport Teams

Addressing staff

shortfalls and lack of

funding

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Working with our networks of HEE local offices to understand local workforce needs and staying connected. Working with STPs to identify where their areas of need are and sharing good practice re how can they be addressed?

Recruitment and retention work led by NHSI to address staff shortfalls, particularly working with MH NHS Trusts

Working with the PVI/voluntary sector to help to identify workforce gaps and innovative solutions to fix them

The workforce dashboard will help to predict supply and areas of need (Check if this is a fair statement or not?)

How can we support to raise the profile of MH and ensure parity of esteem..? MH in the Long Term Plan- spotlight is on us! This is really positive

Addressing the Issues