Recruitment & Retention
Statement of importance
For mental health services to grow and develop, it is vital to recruit and retain good quality staff, which reflects the makeup of the community they serve. Currently, mental health is not seen as an attractive place to work. We need to tacklethis stigma by showing that it actually provides intellectual stimulus, good career opportunities, a fair rate of pay for thejob and good support networks including a family friendly working environment. If there are insufficient staff we willcontinue to waste resources on agency and locum staffing, we will be unable to provide effective services for users andtheir carers and NHS Plan targets will not be achieved.
The Children’s NSF clearly acknowledges difficulties in estimating the numbers of staff required to provide services that can meet all the demands and provide sustainable services. It suggests that the precise level of staffing will vary according to indices of deprivation, whether the service is in a rural or urban setting, and has teaching responsibilities, it does however offer guidance on staffing at tier 3. As services take on the new responsibilities determined by the NSF, additional staffing may be required locally. Whilst great strides are being made to train more doctors, nurses and allied health professionals, to recruit internationally and to retain staff through Improving Working Lives. Demographic factors including an ageing population, fewer school leavers and a healthy economy all indicate a need to be more imaginative in how we expand our workforce. In mental health, whilst training more psychiatrists, nurses, social workers, clinical psychologists, occupational therapists and other professions is critical, it is recognised that there will still be difficulties in producing the numbers required to staff services and that simply increasing numbers will not be the answer to the difficulties we face. The challenge then is to use our highly trained professionals, both currently and in the future, in a way, which maximises the positive impact they have on the service user experience.
The NSF poses a serious challenge to create a workforce of sufficient numbers with the right capabilities across all professional and non-professionally affiliated groups.
The modest 3% growth per annum in workforce suggested would produce demand for 305,000 new staff. This needs to be seen within the context of the overall national workforce. There are record employment levels and by 2010, there will be 700,000 fewer people of working age. Vacancies in the NHS are running at a very high level and legislation, such as the European Working Time Directive, adds additional pressure to reduce hours and recruit more staff to compensate. It is vital that we recognise that the Child and Adolescent mental health workforce spans the health and social care sectors, including the voluntary and independent sectors. To date, workforce planning processes have been separate for each sector. For the NHS, based on new service models, a modest estimate of staffing demand, submitted to the Workforce Numbers Advisory Board (WNAB) in 2003, indicated the need for increases by 2006 of 500 psychiatrists, 3,000 nurses, 1200 social workers and 600 occupational therapists for employment in mental health services and a 15% annual increase in clinical psychology training places. Additional capacity is also required for other groups, including pharmacists, physiotherapists, child and adolescent psychotherapists, art therapists and dieticians.
Whilst increasing numbers of staff alone will not ensure the provision of comprehensive services a critical mass of staffing is required for services to be safe, timely and effective and able to respond to the wide range of needs which include: specialist and multi-disciplinary services (Tiers 2, 3 and 4), support, consultation and face-to-face work within primary care settings (Tier 1), teaching, training, consultation and liaison, research and audit. For Child and Adolescent mental health services to develop it is vital to recruit and retain good quality staff and services need to be seen as an attractive place to work.
There are problems with recruitment and retention within CAMHS and a number of causes and challenges are suggested:
- Image and status. Those working with children particularly social workers have suffered from a poor public image, and childcare is often seen as low status
- Variable management and supervision. This is a problem across the public sector which is identified in the Audit Commission’s Recruitment and Retention report.
- Workload and bureaucracy. High vacancy rates contribute to pressure on those in post, and requirements designed to secure accountability impose increasing demands for information.
- Expansion. New initiatives and increasing investment run the risk of competing for a limited pool of staff
- Complex pay issues may play a part in recruitment and retention difficulties in some areas, and need further exploration. For many groups including social workers, nurses etc. the flexibilities in working conditions may not be enough to ensure employers attract the workforce they require.
CAMHS Mapping report vacancy factors across all services & all services report issues with Recruitment and Retention.
- Vacancies for professional staff are currently running at 11.5% for consultant psychiatrists, 2.9% for nurses, 6% for clinical psychologists and 6% for occupational therapists. This is much worse in some geographic and in some service settings
- Challenges exist in building a workforce that reflects local cultural diversity or promote cultural capability
- Innovative solutions across agencies that take in the whole of the potential labour market second careers are few and far between.
- There is a tendency towards competition for staff between employers rather than collaboration to address common problems.