Pressures on NHS mental health staff causing vicious cycle of staff shortages

An influential parliamentary committee has heard concerning evidence of increasing pressures on NHS mental health staff at a time of spiking demand.

In a new report, the House of Commons public accounts committee (PAC) warned that increased workload is leading to burnout for remaining staff, contributing to a higher rate of staff turnover creating a vicious cycle of more staff shortages.

17,000 staff (12%) left the NHS mental health workforce in 2021/22, up from pre-pandemic levels of around 14,000 a year. Those citing work-life balance reasons for leaving increased from four percent in 2012/13 to 14 percent in 2021/22, and the percentage of days lost from the workforce due to psychiatric reasons doubled in a decade.

NHS England told the PAC that, in common with all NHS staff, mental health problems are one of the biggest drivers of staff sickness.

Staff shortages are holding back NHS mental health services as a whole from improving and expanding. The PAC called on the NHS to address the fact that staff increases are being outpaced by the rise in demand for services. The NHS mental health workforce increased by 22% overall between 2016/17 and 2021/22, while referrals to these services increased by 44% over the same period. The PAC’s inquiry found that staff vacancy rates in acute inpatient mental health services are at approximately 20 percent or more.

The government and NHS England acknowledged to the PAC that mental health services are lagging behind physical services to a particularly concerning degree in using data to improve services. Of 29 integrated care boards surveyed by the National Audit Office, only four said they had all or most of the data they needed to assess patient and user experiences, and none of them felt this in relation to patient outcomes.

Another area of particular concern for the PAC is a continuing lack of progress in treating mental health services with equal priority as physical services – or ‘parity of esteem’. Despite the government setting this ambition in 2011, and the PAC itself calling four years ago for a clear definition of how to measure progress to get there – a recommendation accepted at the time by the government – there is still no clear definition.

Dame Meg Hillier, chair of the PAC, said: ‘The findings of our inquiry must serve as a warning to the government that mental health is still in danger of not being treated with the same urgent priority as physical health. NHS mental health staff deal with some of the most challenging care needs there are. Staff in this space deserve not just our heartfelt gratitude for the job they do, but concrete support and training to work as part of well-staffed workplaces. Our report warns of a vicious cycle, in which staff shortages and morale both worsen in self-reinforcing parallel.

‘The short-term actions being taken by the government and NHS England to tackle ongoing pressure are welcome. But these numbers are still going in the wrong direction, as demand for care well outpaces the supply of staff to provide it. The government must act to pull services out of this doom loop. Invaluable care for some of our most vulnerable cannot and must not be provided at the expense of the welfare of the workforce carrying it out.’