Children and Young People s Mental Health Services Workforce Report for Local Authorities

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Raising standards through sharing excellence

Children and Young People’s Mental

Health Services Workforce

Report for Local Authorities

July 2019

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Contents

Background

3

Introduction

11

Demographic profiling

16

Service provision

28

Conclusion

37

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Raising standards through sharing excellence

Background

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• This bespoke report outlines the Local Authority findings from a national stocktake of the Children and Young People’s mental health (CYP MH) workforce across England. The project was commissioned by Health Education England (HEE) and undertaken by the NHS Benchmarking Network (NHSBN). The project builds on a previous study undertaken by the NHSBN for HEE in 2016.

• CYP MH is a multi-agency service that involves many organisations in providing services across England. The project recognised the multi-agency nature of CYP MH delivery and therefore aimed to collect data across a wide range of organisations that included;

• NHS providers

• Local Authorities

• Independent sector providers

• Voluntary sector providers

• Youth Justice services

• NHSBN conducted a data collection exercise that invited all providers in the above sectors to quantify and describe the shape and nature of their CYP MH workforce. The data collection took place between February and April 2019 and used data relating to 2018 calendar year. The data collection targeted quantifying the total size and shape of the CYP MH workforce, as well as analysing workforce demographics, skills and competencies.

• The headline findings from the project are as follows;

• A total of 18,136 staff are employed in CYP MH, delivering a total of 14,857 WTE staff

• The NHS are the primary provider of community based CYP MH services and account for 74% of total CYP MH staff reported by the project

• Staff working in the inpatient CYP MH sector are provided by both NHS and independent sector with the NHS being the largest employer in inpatient care.

• Workforce demographics suggest a staff base that is largely female (over 80%), has demonstrable diversity, and contains many disciplines.

• The CYP MH workforce has grown in recent years with the NHS employed workforce increasing by 23% since 2016. Other sectors do not offer the complete data position of the NHS to make definitive comparisons against, but evidence of growth does exist in both Local Authority and Voluntary sectors.

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Background

• This bespoke report for Local Authorities outlines details of the second comprehensive national stocktake of the CYP MH workforce, which builds on a previous data collection performed by the NHS Benchmarking Network in 2016. Children and Young People’s mental health services are a high profile service area that has been identified for investment and development in a number of recent national strategies including the NHS Five Year Forward View (2014) and NHS Long Term Plan (2019). CYP MH was also discussed in a recent Government green paper “Transforming Children and Young People’s Mental Health” (2017) which outlined aspirations for an inclusive multi-agency portfolio of CYP MH services that would form the backbone of an expanded delivery model in future years. Much of this vision is articulated in the NHS Long Term Plan with workforce growth central to plans to expand CYP MH services in future.

• The previous national data collection was completed in 2016 and used 2015 as the baseline year for profiling the workforce. This project used the same CYP MH sectors analysed in the 2016 data collection. The 2019 project analyses data from the calendar year 2018 for the following sectors;

• NHS providers • Local Authorities

• Independent sector providers • Voluntary sector providers

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Background (continued)

• The project aims to provide a comprehensive profile of the CYP MH workforce across these sectors including; • Size of workforce (headcount and WTE)

• Demographic profiling • Discipline mix and skill mix • Training / competencies • Service models

• Activity and productivity metrics

• The project was supported by a communications programme which invited all CYP MH providers to take part in the project so that a resilient (updated) national workforce baseline could be established. The project used the same methodology as that used in 2016 and therefore enabled like for like comparisons to be made of

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Timescales

Winter

2018

Feb

2019

March

2019

April

2019

May

2019

June

2019

Consultation & template design

Data collections live

Validation

Interim findings

Final reporting

• The project’s data collection launched in February 2019 in a phased manner by sector. The NHS data collection launched on 8thFebruary 2019 and was followed by data collections across Local Authorities, Independent sector,

Voluntary sector, and Youth Offending Teams.

• Data collections were targeted at a 1stApril 2019 submission date, however, extensions into April were agreed with

some providers to maximise data collection completeness within the project’s parameters.

• Data supplied by providers was subject to a validation process to ensure the accuracy of the project’s findings. Data validation took place during April and May 2019. All data used in this report has been agreed with providers.

• Initial findings from the project were discussed with Health Education England and members of NHS England’s CYP MH policy team in May, and were followed by production of a final national report following a review by Health

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Engagement

• An active process of engagement was undertaken to ensure that the project’s content was appropriate to provide a robust commentary on the CYP MH workforce. The following groups supported the project’s scoping and design work and subsequent data collection process:

National Policy

• Discussions were held with national policy teams in both Health Education England and NHS England.

NHS

• The NHSBN Mental Health Benchmarking reference group provided advice and commentary on data definitions and project scope.

Independent Sector

• NHS England Specialised Commissioning provided input to help promote the project across all independent sector providers commissioned by NHS England.

Local Authorities

• The Association of Directors of Children’s Services helped promote the project across the Local Authority sector.

Voluntary Sector

• The Association of Mental Health Providers helped share the project’s goals and encourage involvement by the voluntary sector.

Youth Justice

• The Youth Justice Board promoted the project across Youth Offending Teams in England. • A number of other organisations also contributed to project design and engagement work. We are grateful to

all organisations who supported the project’s work. The following page provides details of the proportion of providers in each sector that provided data during the project’s data collection period.

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Data completeness

• The chart below illustrates the degree of completeness achieved in data submissions across the various CYP MH sectors. Completeness has been assessed using a definition of known numbers of providers which are drawn from recognised national positions for providers in the NHS, Local Authorities, Independent sector and Youth Offending Services.

• NHS – All NHS Trust providers of CYP MH services responded to the project’s request for data

• Independent sector – 70% of the independent sector providers commissioned by NHS England Specialised Commissioning contributed to the data collection. • A total of 83% of Local Authorities responded to the

survey with CYP MH data or statements that CYP MH services are not provided

• YOTs – 52% of YOTs responded with details of their involvement in wider CYP MH activities. It should be noted that Youth Offending Services do not generally employ dedicated CYP MH workers but include CYP MH activities as part of wider youth justice activities.

• The Voluntary sector is perhaps the most difficult to scope due to the complex commissioning arrangements via a range of agencies and subsequent complexity of provider models. A total of 35 data submissions were received although it is not possible to estimate a degree of completeness based on this position.

• It should though be noted that more data was received from all sectors than was achieved in the 2016 project.

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▪ Across the four core workstreams with dedicated CYP MH posts, 14,065WTE staff were reported as working within CYP MH services. Of these, 80% (11,036 WTE) were employed by NHS Trusts.

▪ Comparisons with the 2016 project (which used 2015 calendar year data) are shown in the table opposite, which also

summarises changes that have taken place over the last 3 years.

▪ Please note that YOT staff are not dedicated CYP MH workers but staff members who have CYP MH

responsibilities as part of wider roles.

Headline workforce summary

0 2000 4000 6000 8000 10000 12000 NHS Independent Sector Local Authorities Voluntary Sector

Total WTE working in CYP MH

Sector 2015 WTE 2018 WTE Change % Number of providers (2015) Number of providers (2018) NHS 8,976 11,036 23% 65 63* Local Authority 865 1,065 23% 37 57** Independent 1,688 1,643 -3% 2 7*** Voluntary 158 321 103% 13 35** Core CYP MH 11,687 14,065 20% YOT 996 792 -20% 84 72**** Total 12,683 14,857 17%

*The position of 63 NHS providers in 2018 has reduced from the 65 NHS providers reported in 2015 due to Trust mergers, a 100% provider participation rate is evident for both years. ** The position of Local Authorities and Voluntary sector is influenced by an enhanced sample size in 2018

*** The position of Independent sector providers represents a different sample mix in 2018. **** The position of YOTs is influenced by a reduced number of contributors in 2018, although it should be noted that staff reported by YOTs do not exclusively work on CYP MH

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Raising standards through sharing excellence

Introduction

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Introduction

• The Local Authorities data collection ran from the 26thFebruary to the 1stApril 2019, with some extensions to enable

participants to maximise data collection completeness.

• The Association of Directors of Children’s Services helped promote the project across the sector, which ensured good visibility and high levels of participation.

• 57 Local Authorities responded that they do provide CYP MH services, and 68 responded that they do not provide such services. No response was received from 27 Local Authorities.

• Key findings from the Local Authorities section of the stocktake include:

• Over a third of staff (36%) are aged 50 or over, which could have implications for future workforce planning. Only 6% of staff are aged 29 or younger.

• Just under two thirds (60%) of the CYP MH staff work full time (0.8 to 1 WTE). Part time roles are common, and are generally for 2 or 3 days per week (0.4 – 0.8 WTE, 32%).

• The analysis of the time in post data for staff working for CYP MH services in LAs suggests that 71% of the staff have been in their current post for 5 years or less.

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Local Authority overview

Headcount

1259 staff working in

CYP MH services

Disability

4% of staff have a

disability

Ethnicity

80% of staff are White

British

Time in post

71% of staff have

been in post < 5 years

Contract type

85% of staff are on

permanent contracts

Age

36% of staff are aged

over 50

Full/part time

60% of staff work 0.8

– 1 WTE

Gender

84% of staff are female

Time allocation

50% of staff time is

patient facing

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Local Authority submissions

Out of the 152 Local Authorities in England, 57 responded that they provide CYP mental health services, and 68 responded that they do not provide directly, but instead commission these services from other providers. In total, a

response was received from 125 LAs. This represents a strong increase in participation since the 2016 collection, in which only 60 Local Authorities took part.

As with the 2016 collection, although there was wide variation in the workforce providing CYP mental health services, the majority of organisations reported a small number of teams, each containing low numbers of staff members.

38%

45% 18%

Does the Local Authority provide CYP mental

health services?

Yes No No response received

Provide CYP MH

services?

Number of

responses

Percentage of

total LAs

Yes 57 38% No 68 45% No response received 27 18%

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Staff in post

The chart to the right shows the headcount of the CYP MH workforce by Local Authority. There is

considerable variation, and a median value of 12 per LA. The total number of staff working in CYP MH services across all Local Authorities is 1259 (headcount). 0 20 40 60 80 100 120 140 160

Number of staff in post working in CYP MH services in the LA (headcount)

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Raising standards through sharing excellence

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Demographic - Age

The Local Authority CYP MH workforce is reasonably well distributed across different age bands.

However, over a third of staff (36%) are aged 50 or over, which could have implications for future workforce planning. Only 6% of staff are aged 29 or younger. The tables in this report show both the national average and the position for your Local Authority from the data supplied.

Age of staff in post

Under 20 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 + Age of staff in post National average STP Under 20 0% ... 20 - 24 1% ... 25 - 29 5% ... 30 - 34 13% ... 35 - 39 17% ... 40 - 44 14% ... 45 - 49 14% ... 50 - 54 10% ... 55 - 59 15% ... 60 - 64 8% ... 65 + 3% ...

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Demographic - Gender

The gender workforce data collected shows that 84% of the staff working in CYP MH services in LAs are female. This is a similar trend to other CYP MH service provider organisations. In 2016, 91% of the workforce were recorded as female, and 9% as male.

16%

84%

Gender of staff in post

Male Female

Gender of staff in

post

National

average

STP

Male 16% 5% Female 84% 95%

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Contracted hours by gender

There are differences in the hours worked by male and female staff, with female staff more likely to work part time. This is shown in the chart to the right.

74% of male staff work 0.8 to 1 WTE compared to 63% of female staff.

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Contracted hours per week

8% of the CYP mental health services workforce work less than 0.4 WTE. Just under two thirds of the CYP MH staff work full time (0.8 to 1 WTE). Part time roles are common, and are generally for 2 or 3 days per week (0.4 – 0.8 WTE, 32%).

2% 6%

19%

13% 60%

Contracted hours per week

0 - 0.2 WTE 0.2 - 0.4 WTE 0.4 - 0.6 WTE 0.6 - 0.8 WTE 0.8 - 1 WTE Contracted hours per week National average STP 0 - 0.2 WTE 2% 0% 0.2 - 0.4 WTE 6% 5% 0.4 - 0.6 WTE 19% 25% 0.6 - 0.8 WTE 13% 35% 0.8 - 1 WTE 60% 35%

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Ethnicity

In LAs, 80% of staff working in CYP MH services are from a White background.

The most under-represented ethnicity was Asian/Asian British people, who account for 7.5% of the general population of England, but only represent 3% of the CYP MH workforce in LAs.

Ethnicity

National

average STP

White / White British / White Other 80% 100%

Black / Black British 5% 0%

Asian / Asian British 3% 0%

Mixed race 1% 0%

Other ethnicity 2% 0%

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Contract type

85% of the staff in LAs working in CYP MH services are on a permanent contract, compared to 14% on a fixed term/temporary contract. In 2016, 87% of the staff were on a permanent contract.

Type of contract Permanent Fixed Term / Temporary (including training posts) Agency Honorary

Type of contract

National

average

STP

Permanent 85% 100% Fixed Term / Temporary (including training posts) 14% 0% Agency 1% 0% Honorary 0% 0%

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Job roles

The most common job role reported in CYP MH services in LAs is Psychology (29%) with Support worker and Social worker following at 11% each.

Nationally, 24% of the CYP MH workforce in LAs was categorised as ‘other’, suggesting the traditional CYP MH roles seen within healthcare settings are less applicable to social care staff.

Job roles

Admin/ Management CYP Education MH practitioner

CYP Psychological wellbeing practitioner Nursing Medical OT Psychology Psychotherapy Family Therapist Therapist/AHP Counsellor Support worker Social worker Job roles National average STP Admin/ Management 7% 5%

CYP Education MH practitioner 2% 0% CYP Psychological wellbeing practitioner 2% 0%

Nursing 2% 37% Medical 0% 0% OT 0% 0% Psychology 29% 0% Psychotherapy 1% 0% Family Therapist 3% 0% Therapist/AHP 5% 0% Counsellor 3% 0% Support worker 11% 47% Social worker 11% 5% Student 0% 0% Other 24% 5%

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Salary banding

66% of the CYP MH workforce have a salary between £20,000 and £39,999. 0% 20% 40% 60% 80% 100% Up to £ 15,000 £15,000 - £19,999 £20,000 - £29,999 £30,000 - £39,999 £40,000 - £49,999 £50,000 - £59,999 £60,000 - £69,999 £70,000 - £79,999

Salary banding

Average Bath and North East Somerset, Swindon and Wiltshire

Salary banding National average STP Up to £ 15,000 3% 0% £15,000 - £19,999 5% 0% £20,000 - £29,999 35% 100% £30,000 - £39,999 31% 0% £40,000 - £49,999 17% 0% £50,000 - £59,999 8% 0% £60,000 - £69,999 2% 0% £70,000 - £79,999 0% 0%

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Time in post

The analysis of time in post data for staff working for CYP MH services in LAs suggests that 71% of the staff have been in their current post for 5 years or less. 14% have been in post for less than 12 months.

This may be due to internal transfers and promotions, or may reflect funding provision that is time-limited leading to shorter term contracts historically (though 85% of staff now in post have permanent arrangements).

14%

56% 14%

16%

Time in post (years)

Under 1 1 to 5 6 to 10 11 or over

Time in post

(years)

National

average

STP

Under 1 14% ... 1 -5 years 57% ... 6- 10 years 14% ... Over 11 16% ...

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Time allocation

The clinical time allocation for staff members was collected and split into the following categories:

• Patient facing time

• Patient non-face to face time • Indirect patient specific activity • Non-patient specific activity • Travel

The time allocation data shows on average 50% of available staff time is patient facing time.

A further 27% of time is spent on non face to face patient time, or indirect patient specific activity.

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Disability

The vast majority of staff for whom disability status was reported had no disability (96%). This is similar to the 2016 figure of 95% of staff.

Disability

National

average STP

Staff who have a disability 4% 0%

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Raising standards through sharing excellence

Service provision

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Services provided

General CYP

LAs were asked to describe the broad categories of their service provision. In the following charts, blue represents yes, red represents no.

92% 8%

Prevention and early help services

15%

85%

Intensive home treatment

24%

76%

Crisis intervention and support team

20%

80%

Single Point of Access to CYP MH community

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Service model (1)

Included within the data collection template was a range of questions identifying the type of service provided by each team.

Evidence based parenting programmes was reported as the most common service available within Local Authorities, with 82% providing this service. In 2016, 55% of Local Authorities provided this service, showing a notable increase.

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Service model (2)

Service model

Percentage responding Yes

National

average

Mental Health Promotion in the community, schools, within

primary care

71%

Evidence based parenting programmes

82%

Early Intervention Psychosis Teams

5%

CYP MH Primary Care Mental Health Team (Dedicated CYP

MH delivery)

24%

Ante- & post-natal specific support

17%

Early years support for infants / toddlers

57%

Training & Education to staff working in primary care/universal

services (schools, GPs)

79%

Paediatric Liaison Service

5%

Outreach work

64%

Specific support to BME groups within the community

17%

Joint working/family therapy/group work

73%

100% 0%

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Service model (3)

Service model

Percentage responding Yes

National

average

24/7 crisis response

8%

Provision of services to Schools or Colleges

69%

Assertive Outreach Teams

8%

Support to Youth Offending Teams

45%

Liaison and diversion for Police custody

15%

Support to Drug & Alcohol Services

15%

Specific services for children in and leaving care, adopted

children and foster carers

76%

Support to LA behaviour support & inclusion services

62%

Treatment and support for CYP with a Learning Disability and

a mental health need

52%

Treatment and support for CYP with ASD

69%

Treatment and support for CYP with ADHD

67%

Sensory Impairment Services

23%

100% 0%

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Skills and training (1)

Skills and training are important for the development of CYP MH staff, although the range of training available to LA staff may be more limited that that available to staff in NHS organisations.

The most common training reported across LA teams included ‘CBT for young people with depression and anxiety’, with 40% of services having staff who have undertaken this training. Other training with high uptake includes: ‘Attachment informed interventions’, ‘Counselling children and young people with mild anxiety and depression’, and ‘Parenting for children (under 10 years) with conduct and behavioural problems’.

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Skills and training (2)

Skills and Training Percentage responding Yes National average

Attachment informed interventions e.g. Dyadic Developmental Psychotherapy or

Video Feedback to Promote Positive Parenting 35% ASD assessment approaches (e.g. ADOS/ADI or DISCO) 30% Cognitive Behavioural Therapy (CBT) for young people with depression and

anxiety 40%

CBT for Eating Disorders 3% CBT for Psychosis 3% Cognitive Analytic Therapy (CAT) 5% Counselling children and young people with mild anxiety and depression 35% Combination - prescribing and psychological therapy 3% Dialectical Behaviour Therapy (DBT) 20% Dietary counselling for eating disorders 3% Enhanced Evidence Based Practitioners (EEBP) 8% Eye Movement Desensitisation Reprogramming (EMDR) 30% Family Therapy (FT) 30% Family Focused Therapy 13% Anorexia-nervosa-focused family therapy for children and young people (FT-AN)

(single or multiple-family) 3% Bulimia-nervosa-focused family therapy (FT-BN) 3% Systemic Family Practice (SFP) for eating disorders 5% SFP for over 10s with conduct problems, or depression and self-harm 5%

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Skills and training (3)

Skills and Training Percentage responding Yes National average

Formal instruction in bio-psycho-social mental health assessment including risk

assessment 5%

Formal instruction (including CYP-IAPT) in ‘developing a formulation 30% Inpatient CAMHS whole team training 3% Mentalisation Approaches (e.g. AMBIT) 15% Interpersonal Psychotherapy for adolescents (IPT-A) with moderate to severe

depression 10%

Adolescent-focused psychotherapy for anorexia nervosa (AFP-AN). 3% Psychodynamic psychotherapy 13% Psycho-education / guided self-help 25% Parenting for children (under 10 years) with conduct and behavioural problems

(e.g. The Incredible Years, Positive Parenting Program -Triple P, Parent-Child 38% Children and young people with learning disabilities or autistic spectrum disorder

training (via CYP IAPT) 15% Supervision (diploma level) 23% Outreach enhanced supervision (for supervisors not attending full diploma

course) 8%

Service Transformational Leadership 5% Non-medical prescribing 3% Approved clinician (non-medical) 3% Social prescribing 5% Systems training for emotional predictability and problem solving (STEPPS) 0% Working with 0-5s training via CYP IAPT 0%

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Workforce metrics

The average sickness rate in General community teams for CYP MH services was 3.2%, which is slightly lower than the NHS average (4.2%).

This metric is a measure of staff retention. The data shows that on average, 94% of staff members who were in post on 1stJanuary 2018 were still in post at the end of the calendar

year. 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0%

Sickness absence rate

All Orgs

Bath and North East Somerset, Swindon and Wiltshire Mean = 3.2% Median = 3.0% 0% 20% 40% 60% 80% 100% 120%

Proportion of staff in post at 1st January 2018 and still in post at 31st December

2018

All Orgs

Bath and North East Somerset, Swindon and Wiltshire Mean = 94%

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Conclusion

• We would like to thank all Local Authorities who took part in the Health Education England CYP MH services workforce data collection, and we hope you find this analysis useful in comparing your local position against national averages. In addition to the Local Authority data returns, Data has been submitted by NHS providers, youth offending teams, voluntary organisations and independent organisations. This stocktake is a key part of implementing the targets in the recently published NHS Long Term Plan which aims to significantly expand capacity in children and young people’s mental health services.

• CYP MH is a multi-agency service with contributions to service delivery provided by organisations in a range of sectors. Data submissions were received from the NHS, Local Authorities, Independent sector, Voluntary sector, and Youth Justice services, although this report focuses on Local Authorities.

• Contributions from the various sectors are not based on 100% like for like comparisons with the 2016 project due to differences in the contributor sample size. However, data from participants does confirm evidence of growth and momentum in CYP MH services. The number of contributions from Local Authorities, Independent sector, and Voluntary sector have all increased in the last 3 years. Growth in workforce size in Voluntary sector providers may be taking place at pace but it should be noted that this is still the smallest of the CYP MH sectors.

• A summary report is available which provides detailed evidence of workforce size and shape across all CYP MH provider sectors. This includes profiling of workforce demographic characteristics, skills and

competencies. Workforce data has been aligned with service delivery data to describe how CYP MH services are delivered across the NHS and other sectors. Almost all of the metrics analysed by the project describe an expansion of the CYP MH service offer across England.

• If you have any queries about the report, please contact Chris McAuley (chris.mcauley@nhs.net) or Zoe Morris (zoe.morris@nhs.net).

Figure

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References