Raising standards through sharing excellence
Children and Young People’s Mental
Health Services Workforce
Report for Local Authorities
July 2019
Contents
Background
3
Introduction
11
Demographic profiling
16
Service provision
28
Conclusion
37
Raising standards through sharing excellence
Background
• 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.
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
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
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
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.
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.
▪ 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
Raising standards through sharing excellence
Introduction
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.
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
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%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)
Raising standards through sharing excellence
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% ...
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%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.
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%
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%
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%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%
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%
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% ...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.
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%
Raising standards through sharing excellence
Service provision
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
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.
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 Teams5%
CYP MH Primary Care Mental Health Team (Dedicated CYPMH delivery)
24%
Ante- & post-natal specific support
17%
Early years support for infants / toddlers57%
Training & Education to staff working in primary care/universalservices (schools, GPs)
79%
Paediatric Liaison Service
5%
Outreach work
64%
Specific support to BME groups within the community
17%
Joint working/family therapy/group work73%
100% 0%
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%
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’.
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%
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%
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%
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).
