This is HSJ’s fortnightly briefing covering quality, performance and finances in the mental health sector.

Feedback and comments are welcome, so please feel free to email me in confidence.

Thin thread of hope

While at first glance the startling figures published in HSJ this week about the nursing workforce appear to be a cause for concern, there is some light at the end of the tunnel. Or at the end of the graph at least.

The analysis shows what we already knew – mental health nursing numbers have dropped by 4,600 – or 11 per cent – between May 2010 and October 2017. The graph is even more depressing when you see a near constant decline, as opposed to the peaks and troughs in the acute sector.

But a close observer will spot the rise at the end of the graph, beginning in August 2017.

Admittedly it’s a thin thread to tie your hopes to, but at least the numbers are going in the right direction.

However, we don’t know if it will continue to rise or drop again. We will also need to wait much longer to see if the sector can recruit the 8,000 new nurses by 2020-21, as promised in Health Education England’s mental health workforce strategy.

But the problem is not just confined to the nursing workforce, with the plans being branded “hard to achieve” by Royal College of Psychiatrists’ president Wendy Burn.

Bums on seats

The pressure is mounting to create a workforce that can drive through the priorities of the Mental Health Forward View and safeguard its achievements.

While bringing in physician associates could fill immediate gaps and make sure the plan does not derail, it will not create the workforce the sector needs to meet demand 10 or 20 years down the line.

Training psychiatrists and nurses takes years, so it is good to hear anecdotally that a record number of applicants applied to specialise in psychiatry for their CT1 year beginning this autumn – more than the 696 in 2016.

But, promising as this sounds, we do not know how this will convert to bums on seats.

The mental health sector had 20,000 vacancies when the HEE workforce plan was published and 21,000 staff are expected to leave the sector by 2020-21. This is a mountain to climb in any climate – let alone in an NHS feeling the financial strain. With much of mental health spending tied up in workforce, the “acid test” will be whether there is enough cash to create the new posts.

The curveball is Brexit. The Mental Health Network published a report last month stating Britain’s departure from the EU will have “significant implications” for mental health services.

The big worry is that changes to immigration controls and curbs on freedom of movement will reduce the pool of clinicians flowing into the NHS. This could have a huge effect on mental health providers while the sector is trying to reverse the downward trend in clinical staff numbers.

A workforce wishlist

So, it is welcome news that HEE has enlisted Lord Willis – who led the 2015 Shape of Caring review for it and the Nursing and Midwifery Council – to lead work on a long term mental health workforce strategy.

It is positive that talks are beginning now, because many in the sector feared we could get to the end of the forward view period and be left with a vacuum of policy.

This was promised in the Stepping Forward report last year and HSJ understands this could extend to 2030. It is not clear what the terms of reference for the investigation will be, but it is vital it addresses some of the biggest questions facing the mental health workforce.

What it cannot be is simply a wishlist that more medics and nursing students will choose careers in mental health. It must provide proposals – which are measurable and demonstrable – to get more trainees into the sector.

Much of the backbone can be found in the forward view, such as getting medical schools to accept psychology A level as one of the entry subjects, or creating roles for graduates with psychology degrees.

But the long term strategy must go further to ensure the sector has the workforce to keep pace with the rising number of patients expected to need mental health services.