I was recently at a meeting with colleagues from NHS England (North) and Health Education England (in the North West and North East) which was facilitated by Clare Baguley – PPN programme manager. The meeting looked at the overlaps and potential for shared work across these.
One of the questions that came up was around our workforce and what do we know about it? So while we can think about the professions who work within NHS mental health services and the range of services provided as part of NHS mental health, what do we know about the overlaps between the professions and how much is shared between the roles? We know that when we work in teams that we often collectively agree who should work with a particular individual and sometimes we disagree on this. However, how well have we defined the competencies? Given the demand for psychological approaches, is there a way of thinking about psychological competencies that should contribute to training in mental health for the future workforce?
Mental health work is also provided outside NHS services by third sector or private providers. Some of this may also be provided by those with lived experience, people who are current or recent service users and also carers and people who volunteer. Some of this is also delivered informally rather than by commissioned services. We know little about how this impacts on NHS provided services whether positively or negatively or even collaboratively.
Another aspect of this is how do we know that any of these make a difference? We have an army of metrics that can show how services are doing on things like length of stay, symptom reduction and also service satisfaction. We have some metrics that ask about patient outcomes and some that ask for ratings of wellbeing. However, it isn’t easy to put these together and it’s often influenced by whose measures we are using and the purpose behind it. This could be activity (numbers of referrals seen in a time period), service performance (length of stay), benchmarking (numbers of staff or patients or beds that can be compared across organisations or locations) or CQC ratings of organisations. Outcomes for people who use our services are often focused on symptom reduction although there are some measures of patient reported outcomes.
Also, how do we ensure that the people working in these services undertake good work and are encouraged to develop and supported to prevent burnout. There’s been a lot written about stress in the psychological professions workforce as well as the wider healthcare workforce that shouldn’t be ignored. Wellbeing of the workforce isn’t just about improving patient or service users’ outcomes; it can prevent the workforce from becoming the next patient or service user.
So if we were to start with a blank sheet of paper then how could we go about designing a service that best meets people’s needs – or is that even the right question? Should we be designing approaches that can be delivered through a range of ways that improve the population’s wellbeing? How would we decide what the workforce should look like? How would we decide what the outcomes should be and how would we measure them? How do we ensure that the wellbeing of the workforce is part of a new service?
So where would you start?