1. The Mental Health Workforce in NHS Trusts and CCGs
Supplementary Report
March 2019

2. Summary
This report focusses on a new and more precise way to count the mental health workforce. This new measure is based on those individuals who directly provide or support the provision of mental health services and not on the organisation they are employed by.
In January 2018, NHS Digital published experimental statistics highlighting three ways of measuring the mental health workforce. The new methodology uses a more detailed combination of two of those ways.
The difference between the new definition and the widest possible definition of the options discussed in the NHS Digital January 2018 publication is it does not count staff in mental health trusts that do not provide or support the provision of mental health services.
The new definition was arrived at by the Workforce Information Review Group through consultation with experts in the field.

3. Glossary
Electronic Staff Record (ESR) - The Electronic Staff Register is the HR and payroll system for NHS trusts and CCGs. Data on the NHS workforce is drawn from ESR and is therefore administrative data.
Organisation type, Cluster groups and benchmark groups – Broad way of classifying what a trust does.
Mental Health and Learning Disability Trust (MHLD) - Mental Health and Learning Disability trusts are those where over half of their outpatient activity is in mental health specialties.
Specialty - This is the medical field that an individual have been trained in. This is defined by the Occupation Code
Care setting – This is the area that an individual has been trained and works in. e.g. A nurse may have been trained in the care setting of “Acute, Elderly & General”.
Primary Area of Work - This is a broad idea of type of work an individual does.
Secondary Area of Work – A more detailed idea of type of work an individual does.
Tertiary Area of Work – The most granular level of detail available on the type of work an individual does.
Occupation Code - Occupation codes are the traditional way of identifying the staff group and Care setting of NHS staff in England in a consistent way. And the Specialty of doctors. The NHS Occupation code uses three characters to identify different groups to which the employee belongs to.

4. Background
In July 2017, Health Education England (HEE) published “Stepping Forward to 2020/2021: The mental health workforce plan for England” which sets out the approach required to deliver the aims of the Five year forward view.
As part of this, in 2016 HEE estimated the size of the mental health workforce using data drawn from audits, censuses and other workforce collections in 2016/17 as well as mental health trust data from NHS Digital publications and tools.
The size and nature of the mental health workforce became a priority area following the HEE publication and figures using different methodologies were quoted publicly. As a rapid response to this, NHS Digital produced information as part of the January 2018 workforce statistics release which presented three ways to count the mental health workforce as well as a measure which included anyone in any of the three categories, referred to as the widest possible definition.
This NHS Digital report did not present a single preferred definition, but by presenting the different ways the workforce could be counted and prompting user feedback it facilitated the next stage of work to reach one.
In June 2018, the Workforce Information Review Group led a process to develop and agree a single definition for the mental health workforce using the data fields and values that currently exist and are available on ESR. This process included representations from DHSC, NHS England, Health Education England, NHS Improvement, NHS Digital and mental health trusts, and this report will outline the definition that has been agreed that will be used in the future. The data in this report comes from the NHS’s Human Resources and Payroll system, ESR and covers staff employed in NHS Trusts and CCGs in England only.
This report does not cover mental health workforce in the following organisations:
Independent Sector Healthcare Providers (including Social Enterprises, Community Interest Companies and those providing Improving Access to Psychological Therapies). Expanding the data collection from Independent Sector Healthcare Providers is underway, especially focused on mental health provision and including IAPT providers.
Primary Care
Social Care providers
Staff in NHS Central and Support Organisations
Local Authorities

5. Basis of New definition
In December 2018, a new definition was agreed based on the following:
The two fields “Occupation Code” and “Tertiary Area of Work” in ESR are the only elements included in the new definition. Organisation type is not included in the definition, this is covered later in this report.
An individual is included if either of the two fields, or broad groupings derived from them, suggest they are providing or supporting the provision of mental health services.
Occupation codes related to learning disability are included in the definition.
Occupation codes which include staff that deliver some provision of mental health services, but also a significant amount of non-mental health provision, are excluded.
Data as at December 2018 shows that there are 111,513 FTE staff providing or supporting the provision of mental health care that meet the new definition.

6. List of Occupation Codes included in the new mental health workforce definition (For doctors this is called their Specialty Code)
Any person with one of these occupation codes would be in the new definition (* shows that a variety of letters or numbers could be used in the middle but the letters at the beginning and end of the code matter.)
Occupation Code
Corresponding care setting
Medical
051/151
Psychiatry of Learning Disability
052/152
General Psychiatry
053/153
Child and Adolescent Psychiatry
054/154
Forensic Psychiatry
055/155
Psychotherapy
056/156
Old Age Psychiatry
HCA and support
H*D
Other Mental Health
H*E
Other Learning Disabilities
Nursing
N*D
Community Mental Health
N*E
N*F
Community Learning Disabilities
N*G
ST&T
S*L
Applied Psychology
S*M
Psychological Therapy
S*H
Art/Music/Drama Therapy

7. List of Tertiary Areas of Work included in the new mental health workforce definition with their broader classifications. This includes new areas about to be introduced.
Tertiary Area of Work
Secondary Area of Work
Primary Area of Work
Psychotherapy
Psychiatry
Psychiatry of Learning Disability
General Psychiatry
Rehabilitation Psychiatry
Substance Misuse Psychiatry
Forensic Psychiatry
Medical Psychotherapy
Old Age Psychiatry
Child and Adolescent Psychiatry
Child Psychotherapy
Liaison Psychiatry
Clinical Psychology
Clinical Support
Improving Access to Psychological Therapies
Substance Abuse
Counselling
Art Therapy
Art/Music/Drama Therapy
Drama Therapy
Music Therapy
Learning Disabilities
Community Health Services
Primary Care
Community Mental Health
Mental Health
Mental Health Eating Disorders
Mental Health Forensic
Mental Health Promotion or Public Mental Health
Mental Health Substance Misuse
Mental Health Liaison
Mental Health Perinatal Care
Learning Disability Other
Learning Disability Mental Health
Mental Health Adult
Mental Health Older People
Mental Health Primary Care
Mental Health Primary Care – IAPT
Mental and Physical Health Integrated Care
Any person working in these Tertiary Areas of Work would be classed as working in the new definition of the Mental Health Workforce.
Some of these would already be included because of their Occupation Code.

8. National Workforce Data Set updates
Since June 2018 improvements have been made to help capture more data about IAPT staff, Mental Health Nurses, Applied Psychologists and Psychological Therapists. These updates have already begun influencing the content of NHS Digital official statistics. 
From the end of March 2019 it will be possible to collect more detailed data about different specialisms within Applied Psychology, Psychological Therapy, and improved details about the areas and settings in which MH staff are working.
NHSD has been working with the Stepping Forward / New Roles in Mental Health task and finish groups looking at new and expanded roles and advising/gathering requirements for these new roles which once defined can be added into the NWD. 
The next version of the National Workforce Dataset (3.1) will include the first updates related to these new roles such  as Peer Support Workers and will also include updates to the Area of Work values to enable a better fit with the existing Stepping Forward groups.
As we start to receive the more detailed data, we will reach a view on the extent to which this represents new staff or existing staff that we have not been able to identify before.

9. Summary of the ways of defining the Mental Health Workforce discussed in the January 2018 publication
The NHS Digital publication in January outlined 3 ways in which the MHLD workforce can be counted.
There is overlap across these groups as some staff work in more than one group. None of these groups on their own can give a full view of staff working in mental health.
For example looking at:
Organisation cluster would miss some staff working in mental health in an acute trust. Where a Trust specialises in mental health, but also provides non-mental health services, all staff working in the MHLD trust would be included.
Specialty or care setting would miss staff performing important functions to enable mental health care to take place.
Primary area of work would miss staff providing a Mental Health service in a different area such as A&E.
The January 2018 publication looked at ways of defining the Mental Health Workforce using some or all (the widest possible definition) of these classifications.
There are several types of NHS Trusts – Acute, Mental Health, Ambulance etc. In the old definition, all individuals who worked in either MHLD or Care Trusts were included.
Organisation
Cluster
This is the specialty that they have been trained in or the care setting in which they work.
Specialty or care setting
This is a broad idea of the area an individual works in.
Primary area of work
1 Mental Health and Learning Disabilities workforce in the NHS (Jan 2018)

10. Rationale for Change – People not delivering MHLD Services
Since January 2018 analysis has been undertaken on the existing definitions and how good they are at estimating the Mental Health Workforce.
Both Stepping Forward and the widest possible January 2018 definitions include people working for Mental Health Trusts who may not be directly delivering Mental Health services.
Other definitions may exclude people who provide or support the provision of mental health care but in a different care setting or area of work.

11. Rationale for Change – Organisational Change
Another issue was that using the type of trust as a classification method meant that any past changes of classification, perhaps due to the merging or splitting of trusts, would create artificial fluctuations in those included in the mental health workforce.
This issue limited the ability to look back at the historic workforce when type of trust was used, and also causes problems when current trusts change or merge to respond to demand.

12. Differences between definitions
Definition
Details
Stepping Forward
Data drawn from one off bespoke data collections and mental health trust data from NHS Digital
No further data collections have been made, so no time series available
The widest possible definition of the options discussed in the NHS Digital January 2018 publication
Comprises of three groups to outline the mental health workforce:
Staff who work in a mental health organisation
Staff who work in a specialty or care setting related to mental health
Staff with a primary area of work related to psychiatry.
The overall definition looks at all staff who meet any of the 3 definitions.
Based on organisation type so includes staff with no specific link to providing or supporting mental health care
Comparisons back to 2010 cannot be made due to organisation changes
New definition
Includes all staff who meet the specified “Occupation Code” and “Tertiary Area of Work” field in ESR.
Not based on organisation type so no impact of organisational changes that distorts mental health figures
Historic comparisons back to 2010 can be made

13. Comparison of mental health workforce definitions
The new definition will count a mental health workforce that is significantly lower in numbers than that used in the widest possible definition of the options discussed in the NHS Digital January 2018 publication.
However, although it may appear that the mental health workforce is tens of thousands smaller, this way of counting the workforce focuses in on those staff who are specifically providing or supporting the provision of mental health care in a wide variety of ways.
It excludes staff who might work at a mental health trust but not be involved in care.
It also allows the inclusion of staff that might not traditionally be thought of as care providers but who are involved in new, and perhaps unexpected, ways of providing therapy.
It allows very specific areas of care to be looked at in detail by the use of the most detailed classifications of care that are available, and it allows the development of those classifications to keep up with developments in care provision.

14. The number of Mental Health staff, using the new definition, since 2009, full time equivalent
Staff Grouping
Sep-09
Sep-10
Sep-11
Sep-12
Sep-13
Sep-14
Sep-15
Sep-16
Sep-17
Sep-18
Dec-18
Doctors
9,208
8,943
8,844
8,864
8,951
8,923
8,948
8,918
9,017
9,165
9,107
Nurses & Health Visitors & Midwives
47,521
46,702
44,894
43,398
42,258
41,324
40,440
40,219
40,097
40,530
41,085
Scientific, therapeutic & technical staff
12,170
13,093
13,464
14,045
14,774
15,418
15,918
16,664
17,490
18,226
18,762
Support to Clinical Staff
46,270
46,086
43,459
41,814
41,402
41,180
41,066
40,559
39,940
40,560
40,183
Central functions & Hotel, property & estates
2,339
2,298
1,991
1,679
1,519
1,477
1,326
1,232
1,129
1,165
1,186
Managers & Senior managers
1,243
1,161
1,138
1,078
970
994
1,086
956
921
904
889
Ambulance staff & Other staff
351
202
183
149
163
246
244
330
300
All Mental Health Staff
119,103
118,485
113,973
111,027
110,037
109,561
109,028
108,899
108,924
110,902
111,513

15. The Mental Health Workforce in the HCHS workforce in Trusts & CCGs in England under the new definition, FTE, September 2009 to December 2018

16. The Mental Health Workforce in the HCHS workforce in Trusts & CCGs in England under the new definition, FTE, September 2009 to December 2018, by staff groupings