HEE CYP MH Workforce collection NHS Providers …...The NHS CYP MH workforce is reasonably well...

Raising standards through sharing excellence

HEE – CYP MH Workforce collection

NHS Providers

July 2019

Report for: South Yorkshire and Bassetlaw STP

Contents

Executive summary 3

Introduction and background 4

Timescales 5

Engagement 6

Workforce overview 9

Demographic profiling 11

Service provision 24

Community 28

• General community team 28

• Eating disorder community team 40

• Forensic community team 52

Inpatient 61

• General adolescent beds 73

• Eating disorder beds 78

• Forensic beds 81

Conclusion 86

Appendix: Skills and training 87

Executive Summary

This bespoke report outlines the findings from a national stocktake of NHS providers of 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). This project

builds on the previous iteration undertaken by NHSBN 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 inviting all NHS providers 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 headline figures for NHS providers are as follows;

• A total of 13,431 staff are employed in CYP MH services, delivering a total of 11,036 WTE.

• The CYP MH workforce has shown growth in recent years with the workforce increasing by 23% in WTE

since 2016.

• Workforce demographics suggest a largely female (84%) workforce.

• Majority of staff members (77%) in CYP MH have worked in their current post for 5 years or less.

• 1110 WTE of vacancies were reported, of which 41% were designated as nursing vacancies.

Introduction and Background

This report outlines details of the second comprehensive national stocktake of NHS Trust providers of CYP MH

services, which builds on a previous data collection performed by 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

The NHS London Term Plan (2019).

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

• Independent sector providers

• Voluntary sector

• Youth Justice (Youth Offending Teams)

The project aimed to provide a comprehensive profile of the CYP MH workforce across the NHS including:

• Size of workforce (headcount and WTE)

• Demographic profiling

• Discipline mix and skill mix

• Training / competencies

• Service models

• Activity and productivity metrics

Timescales

The project’s data collection period began on 8th February 2019, with an initial submission date of 1st April

2019. This was slightly extended to allow some providers to maximise data collection completeness.

Data supplied by providers was subject to a validation process in April and May to ensure the accuracy of

the project’s findings.

EngagementAn 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 scoping and

design of this report.

• 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.

• 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.

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, 14,065 WTE

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

NHS IndependentSector

LocalAuthorities

VoluntarySector

Total WTE working in CYP MH

Sector 2015

Change

Number of

providers

(2015)

Number of

providers

(2018)

NHS 8,976 11,036 23% 65 63*

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

NHS workforce overview

Workforce

11,036 WTE working

in CYP MH

Disability

7% of staff have a

disability

Ethnicity

82% of staff are White

British

Time in post

77% of staff have

been in post 5 years

or less

Contract type

89% of staff are on

permanent contracts

32% of staff are aged

over 50

Full/part time

60% of staff work 0.8

– 1 WTE

Gender

84% of WTE are female

Vacancies

1110 WTE posts are

vacant

Workforce size by Trust

On average, each Trust has 150

staff members for Children and

Young People’s Mental Health.

The NHS has a wide range in

staffing numbers from 851 to 3

per team.

Some Trusts provided multiple

submissions for each site, which

accounts for the lower number

of staffing for some

submissions.

Total CYP MH staffing - headcount

All Orgs South Yorkshire and Bassetlaw STP Mean = 150 Median = 112

Demographic Profiling

Demographic - Age

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

Almost a third of staff (32%) are aged 50 or older. This is slightly below the figure reported in the 2016

stocktake (36%) and may reflect a range of new roles which have developed and been filled by more junior

staff.

Age of staff in postUnder 20

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

Age of staff in postNational average STP

Under 20 0.0% 0.0%

20 - 24 3.1% 5.2%

25 - 29 10.5% 14.3%

30 - 34 14.3% 16.8%

35 - 39 14.0% 12.2%

40 - 44 12.9% 11.0%

45 - 49 13.6% 12.4%

50 - 54 13.0% 11.8%

55 - 59 11.0% 10.4%

60 - 64 5.6% 4.1%

65 + 2.0% 1.7%

Demographic - Ethnicity

Trusts reported that 82% of staff in CYP mental health services were White and 5% of the workforce was

reported as Asian British. When compared to the general population of England, this represents an under-

representation in Asian/Asian British people who account for 7.5% of the resident population.

Ethnicity

National

averageSTP

White / White British /

White Other82.1% 82.2%

Asian / Asian British 5.6% 3.1%

Black / Black British 5.2% 1.5%

Mixed race 2.3% 2.1%

Other ethnicity 1.4% 2.3%

Unknown / not stated 3.4% 8.8%

Demographic - Gender

The workforce data continues to show a largely female workforce, at 84% nationally in the NHS. The

proportion of female to male has increased even further from the 2016 collection, where 82% of the workforce

were female.

Gender of staff in post

Male Female Gender of staff

in post

National

averageSTP

Male 16% 14%

Female 84% 86%

There are differences in the

hours worked by male and

female staff, with female staff

more likely to work part time

hours.

57% of female staff work full

time (0.8 WTE or more)

compared to 71% of male

staff.

Additional Gender Profiling

Contracted hours per week

Analysis of staffing by WTE shows that just under two thirds (60%) of staff work full time or nearly full

time hours (0.8 – 1 WTE).

14%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

National

averageSTP

0 - 0.2 WTE 4.3% 3.1%

0.2 - 0.4 WTE 7.4% 6.2%

0.4 - 0.6 WTE 15.3% 13.5%

0.6 - 0.8 WTE 13.5% 13.9%

0.8 - 1 WTE 59.5% 63.3%

Contract type

The majority of the workforce are on permanent contracts (89%), with a tenth (10%) on fixed term/

temporary contracts. This is very similar to 2016 where 87% of staff were on permanent contracts, and is a

reassuring finding, indicating stability of employment for the majority of the workforce.

Type of contractPermanent

Fixed Term /

Temporary

(including

training posts)

Agency

Honorary

Type of Contract

National

averageSTP

Permanent 89.0% 92.9%

Fixed Term / Temporary

(including training

posts)

9.8% 6.2%

Agency 0.7% 0.8%

Honorary 0.5% 0.0%

Job roles

The most common job role reported in CYP MH services is registered nursing (29% of the workforce). 26% of

these registered nurses work in the inpatient setting and 74% in community. There is also a strong psychology

offer, at 15% of the workforce.

The newer role of CYP Psychological Wellbeing Practitioner was not widely reported, with just 1.1% of the

workforce (118 WTE) categorised in this way. This is expected to rise in coming years.

Job Roles

National

averageSTP

Admin/ Management 15.4% 14.4%

CYP Education MH practitioner 0.1% 0.0%

CYP Psychological wellbeing practitioner 1.1% 0.5%

Nursing 28.9% 48.1%

Support worker 10.4% 1.9%

Medical 2.8% 2.5%

OT 2.2% 1.4%

Psychology 14.5% 12.0%

Psychotherapy 4.8% 2.1%

Family Therapist 0.4% 1.0%

Therapist/AHP 6.6% 3.3%

Counsellor 0.5% 0.2%

Social worker 3.3% 5.3%

Student 0.3% 0.2%

Other 8.6% 7.1%

Time in post

The time in post data shows that over three quarters of staff members (77%) have been in their current

post for 5 years or less. This may be due to staff being promoted to new roles, turnover of staff or

expansion of the workforce.

Time in post (years)

Under 1

Over 11

Time in post

(years)

National

averageSTP

Under 1 year 30.9% 60.6%

1 -5 years 46.4% 35.9%

6- 10 years 12.5% 3.2%

Over 11 years 10.1% 0.3%

Staff retention

Staff retention measures the

number of staff members still

in post on 31st December

2018 that were working in the

same post on 1st January

The data shows that 82% of

staff members were still in

post at the end of the

calendar year.

The range varies across the

NHS with some Trusts

retaining all 100% of staff

members, to other Trusts

which retained less than 30%.%

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

All Orgs South Yorkshire and Bassetlaw STP Mean = 82% Median = 83%

Time allocation

Where available, organisations reported

the time allocation of their staff 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 that on

average 43% of available staff time is

allocated to patient facing time.

A further 18% of time is spent on non-

face to face patient time.

Disability

Where disability status was recorded by participants, the average rate of staff reporting a disability was 7%, with

93% reporting no disability.

This figure is similar to the 2016 figure of 5% of staff reporting a disability and 95% reporting no disability.

Vacancies

• 1110 WTE of

vacancies were

reported. These

included:

• Nursing = 450 WTE

• Psychologists = 116

• Administration and

management = 97

• Support workers = 111

Service Provision

NHS Service Summary

NHS providers reported the types

of services they provided from

the broad categories of

community teams, inpatient beds

and day units, which were then

subcategorised by general,

eating disorder specific, and

forensic specific.

The most commonly provided

service was a general community

team for CYP MH, followed by an

eating disorder specific

community team.

The following page shows how

the workforce is distributed

between these service types.

NHS Workforce Distribution

Just over three quarters (79%) of the NHS workforce in CYP MH is employed in community teams, with general

community teams employing most of these staff (74%).

Although inpatient unit numbers are relatively small, the 24/7 nature of these services means higher staffing levels

are required. 21% of NHS staff in CYP MH work in an inpatient setting.

Workforce distribution by WTE

General community

CYP mental health

Eating disorder

community CYP

mental health team

Forensic CYP mental

health community

Inpatient unit without

day service attached

Inpatient unit with

attached day service

Workforce distribution by WTE

National

averageSTP

General community CYP mental health team 73.7% 68.5%Eating disorder community CYP mental

health team 4.2% 4.9%

Forensic CYP mental health community team 1.0% 0.6%

Inpatient unit without day service attached 17.7% 26.0%

Inpatient unit with attached day service 3.4% 0.0%

Age range of community CYP MH

servicesIn all three services, General, Eating disorder and Forensics, the most frequently used age range is 0-17, with 45%, 45%

and 85% of organisations using this age range respectively.

In General and Eating disorder services, there are a wide variety of different age ranges across the NHS including services

which stop at age 16, 17, 18, 19, 24 or 25, and which are from birth from age 5 or from age 8. However, for Forensic

services, the age range for services is either 0-17 or 0-18 year olds.

The percentage of services that offer the age range of 0-25 is expected to rise with the implementation of the Long Term

Plan which aims to support the transition of patients into adult mental health services.

Community

1. General community teams

Service Model (1)General community team

Organisations were asked to identify the type of functions provided by their general CYP MH community teams.

74 organisations provided answers for this question, with the following two tables showing the percentage of

organisations that answered yes for each element.

Service model Percentage responding YesNational

averageMental Health Promotion in the community, schools, within primary

care 89%

Evidence based parenting programmes 67%

Early Intervention Psychosis Teams 44%

CYP MH Primary Care Mental Health Team (Dedicated CYP MH

delivery) 64%

Ante- & post-natal specific support 29%

Early years support for infants / toddlers 39%

Training & Education to staff working in primary care/universal

services (schools, GPs) 90%

Paediatric Liaison Service 56%

100%0%

Service Model (2)General community team

average

Outreach work 68%

Specific support to BME groups within the community 15%

Joint working/family therapy/group work 97%

24/7 crisis response 47%

Provision of services to Schools or Colleges 79%

Assertive Outreach Teams 32%

Support to Youth Offending Teams 86%

Liaison and diversion for Police custody 31%

Support to Drug & Alcohol Services 35%Specific services for children in and leaving care, adopted children

and foster carers 78%

Support to LA behaviour support & inclusion services 40%Treatment and support for CYP with a Learning Disability and a mental

health need 93%

Treatment and support for CYP with ASD 68%

Treatment and support for CYP with ADHD 92%

Sensory Impairment Services 14%

100%0%

Job rolesGeneral community team

The largest single staff category in general

community teams for CYP MH is registered

nursing (23% of the workforce).

3% of the workforce is comprised of support

workers, giving a ratio of 8:1 qualified to

unqualified nurses.

There is typically a strong specialist therapy

presence in these teams, with psychologists

representing 18% of the workforce.

Admin/ Management

CYP Education MH practitioner

CYP Psychological wellbeingpractitioner

Nursing

Support worker

Medical

PsychologyPsychotherapy

Family Therapist

Therapist/AHP

Counsellor

Social worker

Student

General Community Job roles

Average South Yorkshire and Bassetlaw STP

Job Roles

National

averageSTP

Nursing 23.3% 32.0%

Medical 5.1% 3.9%

OT 2.2% 1.2%

Student 0.4% 0.3%

Other 10.1% 9.0%

Registered nurses

Newly qualified band 5 nurses are rarely

seen in general community teams. Half of

the nurses employed are band 6, with a

further 34% at band 7.

General community team

Band 5

Band 6

Band 7

Band 8a

Band 8b

Band 8c

Band 8d

Band 9

General Community Registered nurses (Band 5-9)

Nursing bands

National

averageSTP

Band 5 8.8% 5.1%

Band 6 50.7% 63.3%

Band 7 33.5% 28.6%

Band 8a 6.4% 2.0%

Band 8b 0.5% 1.0%

Band 8c 0.2% 0.0%

Band 8d 0.1% 0.0%

Band 9 0.0% 0.0%

Skills and trainingGeneral community team

Organisations were asked what interventions and competencies they had staff members trained to deliver in the

general community team. Organisations could choose from a prepopulated list of 37 different interventions and had

the option to submit other interventions not listed, which have been collated in the Skills and Training Appendix.

Overall, 53 organisations answered this question and the following two pages show the percentage of those

organisations that provided the interventions and competency training to their staff.

Skills and training Percentage responding YesNational

averageAttachment informed interventions e.g. Dyadic Developmental

Psychotherapy or Video Feedback to Promote Positive Parenting 85%

ASD assessment approaches (e.g. ADOS/ADI or DISCO) 92%

Cognitive Behavioural Therapy (CBT) for young people with

depression and anxiety 96%

CBT for Eating Disorders 40%

CBT for Psychosis 47%

Cognitive Analytic Therapy (CAT) 43%

Counselling children and young people with mild anxiety and

depression 75%

Combination - prescribing and psychological therapy 70%

Dialectical Behaviour Therapy (DBT) 91%

Dietary counselling for eating disorders 25%

Enhanced Evidence Based Practitioners (EEBP) 32%

Eye Movement Desensitisation Reprogramming (EMDR) 87%

Family Therapy (FT) 91%

Family Focused Therapy 57%

Anorexia-nervosa-focused family therapy for children and young

people (FT-AN) (single or multiple-family) 40%

Bulimia-nervosa-focused family therapy (FT-BN) 23%

Systemic Family Practice (SFP) for eating disorders 40%

SFP for over 10s with conduct problems, or depression and self-

harm 51%

100%0%

averageFormal instruction in bio-psycho-social mental health

assessment including risk assessment 74%

Formal instruction (including CYP-IAPT) in ‘developing a

formulation 72%

Inpatient CAMHS whole team training 21%

Mentalisation Approaches (e.g. AMBIT) 42%

Interpersonal Psychotherapy for adolescents (IPT-A) with

moderate to severe depression 70%

Adolescent-focused psychotherapy for anorexia nervosa (AFP-

AN). 11%

Focal psychodynamic therapy (FPT) 8%

Psychodynamic psychotherapy 72%

Psycho-education / guided self-help 74%

Parenting for children (under 10 years) with conduct and

behavioural problems (e.g. The Incredible Years, Positive 77%

Children and young people with learning disabilities or autistic

spectrum disorder training (via CYP IAPT) 45%

Supervision (diploma level) 72%

Outreach enhanced supervision (for supervisors not attending

full diploma course) 40%

Service Transformational Leadership 49%

Non-medical prescribing 62%

Approved clinician (non-medical) 19%

Social prescribing 26%

Systems training for emotional predictability and problem

solving (STEPPS) 11%

Working with 0-5s training via CYP IAPT 23%

100%0%

Contacts per clinical WTE

On average, 404 contacts are

delivered per clinical WTE per

This equates to approximately

1.8 contacts per WTE per day,

assuming a 44 week year

(allowing for annual leave,

training days and sickness

absence).

There is quite a noticeable

range which spans from over

900 to fewer than 150.

This figure does not reflect the

content and duration of

contacts which may differ

between organisations.

Total contacts per clinical WTE (General)

Patients on caseload per clinical WTE

Caseloads are a snapshot of

open cases i.e. CYP receiving

treatment at a point in time.

On 31st December 2018, there

was on average 39 patients on

a caseload per clinical WTE.

The data shows notable

variation on this metric, with the

top two providers supporting

over 100 patients and the

bottom two providers supporting

fewer than 10 patients per

clinical WTE.

Patients on caseload per clinical WTE (General)

Sickness absence

The average sickness

absence rate in general

community teams for

CYP MH services is

4%, which is the same

as the national NHS

average.

Sickness absence (%) (General)

Staff turnover

The average staff

turnover in general

community teams is 17%.

This is quite high and

could explain the reason

why most staff members

have been in their post for

less than 5 years (page

The range in staff

turnover is high, with two

organisations reporting a

staff turnover of 50% or

above.

Staff turnover (%) (General)

Community

2. Eating disorder community teams

Service Model (1)Eating disorder

48 organisations provided answers for which service functions their eating disorder community teams provided.

The following two charts show the breakdown of the percentage of organisations that said they had these service

models.

care 77%

delivery) 42%

100%0% 100%0%

Service Model (2)Eating disorder

average

Outreach work 54%

health need 66%

100%0% 100%

100%0%

Job roles

There is a higher percentage of nursing

staff in eating disorders than general

community teams, with 33% of the ED

workforce nurses, compared to 23% of

the general workforce.

17% of staff are psychologists and 14%

are Therapists/ AHPs.

Eating disorder

Admin/ Management

Nursing

Support worker

Medical

Family Therapist

Therapist/AHP

Counsellor

Social worker

Student

Eating Disorders Community Job roles

Job Roles

National

averageSTP

Nursing 33.1% 47.6%

Medical 3.4% 4.8%

OT 1.2% 0.0%

Student 0.0% 0.0%

Other 8.1% 0.0%

Registered nurses

The skill mix of registered nurses in

eating disorder community teams is

similar to general community teams,

with 58% at band 6 and 34% working

at band 7.

Eating disorder

Band 5

Band 6

Band 7

Band 8a

Band 8b

Band 8c

Band 8d

Band 9

Eating Disorders Community Registered nurses (Band 5-9)

Nursing bands

National

averageSTP

Band 5 3.0% 0.0%

Band 6 57.8% 70.0%

Band 7 34.1% 20.0%

Band 8a 5.2% 10.0%

Band 8b 0.0% 0.0%

Band 8c 0.0% 0.0%

Band 8d 0.0% 0.0%

Band 9 0.0% 0.0%

Skills and trainingEating disorder

27 organisations answered what interventions and competencies their eating disorder community teams had

undertaken.

The following two pages detail the percentage of organisations that responded yes to having staff members

trained in the relevant skills.

depression 43%

harm 21%

100%0%

formulation 54%

AN). 21%

solving (STEPPS) 4%

100%0%

Contacts per clinical WTE

On average, 392 contacts

are delivered per clinical

WTE in eating disorder

teams.

This is similar to the

number of contacts

delivered by general

community teams, 404

(page 36).

Eating disorder

Total contacts per clinical WTE (Eating disorder)

Patients on caseload per clinical

Clinical staff in eating

disorder teams have an

average of 13 patients

on caseload per clinical

The number of patients

on caseload per clinical

WTE across eating

disorder services ranges

from 4 to 34.

Eating disorder

Patients on caseload per clinical WTE (Eating disorder)

Sickness absence

The average sickness

absence for eating

disorder community

teams is 4%. This is the

same percentage of

sickness absence shown

in general community

teams.

Eating disorder

Sickness absence (%) (Eating disorder)

Staff turnover

The staff turnover

for ED community

teams shows that

just under 1 in 5

staff members

leave per year

(19%).

Eating disorder

Staff turnover (%) (Eating disorder)

Community

3. Forensic community teams

Service Model (1)Forensic

Organisations were asked about their forensic community teams service models. This question received responses

from 21 organisations. The next two tables show the percentage of these 21 organisations that responded yes to

providing certain service models.

care 10%

delivery) 10%

100%0% 100%0%

Service Model (2)Forensic

average

Outreach work 81%

health need 80%

100%0% 100%

100%0%

Job roles

Forensic community teams are mainly

staffed with registered nurses (35% of

the workforce) and support workers,

8%. This gives a ratio of 4:1 qualified to

unqualified nurses.

Other notable job roles are

psychologists who make up 13% of the

workforce.

Forensic

Admin/ Management

Nursing

Support worker

Medical

Family Therapist

Therapist/AHP

Counsellor

Social worker

Student

Forensic Community Job roles

Job Roles

National

averageSTP

Nursing 35.4% 60.0%

Medical 3.5% 20.0%

OT 4.4% 0.0%

Student 0.0% 0.0%

Other 25.7% 0.0%

Registered nurses

Most registered nurses are band 7 in

forensic community teams (47%)

unlike in general and eating disorder

community teams where band 6

nurses are most prevalent.

Forensic

Band 5

Band 6

Band 7

Band 8a

Band 8b

Band 8c

Band 8d

Band 9

Forensic Community Registered nurses (Band 5-9)

Nursing bands

National

averageSTP

Band 5 25.0% 0.0%

Band 6 15.6% 0.0%

Band 7 46.9% 0.0%

Band 8a 9.4% 66.7%

Band 8b 3.1% 33.3%

Band 8c 0.0% 0.0%

Band 8d 0.0% 0.0%

Band 9 0.0% 0.0%

Contacts per clinical WTEForensic

The average number of

contacts per clinical WTE in

forensic community teams is

106. This is much lower than

general and eating disorder

which are around 400 contacts

per clinical WTE.

HEE_017 HEE_015 HEE_067 HEE_036 HEE_021 HEE_078 HEE_047 HEE_027

Total contacts per clinical WTE (Forensic)

Patients on caseload per clinical

WTEForensic

There is an average of 12

patients on caseload per

clinical WTE in forensic

community teams.

This has some wide variation

with the data ranging from 25

patients on caseloads per

clinical WTE to 1.

HEE_036 HEE_017 HEE_078 HEE_027 HEE_047 HEE_015 HEE_067

Patients on caseload per clinical WTE (Forensic)

Sickness absenceForensic

The sickness absence

in forensic community

teams is consistent

with the general and

eating disorder

community teams,

with an average of 4%

of staff members with

a sickness absence.

HEE_015 HEE_078 HEE_021 HEE_036 HEE_067 HEE_001

Sickness absence (%) (Forensic)

Staff turnoverForensic

The data shows

that staff turnover

in forensic

community teams

is just over a fifth

(21%).

HEE_027 HEE_036 HEE_021 HEE_078 HEE_001

Staff turnover (%) (Forensic)

Inpatient

Services ProvidedGeneral CYP

Most general CYP MH services do not provide inpatient beds (54%), and only a sixth (15%) provide day units.

Over a quarter (29%) of general CYP MH services provide intensive home treatment as an alternative to inpatient care.

Do you provide general CYP inpatient beds?

Yes No

Do you provide a general CYP day unit?

Yes No

Do you provide general CYP intensive home treatment (as an alternative to

inpatient care)?

Yes No

Services ProvidedEating disorder

In eating disorder CYP MH services, less than a fifth (19%) provide inpatient beds and only 6% provide a day unit.

16% of services said they provided eating disorder intensive home treatment.

Do you provide eating disorder inpatient beds?

Yes No

Do you provide an eating disorder day unit?

Yes No

Do you provide eating disorder intensive home treatment (as an

alternative to inpatient care)?

Yes No

Services ProvidedForensic

A tenth of forensic services provide inpatient beds (10%). Day units and intensive home treatment models

are not seen within forensic services for young people.

Do you provide forensic inpatient beds?

Yes No

Job roles

Over a third of staff (37%) in inpatient units

with attached day services are registered

nurses, and 33% are support workers. This

gives a near 1:1 ratio of qualified to

unqualified nurses.

Inpatient unit with attached day services

Admin/ Management

Nursing

Support worker

Medical

Family Therapist

Therapist/AHP

Counsellor

Social worker

Student

Inpatient with day unit Job roles

Job Roles

National

averageSTP

Admin/ Management 5.3% -

CYP Education MH practitioner 0.0% -

CYP Psychological wellbeing practitioner 0.0% -

Nursing 36.9% -

Support worker 32.7% -

Medical 2.3% -

OT 3.3% -

Psychology 5.5% -

Psychotherapy 2.3% -

Family Therapist 0.0% -

Therapist/AHP 3.5% -

Counsellor 0.0% -

Social worker 1.0% -

Student 1.0% -

Other 6.3% -

Registered nurses

The majority of registered nurses in inpatient

units with attached day services are band 5

(60%). 27% are band 6 and just over 8% are

band 7. This confirms a more junior nursing

profile than is seen in CYP MH community

services.

Inpatient unit with attached day services

Band 5

Band 6

Band 7

Band 8a

Band 8b

Band 8c

Band 8d

Band 9

Inpatient with day unit Registered nurses (Band 5-9)

Nursing bands

National

averageSTP

Band 5 59.7% -

Band 6 27.1% -

Band 7 8.3% -

Band 8a 3.5% -

Band 8b 0.7% -

Band 8c 0.7% -

Band 8d 0.0% -

Band 9 0.0% -

Job roles

The majority of staff in inpatient units

without day services attached are either

qualified nurses (33%) or support

workers (35%).

The proportion of qualified to unqualified

nurses shows slightly more unqualified

nurses.

Inpatient unit without attached day services

Admin/ Management

Nursing

Support worker

Medical

Family Therapist

Therapist/AHP

Counsellor

Social worker

Student

Inpatient without day unit Job roles

Job Roles

National

averageSTP

Nursing 32.7% 78.7%

Medical 3.6% 6.6%

OT 2.9% 2.5%

Student 0.3% 0.0%

Other 8.3% 2.5%

Registered nurses

Most registered nurses are band 5 (60%)

while 29% are band 6.

Inpatient unit without attached day services

Band 5

Band 6

Band 7

Band 8a

Band 8b

Band 8c

Band 8d

Band 9

Inpatient without day unit Registered nurses (Band 5-9)

Nursing bands

National

averageSTP

Band 5 59.1% 67.3%

Band 6 28.3% 24.5%

Band 7 8.7% 6.1%

Band 8a 3.1% 2.0%

Band 8b 0.7% 0.0%

Band 8c 0.0% 0.0%

Band 8d 0.0% 0.0%

Band 9 0.0% 0.0%

Skills and trainingInpatient

22 organisations detailed the skills and training accessed by staff members in their inpatient units.

The following two pages give a national breakdown of the percentage of organisations that reported the

relevant skills and training.

depression 68%

harm 41%

100%0%

formulation 77%

AN). 23%

solving (STEPPS) 9%

100%0%

Clinical WTE per 10 bedsInpatient

On average, there are

29 clinical WTEs per

10 beds.

The data shows a

range spanning from

55 to 5 clinical WTE

per 10 beds.

Clinical WTE per 10 beds - Total

Inpatient

1.General adolescent beds

Bed occupancy (excluding leave)General adolescent

The average bed

occupancy in general

adolescent inpatient

beds, excluding leave, is

Bed occupancy (excluding leave) General

Admissions per bedGeneral adolescent

On average, there are 5

admissions per bed per

year in general inpatient

services.

Admissions per bed (General)

Sickness absenceGeneral adolescent

The workforce sickness

absence in general

inpatient services is 5%.

This is slightly higher than

general community

services (4%).

The range in inpatient

services is also higher,

with Trusts reporting from

as high as 15% sickness

absence to below 1%.

Sickness absence (%) (General)

Staff turnoverGeneral adolescent

The staff turnover in general

inpatient services averages

17%, with some Trusts

reporting as high as 43%

staff turnover.

Staff turnover (%) (General)

Inpatient

2. Eating disorders beds

Bed occupancy (excluding leave)Eating disorder

The data shows that

bed occupancy in

eating disorder services

is three quarters

occupied (75%), and

consistent across all

NHS Trusts.

HEE_065 HEE_067 HEE_036 HEE_027

Bed occupancy (excluding leave) Eating disorder

Admissions per bedEating disorder

In eating disorder

services, there is an

average of just over 1

admission per bed per

HEE_036 HEE_065 HEE_067 HEE_027

Admissions per bed (Eating disorder)

All Orgs South Yorkshire and Bassetlaw STP Mean = 1.27 Median = 1.32

Inpatient

3. Forensic beds

Bed occupancy (excluding leave)Forensic

Bed occupancy in

forensic services

(excluding leave) is 65%.

Bed occupancy (excluding leave) Forensic

Admissions per bedForensic

Forensic inpatient

services have on

average just over 1

admission per bed per

Admissions per bed (Forensic)

All Orgs South Yorkshire and Bassetlaw STP Mean = 1.09 Median = .8

Sickness absenceForensic

Workforce sickness

absence in forensic

inpatient services is

5%. This is consistent

across all three

inpatient bed types.

Sickness absence (%) (Forensic)

Staff turnoverForensic

The staff turnover in

forensic inpatient

services shows under 1

in 10 staff members left

(8%) during the year.

This is much lower than

general and eating

disorder services,

which are 17% and

16% respectively.

HEE_051 HEE_078 HEE_036 HEE_001 HEE_067 HEE_015

Staff turnover (%) (Forensic)

▪ We would like to thank all NHS organisations 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 the national average. In addition to the NHS data returns, data has been submitted by

independent organisations, local authorities, youth offending teams and voluntary 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 independent sector, local authorities, voluntary

sector and youth justice services, although this report focuses on NHS organisations.

▪ 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 independent

sector, local authorities 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 si 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 Alexander Ng (a.ng1@nhs.net) or Zoë Morris

(zoe.morris@nhs.net)

Conclusion

Appendix: Skills and training

The following qualifications / training courses were reported by services, in addition to the list provided.

Additional skills and training

• ACT (Acceptance and Commitment Therapy)

• ADOS-2 Training (Positive about autism)

• AMHP training

• Approved Clinician for MHA (Medical)

• Art Psychotherapy

• Art Therapy

• Attachment and psychotherapy - Dynamic

• Behavioural Family Therapy BFT

• Behaviour activation graded exposure

• Behaviour Management /PBS

• BTEC plus advanced certificate in health management

• CBT informed intervention - Group & Individual (Parent

only, Parent and young person & Young person only)

• Certificate in Education (Further education) post 16

• Child and Family Development

• Cognitive Assessments (WISC.WASI,WAIS)

• Compassion - focused therapy

• CYP IAPT for Learning Disabilities and working with 0-5s

- courses not attended, but skills in the workforce.

• DBT skills training

• DDP

• DNA-V

• Drama therapy

• Edward Jenner Programme

• EMDR practitioner partially trained

• ENB 603 - Child and Adolescent Psychiatric Nursing plus

certificate in the understanding and treatment of

disturbed behaviour in childhood and adolescence.

• Evidence-based Diploma in Parenting Interventions for

Children and Young People

• Family Based Treatment-

• Family Intervention for Psychosis

• Family therapy & Systemic Practice

• Filial Therapy

• FRIENDS

• Functional analysis of children with learning disabilities

• Guided Self Help

• Hearing Voices Work

Additional skills and training• IAPT 6 day supervision training

• Imaginal Exposure Therapy

• Incredible Years Peer Coaching/Video Interaction

Guidance Supervision

• International School for Infancy and Early Years

• Master of science in applied social learning theory and

counselling - provided CBT qualification

• Maudsley model • Mental Health and intellectual disability - assessment

liaison and care coordination. Psychotropic

management

• Mentalization and CBT

• MET

• Mindfulness

• Motivational Interviewing

• Music therapy (group)

• Music therapy (individual)

• Narrative Therapy

• National CAMHS eating Disorders training programme• National community Children’s Eating Disorders

training• Neuropsychological assessment, formulation &

treatment

• NG Insertion / Feeding

• Non violence resistance training

• Occupational Therapy

• Parent Child Game• Person Centred Expressive Therapy• Play Therapy• Positive Behaviour Support• Psychodrama• Psychology trainees on a rotating basis• Psychosocial Interventions for Psychosis.• QB training• Radically Open Dialectical Behaviour Therapy

(RO-DBT)• Rewind treatment for PTSD and Phobias• Risk Assessment Training• Risk management and care planning • RNLD• SFBT• Short term Psychoanalytical Psychotherapy • Solution Focused • Specialist group work • Specialist sensory assessments • System practice IAPT• Systemic Practitioner• Theraplay• Therapuetic Assessment and Intervention for

Sexually Harmful Behaviour• Trauma

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