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If he’d stop doing it, I’d stop writing about it, but…
... he’s done it again.
Streeting's a helicopter politician. He hovers above the reality and doesn't see the full picture.
His latest; ‘… another 8,500 mental health staff recruited’ Hurrah!
Err… yes and no…
These are not 8,500 newly minted specialists emerging fully formed into clinics and wards. Rapid expansion (ahead of target) of staff numbers can only mean one thing… role substitution and skill-mix change.
In the numbers there will be;
- staff already in the NHS, moving roles.
- newly qualified professionals already in the training pipeline.
- international recruits or more likely,
- people in support roles that require shorter preparation, and…
… that matters...
... because mental health care is not an entry-level business. An influx of complimentary skilled people could be taking MH services in a direction none of us know about, or agree with.
It's a fact; 4% of consultant psychiatrist posts are vacant, that’s up from, 10% in 2021 and 6% in 2015.
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Eating disorders, ~20% vacant
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General adult psychiatry, ~17%
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Child & adolescent psychiatry, ~16–20%
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Children’s services, 1 in 3 posts not properly filled when locums included
MH services run on expertise that takes years to develop. A consultant psychiatrist is the product of a long, complex training-journey...
... you cannot accelerate that with a policy announcement or a funding round. You cannot compress experience into a two-year recruitment drive.
There’s an uncomfortable truth behind the numbers.
It is easier to expand roles that can be trained quickly than it is to grow the number of senior clinicians.
This has more than a hint of the McNamara fallacy;
'...valuing what can be counted over what actually counts.'
The workforce expands, but not in the places where the system is most constrained.
Work and how it's done, shapes the outcome of the work and is defined by the skills and experience of the people doing the work.
If it takes three years to train a plumber. Under two for a mental health worker? The arithmetic deserves a second look.
Meanwhile...
... vacancy rates for consultant psychiatrists are still high. Services rely heavily on locum. Clinical leadership remains thinly-spread…
… against a backdrop of rising demand.
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More people knocking on the door.
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More people with complexity.
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More people on waiting lists …
… growing in parts of the system that matter most; diagnosis, medication-management, crisis care.
Support roles can extend care, but they cannot replicate the clinical judgement that comes with years of specialist training, and...
... people are leaving.
MH services lose around one in eight staff every year. In some community and social care settings, it is closer to one in five.
In real numbers the scale becomes clear: tens of thousands walking out of the system annually, taking experience, continuity and stability with them.
Set that against the headline figure of 8,500 ‘extra’ staff and the arithmetic hurts
You can recruit thousands… and still, stand still.
Which brings me to candour.
Not dishonesty in the crude sense. The numbers are, in isolation, correct, but…
… it’s a selective truth.
With a calculator and a few basic questions, the picture looks very different. How many have been recruited? What can they do? How many have left? Where are the real constraints?
This is not difficult; it’s simple arithmetic, and…
A technically accurate headline that invites a misleading conclusion, is...
...political theatre...
... the audience given a number; the workings-out, kept out of the spotlight.
This is not a criticism of the people being recruited. They are needed, valuable, and they are doing difficult work in a system under strain.
The issue is, counting staff is easy. Measuring capability, much harder.
Skill-mix expansion does not equate to capability replacement. Support roles can extend care, but they cannot replicate the clinical judgement that comes with years of specialist training.
A workforce isn’t just headcount; it is a mix of skills, experience and judgement. It is that mix… not the total number, that determines whether a service works.
At the moment, we’re adding volume without fully addressing capability or the future of workplace design.
Access may improve at the margins. More people may be seen, assessed, signposted, but…
… the harder parts of care; decisions, diagnoses, ongoing management…
… remain bottlenecked.
Which leaves us with the real question…
… are we building a workforce that can meet demand, or are we assembling one that looks good in a press release?
If the constraint is senior clinical capacity and all the evidence suggests it is, then this approach will only take us so far.
You simply create a bigger queue, managed by;
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More people.
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More staff.
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More effort.
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More cost.
But…
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no more grip on the problem and
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no more productivity.
Political theatre…
…applause for the announcement…
… deafening silence for the outcome.
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