Ewan Hilton, Executive Director
Gofal Cymru
26 Dunraven Place, Bridgend
CF31 1JD

29th October 2007

Steve George, Clerk to the Committee
Assembly Parliamentary Service, Cardiff Bay
Cardiff
CF99 1NA

Re: Committee Inquiry: Health and Social Care Workforce Planning

Dear Sir,

Gofal Cymru is a leading mental health charity that has been working for over 16 years in Wales to provide support and assistance for people experiencing mental ill health, to enable them to manage their mental health, overcome stigma and live independent and fulfilling lives. We offer a wide range of services, delivered and developed in partnership with local authorities, local health boards and statutory bodies, including: support to people in their own homes in order maintain independence and quality of life; supported housing and rehab services; employment support and work preparation; out of hours and crisis service; carers services; and unique specialist mental health link services, bridging the gap between hospitals and homelessness departments, thus reducing the risk of homelessness amongst mental health service  users.

We welcome the opportunity to respond to this inquiry. Mental health services are often described as the 'Cinderella’ of the Health and Social Care portfolio, and we would urge this Committee to give them due attention as they undertake this inquiry.

The Committee has already seen, in the submission from the Care Council for Wales (HWLG(3)-05-07 - Paper 2: Appendix 1, figure 22), some of the recruitment difficulties experienced in mental health. We would also draw the Committee’s attention to the Wales Audit Office’s 2005 report, Adult mental health services in Wales: A baseline review of service provision, which details problems in recruiting many different mental health professionals. For example, they found a 29% vacancy rate for consultants in general adult psychiatry across Wales, with some Trusts having over 50% of posts vacant. They also found vacancies were taking up to 60 months to fill. This has a clear implication on service delivery.

We note that when the National Leadership and Innovations Agency for Healthcare came to give evidence there was some discussion about the distinction between having a shortage of trained personnel to fill posts, and a shortage of posts available. Since 2001, workforce planning is supposed to have been based on need, rather than affordability, but we have severe doubts as to whether this has been the case. We are confident that all Assembly Members will be aware from cases within their own constituencies of the long waiting times to access a variety of mental health services and, as an illustration, we have discovered that in some parts of Wales adults are waiting 9-12 months to see a psychologist. These long waiting times are a clear indication that more staff are needed, and we would concur entirely with the statements made by Dai Lloyd AM during the debate on Jonathan Morgan’s Proposed Legislative Competence Order on the 17^th October ("We do not have enough counsellors, consultant psychiatrists or mental health workers on the ground. As a result, the services that they would populate are either deficient or nonexistent. Nowadays, there are vacancies for consultant psychiatrists, psychologists and community psychiatric nurses, and community and mental health teams are stretched, under severe strain, in delivering services on the ground.”). We are concerned that the Mental Health Act 2007 will stretch resources still further, with the result that only those whose mental health has reached crisis point will be able to access services.

Another key finding of the Wales Audit Office report was that not all Trusts and Social Services departments had annual workforce plans for mental health staff and that even among those that had, joint workforce planning was poor. We have long been concerned about the difficulties of effective mental health service planning and commissioning when there are so many different bodies involved, and we hope that the on-going Burrows-Greenwell review, and the recent indications given by the Health Minister, may pave the way for a more streamlined and efficient approach.

One fundamental necessary to effective workforce planning and commissioning is detailed knowledge of need for a service. The Wales Audit Office identified a real lack of any comprehensive needs assessment data for mental health services. We would urge the committee to investigate what information is currently available to facilitate workforce planning for mental health; our experience is that obtaining any sort of statistics on mental health is very difficult, because so little is collated centrally.   

We welcome the committee’s interest in developing a diverse workforce. At Gofal Cymru, we have been calling for more support and encouragement for individuals from different communities to train as mental health professionals, because we are concerned that there is currently a lack of understanding of how different cultural and ethnic groups perceive and respond to mental health, and whether services are currently being delivered in a way that best meets their needs.

Finally, we would like to turn to the training needs of the workforce. We believe that there are a number of training gaps at present, with health and social care professionals not always having the awareness and knowledge of mental health issues to best respond to the needs of those experiencing mental ill-health. To give one example, we believe all care home staff, and those working with older people in their own homes, should be trained to recognise, monitor and respond to depression and other forms of mental ill-health that their elderly service users may be experiencing.  

In conclusion, we believe there are a number of serious issues concerning the mental health workforce. There are severe problems with filling vacancies in some areas, and waiting times show that services are widely unable to meet demand. Despite the high priority the Welsh Assembly Government says it gives to mental health, we do not believe this is always shared by the plethora of local commissioners, and would hope to see moves towards more centralised commissioning to help alleviate that problem. We are also concerned that the lack of data available acts as a barrier to good workforce planning, and would urge the Welsh Assembly Government to start collating more statistics centrally, including information on waiting times.

Thank you once again for the opportunity to respond to this inquiry. If you require any further information please do not hesitate to get in touch with our Policy and Information Officer, Alexandra McMillan, using the contact details below.        

Yours sincerely

Ewan Hilton
Executive Director

For further information, please contact: Alexandra McMillan, Policy and Information Officer, Gofal Cymru, t:01656 647722, m: 07747 686928.