'MOVING ON' from New Ways of Working to a Creative, Capable Workforce

The NIMHE National Workforce Programme (NWP) finished its’ work in March 2009. It operated for over six years; quite a long time in the nature of NHS organisations.

The programme focussed, in its early years, on workforce planning, recruitment and retention, New Ways of Working (NWW), new roles, learning and development and leadership, working collaboratively with the Changing Workforce Programme.

The main focus in latter years has been on NWW, underpinned by the values articulated in the Ten Essential Shared Capabilities. Readers may be familiar with the various best practice guides and reports on this website. These have been produced through excellent multi-disciplinary, multi-agency and professional working, with service users and carers, in a process overseen by a National Steering Group on NWW, co-chaired by NIMHE and the Royal College of Psychiatrists.

We have seen some huge changes in practice over the years: the reduction or elimination of psychiatric outpatient clinics; the specialisation of some psychiatrists in acute care and others in new models of community based teams; significant reductions in waiting times for psychological therapies as psychologists work collaboratively with other therapists rather than keeping their own waiting lists. Where consultant practitioners of all kinds rationalise what they do, they can become more effective consultants to teams and enable others to extend their practice. As a result, we have seen new psychological therapists, non medical prescribers and other specialists develop their roles to provide what service users and carers say they need. New roles, such as Support, Time and Recovery (STR) workers, have been developed to step in to support qualified practitioners to use their time and expertise most effectively.

Most service users and carers in England will have seen these changes occur although they may not always recognise or appreciate them as part of modernising mental health services by way of NWW. NWW is a term used almost everywhere, even to the extent that, in the last 18 months, people have been asking when is NWW not new any more!

It would be naïve, however, and would not strike an authentic note with practitioners, managers, service users and carers to say that NWW is what everyone does in practice now. We can still see where there are traditional outpatient clinics running, acute inpatient wards with a dozen or more consultant psychiatrists all with their individual ward rounds, long waiting lists for psychology, nurses trained in but not using non medical prescribing skills, staff trained behavioural family therapy skills but not having time to implement them. Why is this?

There is not a single answer, but clearly cultural change - a move to dispersed responsibility in multi-disciplinary teams with a person centred/recovery focus- takes time. Even six years is a short time, in the context of professions who train and work separately; in fact, we are seeing some organisations and services only now coming forward seriously to explore how they can implement NWW. We have seen some Royal College of Psychiatrist officers and members of the British Medical Association wanting to roll back the years to reassert the primacy of the psychiatrist in an Multi-Disciplinary Team. This is not only undesirable, but it is not possible and based on a misunderstanding of the professionalism of all practitioners. Trusts increasingly are becoming clearer about their workforce requirements, which include effectiveness and efficiency. But fundamentally, it is what service users and carers feel about what they are getting that counts. Although we are seeing improvements in responses to the national patient survey, most people acknowledge that we are not there yet.

So what does the finishing of the NWP signify? Well, it does NOT mean the end of NWW; some people and organisations want to continue to use the term as it is still has real currency in their organisations, others will adopt our suggestion of a Creative, Capable Workforce or use terms that fit locally. In a sense, this matters less than the fact that the principles of NWW are as vital and critical as ever. This is confirmed by the fact that the NHS Confederation Mental Health Network, supported by the new National Mental Health Development Unit, has announced that it will support a new National Steering Group for Workforce. This is important as it will provide a national multi-disciplinary forum, led by employers, to continue to provide a focus on workforce reform. The NHS Confederation briefing on NWW, which was published and released at the Moving On conference held on 24 March 2009, illustrates its commitment to this agenda.

The final products produced by the NWP will help in this process. These are:

• Responsibility and Accountability guidance - for use in teams and organisations to clarify what professional and regulatory bodies expect and to tease out issues where there is lack of clarity.
• Joint Guidance on the Employment of Consultant Psychiatrists - revision of the 2005 publication - reaffirming commitment to NWW principles and recognising that job plans are the key to development of roles for the psychiatrist; all reference to numbers have now been removed. You can also use the job description template.
• Positive Practice Guide on the Creating Capable Teams Approach (CCTA) - learning from experience to help support future use of the CCTA.
• A report on the field testing of the new Clinical Roles for the Mental Health Act - showing a slow but promising start.
• An evaluation of the CAMHS NWW pilots - CAMHS workforce is continuing as a national programme with a continuing commitment to CCTA.
• A DVD, bringing together all of the learning materials for the Ten ESC, Race Equality and Cultural Competences [RECC], Recovery and others, including the Three Keys to Assessment (2009) and the STR Competence Framework (2008). If you require copies of the DVD please contact This email address is being protected from spam bots, you need Javascript enabled to view it .
• A report on the role of the Community Development Worker [CDW] for Black and Minority Ethnic communities as it has been implemented to date.

As the NWP team moves on, we want to wish you all well in your efforts to support the workforce to reform. Workforce will continue to be vital to address in policies and will be articulated in New Horizons, the next step on from the Mental Health National Service Framework. It is core to the national programme for Improving Access to Psychological Therapies (IAPT). It is an essential component in the development of care clusters and care pathways in mental health, which will preoccupy Trusts for some time to come...

Roslyn Hope

A SPECIAL EDITION of The Journal of Mental Health Training, Education and Practice - Issues for Workforce Development (June 2009) will be dedicated to sharing the work and publications of the NIMHE National Workforce Programme.

• Creating Capable Teams Approach (CCTA)
• Services users and carers’ perspectives
• Psychiatry, Psychology, Nursing, AHPS, Pharmacy, Social Work
• CAMHS
• IAPT
• Accountability & Responsibility
• Mental Health Act – New roles
• Non professionally affiliated staff
• 10 Essential Shared Capabilities

Healthcare Events: Upcoming Conferences

Psychological Therapies in the NHS
Date: Thursday 26th and Friday 27th November 2009
Venue: Savoy Place, London
The third annual conference examining the challenges and opportunities of evidence based practice for the Psychotherapy professions. A unique two day event that brings together leading clinicians, policy makers, academics and service users from across the UK, Europe and the US, to consider and debate the future of Psychological Therapies within the NHS.
Contact: For more information please call Hanisha on 020 8541 1399, email This email address is being protected from spam bots, you need Javascript enabled to view it or visit www.healthcare-events.co.uk
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