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Volume 800: debated on Monday 21 October 2019


Asked by

To ask Her Majesty’s Government what steps they are taking to tackle the shortage of psychiatrists in the United Kingdom.

Expanding the mental health workforce, including psychiatry consultants, is an important priority for this Government. We are not complacent about the scale of this historic challenge. In particular, we are focused on driving forward work to improve recruitment in psychiatry, including working with the Royal College of Psychiatrists on its excellent Choose Psychiatry campaign. Our NHS interim plan has also set out a wide range of actions that we will take to reduce the number of vacancies and secure the staff we need for the future.

Vacancy rates for psychiatric posts have doubled in the past six years. Eating disorder services are particularly affected, contributing to lengthy waiting times for treatment, which can be life threatening given the mortality rates for anorexia. Will the Government agree to double the number of medical school places over the next 10 years to deliver more psychiatrists and better care for people suffering from eating disorders?

The Government recognise the issue with recruitment, in particular at the higher, consultant end, where it takes 14 years to train a consultant. There is undoubtedly an issue with filling all those places. The work of the noble Baroness on eating disorders is well known and the Government are very focused on that issue; in fact, we announced in 2014 that we would invest £150 million to expand community-based care for children and young people with eating disorders. Recruitment remains an issue that concerns us and we are focused on responding to it.

My Lords, in 2011, 70% of foundation doctors went on to specialty training, but in 2018 the figure was 40%. Does the Minister agree that in psychiatry, this may have something to do with concerns about working conditions, lack of support from specialist nurses and personal safety? I heard just last week of a young doctor who went to work in the evening wearing a stab vest because another trainee had been stabbed while on duty as a psychiatrist the previous week.

The noble Baroness is quite correct to suggest that the issues of psychiatry recruitment are complex. They are not simply a matter of funding; the Government have put a large amount of money behind mental health. It is not just a question of places—a large number of vacancies are available in psychiatry; it is one of the employer brand. The employer brand around psychiatry is not where we would like it to be, and safety is a difficult and challenging issue to address. We are focused on that. The campaign by the Royal College of Psychiatry addresses this very issue, and we will continue to work on it.

My Lords, two years ago, Sir Simon Wessely, then president of the Royal College of Psychiatrists, identified a serious problem with psychiatric recruitment, particularly among trainees as the Minister has mentioned. As it takes five years to get a trainee through to becoming a doctor, and bearing in mind that we are nearing Brexit or the effects of it and that many doctors come from the European Union, what action are the Government taking now to deal with this problem?

I am grateful for my noble friend’s question. He is correct that Brexit is a challenge, but I draw his attention to the interim people plan, which is focused on the issue of psychiatry recruitment. It addresses pension tax concerns—a key hurdle for those later in their careers—and increasing university clinical placements, and it bolsters the workforce through greater international recruitment. I remind my noble friend that there were 2,000 more EU nationals working in the NHS in June 2018 than in June 2016.

My Lords, there is a massive shortage of consultant psychiatrists, especially for children. What action will the Government take in the next few years to address that problem, which is getting worse, not better?

The issue with consultant psychiatrists will take years to address. However, I reassure the noble Lord that it is not only consultants who can help with children’s mental health; so can other strata of the workforce. We are providing an extra £1.4 billion to improve specialist mental health services for children and young people. That money will be dedicated to all levels of the workforce.

My Lords, the Minister has referred to the mix of psychiatrists and psychiatric nurses who support children. If the Government’s plans are carried out, by when should every part of the country be covered to an acceptable and safe level?

The long-term plan published on 19 June announced that, by 2023, an extra 345,000 children and young people aged between nought and 25 will receive mental health support via NHS-funded mental health services. That commitment will go a long way to achieving the objective that the noble Baroness addressed.

My Lords, is there not also a problem of retention of young male and female doctors when they qualify? Should we not look at the system in Singapore, where young doctors have to sign on for five years after they qualify? We use that system in our Armed Forces. Is the answer to one of the challenges to look at retention?

My noble friend is correct that retention is an issue, although I reassure him that NHS Improvement’s retention programme has improved turnover rates of clinical staff in mental health trusts from 14.4% to 13.1% since 2017. However, these numbers are not good enough. The Government recognise that, which is why we are investing money in it. I will take his very good idea to the Minister and raise it up the chain.

My Lords, I declare an interest as the Royal College of Psychiatrists provides me with a psychiatrist to help me with my work here. While working with psychiatrists and the royal college, I have learnt that, although understandable concern exists about the dangers of technology for children—particularly gaming—there is also a body of evidence that technology can be very useful in dealing with psychiatric and mental issues. However, there is a lack of work being done on this positive side. Will the Minister undertake that the Government are prepared to explore this more fully than they have so far? That might go some way towards solving the problem of a shortage of psychiatrists.

The Government have articulated their commitment to technology in the long-term NHS plan; no Government have ever been more committed to technology. I pay tribute to the work of professionals in the mental health services. It has the human touch more than any other medical discipline. The work done by those in the NHS is exceptional.