Think Ahead has raised concerns about cuts to mental health social work job numbers as it launched a campaign for the government to invest in thousands more roles.

The fast-track social work training provider said it had seen “trends of mental health social work roles disappearing in some NHS teams”, while some employers were pulling out of its programme on budgetary grounds because they could not commit to providing salaried jobs for trainees on qualification.

Under Think Ahead’s two-year programme to train people as adult mental health social workers, participants spend a qualifying year placed with an NHS or local authority employer, who then takes them on as a salaried employee in year two.

Cutbacks in mental health social work roles

The charity said that, of employers who partnered with it in 2024, 35% were unable to do this year for financial reasons, up from 20% of partners who pulled out last year for similar reasons. It said this was affecting NHS trusts more than councils.

“What we are experiencing in terms of the development of our programme is that where budgets are squeezed, non-clinical roles, like mental health social workers, seem to be first to take the hit – perhaps because they are seen as non-essential to mental health,” said Think Ahead chief executive Philippa Mariani.

Cutbacks to mental health social work numbers would mark a turnaround from the 20% growth in NHS mental health trusts seen from 2019-22, which left 3,576 whole-time equivalent (WTE) practitioners in post.

Despite the growth, this accounts for just 2% of England’s NHS mental health workforce, which numbered about 143,700 in 2023, according to think-tank the Nuffield Trust, with about twelve times as many mental health nurses (about 45,000) as social workers.

Also, the profession was not mentioned at all in the 2023 NHS workforce plan, prompting criticisms from Think Ahead and the British Association of Social Workers.

Call for 24,000 more practitioners

The plan is due to be refreshed this year and Think Ahead said it wanted to see a sevenfold rise in the number of NHS mental health social workers, to almost 28,000, over the next 10 years.

This is based on everyone with severe mental illness in England – of whom there were about 624,000 in 2024, according to an NHS estimate – having a social worker, and practitioners having a caseload of 20-25. The latter is based on a proposed limit for adults’ social workers set out in a 2022 report for Social Work Scotland.

Think Ahead said recruiting many more social workers would help tackle the social issues that were associated with mental ill-health, including those related to housing, poverty, employment, relationships and social connections.

Mariani said that, besides working in community mental health teams, social workers could be used more in inpatient settings, to support people’s recovery and discharge.

Think Ahead’s ambition would involve the recruitment of a net additional 2,400 social workers annually over the next decade, which the charity said would cost £130m in year one, including salary, oncosts and recruitment.

Social workers ‘a vital lifeline’ for tackling inequalities

Its Social Work Matters campaign was backed by charity the Centre for Mental Health, whose chief executive, Andy Bell, said social workers were “a vital lifeline” for tackling the inequalities faced by people with severe mental illness, including in relation to income, employment and life expectancy.

The NHS Confederation, which represents healthcare bodies, was also supportive, with its mental health director, Rebecca Gray, saying: “We welcome Think Ahead’s call to invest significantly more in mental health social workers in the NHS.

“They play a crucial role as part of multidisciplinary mental health teams – for example, in supporting patients who are leaving hospital, to finding suitable accommodation and working with parents who have mental health issues. This is so important as parental mental health is a significant risk factor for child mental health.”

Call for Casey Commission to address mental health social work

She said the Confederation hoped that Baroness Casey’s government-appointed commission on adult social care, due to start work shortly, “will present an opportunity to properly address the role and contribution of mental health social workers”.

In response to Think Ahead’s campaign, a Department of Health and Social Care spokesperson said: “Mental health social workers provide an invaluable service, and the workforce is critical to our reforms.

“We will publish a refreshed long-term workforce plan that ensures we have the right people, including mental health staff, in the right places, with the right skills to deliver the care patients need when they need it.”

The government should invest in mental health social work to meet its key objectives for the NHS, Think Ahead has said.

Recruiting more social workers will help mental health services move from “hospital to the community” and “from sickness to prevention”, two of three overarching goals set by Labour for the NHS, the training provider claimed.

However, the profession is not being prioritised by the health service, with practitioners facing “unacceptably high caseloads”, it warned.

Profession not mentioned in workforce plan

And despite about 3,600 full-time equivalent mental health social workers working in the NHS as of 2022, the profession was not mentioned once in last year’s NHS long-term workforce plan, published under the Conservatives.

Think Ahead, which runs a fast-track course to train people as mental health social workers, made the claims in a submission to a government consultation designed to shape the forthcoming 10-year plan for the NHS.

It said supporting mental health recovery involved addressing the social challenges people faced – such as housing, poverty or relationship issues – alongside clinical care, with social workers being ideally placed to carry out this role.

Lack of investment in mental health social work

However, this was being stymied by a lack of investment in the workforce that left practitioners “overstretched” and carrying “unacceptably high caseloads”.

As a result, they were only able to respond to people in crisis and were unable to carry out the relationship-based practice needed to help them navigate complex challenges in their lives, build independence and overcome barriers to treatment.

Though the number of mental health social workers in the NHS grew by 20% from 2019-22, Think Ahead said some trusts saw the profession as a “nice to have”, rather than critical to service delivery.

Councils withdrawing social workers from joint teams

And over the past several years, several councils have withdrawn social workers from integrated NHS-based teams by dissolving partnership agreements under section 75 of the NHS Act 2006.

Think Ahead pointed to a recent report on out of area placements by the Health Services Safety Investigations Body, which cited this issue and said that placing social workers in integrated mental health teams could speed up hospital discharge.

“When leaving hospital, service users may have lost their homes, their jobs, relationships may have suffered, they may even be in a new area of the country,” said Think Ahead. “Embedding social work within post-hospital care means that these social issues can be improved, tackling isolation, and reducing chance of re-admission.”

The government is planning to refresh the NHS workforce plan next year, and Think Ahead said this should set targets to grow the number of mental health social workers, which should be adopted by integrated care boards.

The Change NHS consultation runs until spring 2025.

Fast-track programme Think Ahead will train 320 more mental health social workers after the Department of Health and Social Care (DHSC) extended its contract up to 2027.

The £18.9m extension covers two cohorts, starting in 2024 and 2025, each of 160 trainees, the same size as the 2023 cohort.

Following a five-week grounding in social work law and theory, mostly delivered online, the participants will be placed in units of four to six in NHS or local authority mental health services and expected to qualify as a social worker in one year. During this time, they will receive a bursary of £18,250 outside of London and £20,250 within the capital, a £250 increase on current levels.

They will then be expected to complete a master’s degree, alongside their assessed and supported year in employment (ASYE), in year two of the programme, during which they are employed by the council or NHS body.

Think Ahead’s record so far

Since its inception in 2016, the scheme has trained almost 1,000 social workers to work in adult mental health – including its current 2022 and 2023 cohorts – with 92% of trainees qualifying as social workers, up to and including the 2021 cohort (source: Skills for Care).

Of those who complete the second year of the programme, 84% remain in social work practice after 12 months, said Think Ahead, based on figures drawn from its 2016-20 cohorts.

The contract extension follows calls earlier this year from NHS leaders for the programme to continue, after a workforce census revealed a 15% vacancy rate for mental health social work roles, despite a 20% boost in the number employed by NHS trusts from 2019-22.

As of last year, Think Ahead participants, qualified and unqualified, represented 3% of the NHS mental health social work workforce and 1% of local authority practitioners. This reflects the fact that the programme places more trainees in trusts than councils, with partnering with 17 NHS bodies and 10 local authorities for its 2023 cohort.

‘Essential to invest in social work’ – Lyn Romeo

“We are delighted by this opportunity to continue bolstering the workforce: finding, training and supporting compassionate and dedicated trainees who can help change the lives of the people they support,” said Think Ahead chief executive Philippa Mariani.

Lyn Romeo (photo: DHSC)

The DHSC’s chief social worker for adults, Lyn Romeo, added: “We know that mental ill health affects people across the life course and that social workers working with people in many areas will be providing support in relation to their mental health often alongside other multiple needs. It is essential we invest in and develop social work capacity and capability to provide the right support at the right time for those we are here to serve.”

The news came as figures released by Think Ahead showed a shift in its make-up since its inception in 2016, with trainees older, more likely to have worked in health and social care and, increasingly, from black, Asian or minority ethnic groups.

Changing profile of Think Ahead trainees

Just under half of trainees (49%) in the 2023 cohort this year were aged 31 and over, compared with a quarter in 2020 and just 17% in 2016.

The proportion who joined the programme from a related role increased from 34% to 46%, from 2020-23, while the share from minority groups grew from 17% to 27% over this time.

The latter is above their proportion in the NHS mental health social worker workforce (24%) and the target set by DHSC for representation from black, Asian and minority ethnic groups (22%) on Think Ahead.

Philippa Mariani , chief executive, Think Ahead

Mariani said: “I think the workforce is shifting and changing – people are going into other types of roles and testing what they want for their careers – which means we are getting more applications from people already in health and social care, like mental health support workers. And Think Ahead offers a career development pathway, which people find very attractive.”

She added that the programme had sought to increase representation from black, Asian and minority ethnic groups by “making our recruitment and marketing campaigns very diverse so they reach out to people in communities and speak to people in ways they recognise”.

Focus on recruiting men to scheme

The DHSC has set the programme a 30% target for the proportion of men recruited to the 2024 and 2025 cohorts, a proportion it achieved in 2021 and 2019, but not in 2022 (23%) or 2023 (20%). A quarter of NHS mental health social workers were men, as of 2022.

Mariani, who was previously chief executive of mental health charity Mind in Croydon, said: “There’s an underlying tendency for men not to talk about their mental health. And that applies equally to people working with social workers.

“To bring men into the profession is a really good thing – it provides more roles models for young men and boys – both in terms of future careers but also in relation to talking about their mental health.”

The extension of Think Ahead’s contract underlines the significant diversity of training routes into social work in England (see box, below).

Social work bodies have voiced their disappointment at the absence of any references to the profession in the health service’s long-term workforce plan, issued by NHS England last month.

The British Association of Social Workers (BASW) England criticised the omission in the context of social workers being “a crucial component of the healthcare system”, a stance then backed by Think Ahead, the fast-track training provider for mental health practitioners.

The long-awaited strategy lists student training targets for 36 separate roles, in order to grow the workforce to address the current 112,000 NHS vacancies and meet the needs of an ageing population.

Besides doctors, nurses, pharmacists and dentists, the roles include occupational therapists, physiotherapists, speech and language therapists, psychologists, child and adolescent psychotherapists and peer support workers.

Within mental health – where most NHS social workers are employed – the plan calls for increasing numbers of other roles, including mental health and wellbeing practitioners, who work with people with severe illnesses.

Social work excluded from NHS plan

However, despite mental health trusts having grown their social work workforces by 20%  on the back of NHS targets set in 2019, there were no references to ‘social work’ or ‘social workers’ in the 151-page workforce plan.

Also, while NHS England engaged with 33 royal colleges or professional bodies and seven professional regulators, representing over 30 separate professions, while drawing up the strategy, it did not list BASW or Social Work England among them.

BASW England said social work’s exclusion came despite it undertaking “extensive engagement” with its members to inform its contribution to a call for evidence in 2021 on long-term workforce planning by NHS workforce development body Health Education England (now part of NHS England).

BASW’s ‘deep disappointment’

“It is with deep disappointment that, despite extensive engagement, we note the glaring omission of any mention of social work in the NHS Long Term Plan which constitutes the final report,” said BASW England.

“This omission perpetuates the disheartening sense that social work is simply not considered when it comes to discussions and planning in health and social care services. As a crucial component of the healthcare system, social work should be recognised and valued for the significant contributions it makes towards holistic patient care and the overall well-being of individuals and communities.”

Think Ahead – many of whose trainees go on to work in the NHS as mental health social workers – supported BASW’s stance in a thread on Twitter.

#MentalHealthSocialWorkers are an integral part of the #NHSWorkforce, and it is crucial that they are both recognised and invested in for the support they provide to people living with mental health needs.

— Think Ahead (@ThinkAheadMH) July 19, 2023

There are several references to social care within the workforce plan, stressing the need to tackle its severe workforce problems and its interdependency with the NHS.

£250m to develop care workforce

In response to the concerns around social work’s omission from the plan, the Department of Health and Social Care (DHSC) said the social care workforce was “at the centre” of Next steps to put people at the heart of care, the policy paper issued in April setting out its adults’ services agenda.

“This includes £250m for staff to develop their skills through relevant training and progress within their careers with the introduction of the care workforce pathway,” a DHSC spokesperson said.

However, the £250m, available up to 2025, is half the £500m the DHSC originally committed to developing the workforce over this period, which has prompted severe criticism from social care bodies.

In response to this, the DHSC has pointed out that it is yet to allocate £600m in adult social care reform funding up to 2025, some of which may go on the workforce.

The DHSC spokesperson added: “We are also making available £15m for 2023-24 to help local areas establish support arrangements for ethical international recruitment in adult social care.”

The NHS increased the size of its mental health social work workforce by 20% from 2019-22, official figures show.

However, there appears to have been a sharp fall in the number of partnership arrangements between NHS trusts and councils to deliver services while vacancy rates also appear to have risen, according to a census of the mental health social care workforce carried out for NHS England.

It showed that, as of 31 March 2022, the 58 mental health trusts had 3,576 whole-time equivalent (WTE) social workers in post, up from 2,894 in 2019, marking a 20% rise when differences in the two datasets are accounted for. The figures includes trainee social workers in year one of the Think Ahead fast-track qualifying programme.

The rise in NHS staff exactly matches an ambition set in 2019 for the health service to recruit an additional 600 social workers to work in mental health to deliver on its long-term plan, including in improving access to services.

As well as the increase in numbers, there has been a shift towards the NHS directly employing its own social workers – as opposed to seconding them from local authorities – with 91% of NHS practitioners being on health service contracts, up from 76% in 2019.

Fewer NHS-council partnership arrangements

This was reflected in the fall in partnership arrangements between trusts and councils. While in 2019, just over a quarter (27%) of NHS trusts directly employed all of their social workers, this grew to 59% in 2022.

There were corresponding falls in the proportion of trusts with a mix of practitioners who were directly employed or deployed through partnerships – from 61% to 40% – and in the percentage with practitioners only deployed through partnerships (from 12% to 1%).

Partnerships, in which practitioners from councils and trusts work alongside each other, either through secondments or having their employment transferred to the other organisation, had historically been a common way to deliver mental health services.

However, they have fallen out of favour in recent years, with some councils having ended deals due to the alleged neglect of their statutory social care duties under the Care Act 2014 through having their social workers working to NHS priorities.

More social workers in management or newly qualified

Compared with 2019, more NHS mental health social workers (9% up from 7%) were in management, but there had also been an increase, from 5% to 7%, in those who were either Think Ahead trainees or on their assessed and supported year in employment (ASYE).

Social workers were deployed across the full range of community and inpatient NHS services, the census revealed.

Within adults’ community services, they were most often deployed in generic community mental health teams (in 82% of trusts), early intervention services (79%) and brief intervention and assessment teams (75%). They were also commonly found in perinatal (68%), older people’s (67%), forensic and single point of access services (both 65%).

In inpatient settings, social workers were most commonly deployed in children’s (59%), acute inpatient (53%) and low secure (45%) services.

The 2022 census also recorded councils employing 1,794 WTE mental health social workers – though data was only provided by 63 of the then 152 authorities – and 93 practitioners employed by the four independent providers who supplied information.

Vacancy rate up

Across the full dataset, the social worker vacancy rate was 15%, up from the 9% recorded for NHS trusts alone in 2019, while there were also significant variations between in the number of practitioners organisations employed per 100,000 population in 2022, which ranged from 1 to 41 WTE staff.

The social worker workforce across the NHS, councils and independent providers in 2022 was more ethnically diverse than that for NHS trusts alone in 2019, with 24% of staff being from black, Asian, mixed or Chinese/other ethnic groups, compared with 18% for trusts in the original census.

The 2022 figure is broadly in line with that for local authority children’s services (24%) but behind the proportion in council adults’ services (29%).

The rise in mental health social worker numbers was welcomed by the NHS Confederation’s mental health network, which represents providers.

“Good social care is crucial in helping deliver the care needs of people experiencing mental health issues, so health leaders will welcome the rise in the number of social workers working in the NHS to support these patients,” said network chief executive Sean Duggan.

“Members will be concerned about the regional variation in the number of mental health social workers, as well as the vacancy rate being 15% , but leaders know that these issues are similar in other mental health teams and the health workforce generally.”

Call for further investment in Think Ahead

He urged the Department of Health and Social Care (DHSC) to ensure that the long-awaited NHS workforce plan – due imminently addressed requirements for mental health social workers – and also called for Think Ahead to continue.

The fast-track programme trains practitioners over just over a year, through placements in NHS trusts or councils, with social workers then undertaking their ASYE with the same employer, while also studying for a master’s degree.

Under its existing contract with the Department of Health and Social Care, Think Ahead is due to train a further cohort of 160 participants this year, in order to qualify in 2024 and complete their master’s in 2025.

In its response to the social work workforce census, a DHSC spokesperson said: “Social workers are crucial in supporting people with their mental health and emotional wellbeing. Since 2016 the Think Ahead mental health social work programme has created 820 qualified social workers, who have gone on to join the mental health sector working in NHS Trusts and Local Authorities.

“The increase of social workers employed within the NHS helps to join up health and care for people needing mental health support, giving those using inpatient and community services for their mental health, the opportunity to access excellent social work interventions like assessment, crisis care, safeguarding and discharge planning.”

Frontline has a lower social work qualification rate than other fast-track programmes, according to data from the providers.

About 90% of Frontline candidates completed the first year of the programme – thereby earning a social work qualification – in the three most recent intakes: 2018-19 (91%), 2019-20 (88%) and 2020-21 (90%).

This was below the completion rates for Step Up to Social Work’s three most recent intakes, which were 95% in 2016-17 and 96% in each of 2018-19 and 2020-21. Like Frontline, Step Up is focused on training practitioners to work in children’s services.

For Think Ahead, which trains social workers to work in adult mental health services, primarily, 94% completed their first year, earning a post-graduate diploma in social work, in the most recent intake (2020-21), with 92% doing so in the two previous ones, 2018-19 and 2019-20.

While the three courses have differences, they are of similar lengths (around 14 months), involve similar levels of financial support for students (tax-free bursaries of between £17,000 and £20,000 with no tuition fees) and involve the trainee being placed in a host local authority or – in Think Ahead’s case – an NHS mental health trust. Both Frontline and Think Ahead have a second year in which trainees are expected to complete a master’s degree alongside their assessed and supported year in employment.

Lack of comparable figures for university courses

There are no comparable figures available for university undergraduate courses – which tend to be over three years if done full-time – or postgraduate schemes, which tend to be two years full-time.

Ninety-three per cent of those who left university social work courses in 2018-19 achieved a qualification (91% for undergraduate and 96% for postgraduate), according to Skills for Care’s most recent report on social work education. But it did not report figures for the proportions of degree starters who successfully completed their courses, which may be lower than Frontline’s figure.

However, university courses are not directly comparable to fast-track ones as they are longer and offer much less financial support; students pay tuition fees and are not guaranteed a bursary which, in any case, is of much lower value than those provided to fast-track students.

Differences in intake

An academic source suggested that Frontline’s lower completion rate than Step Up could be to do with differences in intake. Step Up trainees must have significant experience of working or volunteering with vulnerable children. The programme draws from people working in similar fields to children’s social care, who may be expected to have committed to social work and so be more likely to complete their course.

Frontline targets high-achieving graduates who may not otherwise have considered a career in social work and who, because of their academic records, could choose other career paths if they decided social work was not for them, the source suggested.

‘We want as many to complete as possible’

A spokesperson for Frontline said it wanted “as many participants as possible” to complete both years of the programme.

“Our aim is to develop excellent social workers ready for a career in child protection social work, and the Frontline programme has been designed to ensure participants are prepared and equipped with the skills and resilience they will need to do their best work for children and families,” the spokesperson said.

“We know this is a challenging career, which is why we have strong support systems in place. But, if after all the extra help and support someone decides the programme is not for them, then we support their decision to leave.”

A spokesperson for Think Ahead said: “We always look to increase the number of trainees who qualify and who complete the programme.

“We prioritise their wellbeing and support the trainees to give them the possible chance of success. Our aim is to recruit and train excellent, compassionate social workers that will make a difference to people with mental health problems, and we are always looking for ways to improve and achieve that goal.”

Completion gap ‘of concern’

The Joint University Council Social Work Education Committee (JUCSWEC), which represents university social work academics, said it was “of concern” that completion rates for Frontline and Think Ahead were lower than for Step Up during the same period.

The spokesperson said the data needed to be “treated with caution” because of the possible impact of Covid-19 on completion rates across all types of social work course, adding: “Further analysis of this is needed including once data for mainstream programmes are available for the same periods.”

The news comes after the Department for Education (DfE) extended Frontline’s contract to deliver fast-track training for another year, meaning it will offer a programme starting in 2023, at a cost of £22.6m.

In December of last year, the DfE started consulting with potential providers on a contract  for an £80m Frontline-style social work training scheme starting in 2024, but it has not yet issued the tender.

The contract would replace the provision currently offered by Frontline and run for four cohorts.