The Surviving Work Survey

Hello everyone.

The following post is from Elizabeth Cotton, and provides background information about the ‘Surviving Work Survey’. It is an important project that we feel will interest mental health nurses (it is for other professionals too).

Please forward the link to your colleagues, too.


The CMHNN team.

If you’re working in mental health it’s time to talk about money. Whether you’re a mental health nurse, psychologist or a counsellor, trainee or occupational therapist, or community mental health team the growing reality is that you’re probably concerned about earning enough to sustain yourself in the current mental health job market.

The lack of understanding about employment relations in the sector exposes a range of problems faced by mental health workers, including the growth of contract and agency labour, the use of unwaged labour, the insecurity of ‘permanent’ staff in the NHS.

Because of the growing insecurity of work in mental health and the fear of blacklisting of individuals who raise their concerns, people are often unwilling to speak up at work. As a result not much is known about what is happening to wages, working conditions and clinical practice in our sector.

In our society there is a growing split between the established and the disestablished.  We see it every day in our mental health services – we now need to allow ourselves to see it in our profession.

After four years of talking to mental health workers and now carrying out The Surviving Work Survey mapping jobs and working conditions into our sector,  I think it’s fair to say that we are experiencing a rise in what Sally Weintrobe calls Noah’s-arkism. This is the phenomena where those people who still have decent jobs –  or who are safely established on pensions or private practice, leadership positions in our professional and training bodies –  are protecting what they have while turning a blind eye to those of us who are very-soon-to-be-disestablished.

This second tier of workers includes the declining number of mental health nurses, the Psychological Wellbeing Practitioners who provide the main bulk of IAPT services, the hundreds of honoraries working for free in the NHS, the people manning the mental health call centres, the clinicians carrying out disability welfare assessments and the ones working in social care and support services who were forced to leave their clinical jobs.

The debate about precarious work is a defining one in the field of employment relations. It links research between nationally set cuts and targets, privatisation of health and social care services and growth of labour outside core-public sector, the shift and confusion over commissioning powers, the use of command and control management, work intensification and bullying cultures.

Over the last 5 years there has been a 50 per cent increase in services provided by non-NHS providers with expenditure rising from £6.6 billion to £10 billion. There are an estimated 53,000 private contracts in the NHS with 15,000 within 211 CCGs in community health services and secondary care. An estimated 12.7 per cent of the CCG budget is spent on specialist mental health services – and the primary problems relate to poor contract management and very low penalties for poor delivery. What we do know is that in 2014 half of the private mental health providers commissioned by NHS England to provide specialist care were not fully compliant with NHS standards.

Commissioning Support Units were set up to administer the NHS contracting process and raise any concerns about the governance and monitoring those services provided by private providers. From April 2016, these Units will be privatised. You read that correctly; the administrators in charge of managing third-party contracts will themselves be working for third parties.

Although it’s possible that the third parties currently may offer a good-enough service, if the experience of every other sector is anything to go by, within a two-year period the contracts will be downgraded to compete with ever-stringent budgets. Within 5 years the clinicians and managers in these private companies that came from the public sector will have retired or moved, leaving a new generation of workers without any living memory of good clinical practice or decent work without even the slightest fuss over patient safety.

Our professional bodies are in crisis – torn between defending the sector and their organisation which increasingly cannot happen at the same time. Our unions are literally asleep at the wheel with a growing gap between the rhetoric of collectivisation and the reality of it. This dis-connect creates a professional culture in psychological therapies much like a 17th Century French Court – a preoccupation with the minutia of court procedures rather than the blood and guts of economic crisis and finding therapeutic modalities that can respond to it. There is a growing possibility that we are within a decade of our profession dying out as we become de-professionalised, downgraded and demoralised and our experienced leadership retire.

This is what we know about as people working in mental health; that all we have is each other, right now, listening and talking long enough to see and understand reality for what it is. A relational model of solidarity where we make the best of the people around us and the bad lot we have been left with in mental health.

If you work as a mental health nurse help us build up a picture of the facts of work by taking our anonymous Surviving Work Survey here.

The aims of the Surviving Work Survey are to help us build a map of the trends in working conditions for mental health workers in the UK. Through the questionnaire and anonymous case studies we want to create a map which measures:

  • trends in wages and earnings in the sector
  • what jobs people are doing in mental health
  • the scale of unwaged and honorary work, principally by trainees
  • growth of private contractors and private employment agencies providing clinical services
  • impact on clinical supervision and professional practice
  • impact on our states of mind and our relationships with each other

The online survey can be accessed here

As we build a picture of our sector, we will produce infographics and an online map to raise awareness and encourage debate about the future of work in mental health.

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