An open letter from Harmless

Wednesday 28th December 2022

To all whom this concerns,

I would like to bring to your attention our serious concerns as we approach 2023 and the adversity that lies ahead. This is not so as to reinforce the concern that already exists, but as an effort to foresee and therefore plan and avert the potential risk and crisis ahead.

As you will be aware, we are a specialist self harm and suicide prevention service; a training and clinical service that pride ourselves on being the Centre of Excellence for Self Harm and Suicide Prevention. Amongst our service offers, we deliver a suicide crisis service, including an out of hours service, a text service and targeted services for particular at risk user-groups; we deliver one of the only specialist self-harm services in the UK, delivering both stabilisation and psychotherapeutic services to individuals, and carer support to those around them. Further more, when the worst happens, we are there to provide a prompt and thorough clinical support service to those who have been bereaved or impacted by suicide.

These services are critical; they are critical in working with and ultimately saving the lives of those who may die by suicide and beyond this, improving lives so that people can be functioning, settled, safe and productive members of society.

These services are delivered by a qualified and specialist team, trained to work in their pathway-specific interventions; their training takes time and is of a specialist nature. The roles are challenging and demanding of knowledge, skill and emotional resilience. We also know that by exposing individuals in an employment capacity to relentless proximity to suicide we are also placing them at a heightened risk of duration duress and also regretfully, of suicide.

This is a specialist workforce who, if not taken care of now, will undoubtedly become a profession of concern in future years. This is also a responsibility so great, and a role so significant that we cannot deliver this to those who are at the entry point to the sector.

As the cost of living crisis continues to place the health and social care sector under great strain we are observing many factors which are making it harder for us to do our work, but that may become even more of a struggle in future.

As those who are impacted by the cost of living crisis the most feel the financial pressure there is an exodus of staff from the sector (including our service); swathes of personnel are seeking employment with higher financial reward, either outside of the sector (e.g. Amazon), leaving huge gaps in personnel; or toward promoted roles where they do not yet have the skills to perform as such. The role retention in move-on roles is also low (on average 3 months), so those individuals are not staying in the roles they are moving on to either. This is leaving the sector in a state of uncertainty.

To train a qualified and skilled workforce takes two years and we have had high retention amongst our teams with on average our services retaining staff for in excess of 6 years.

Our turnover in the last year has seen people leaving in an average of under 18 months.

We cannot deliver the same quality if we cannot keep the qualified team. People’s lives are at stake.

Just as with covid, the issues that we are supporting our client group with, we are facing ourselves. This makes the roles even harder than they were already and I am sure this is not exclusive to our service, however, somehow we need to agree remedial steps to mitigate the risk of further strain on our workforce, further lack of retention of this specialist workforce, and on the emotional capacity of our workforce to deliver the quality of service we expect of them.

As the cost of living continues to rise, our estimated service costs have risen by 21%. This means that without any match in income percentage, we are costing 21% more to deliver the same levels of care as we were before – this financial discrepancy has to be recovered from somewhere otherwise it will be impossible to continue to deliver.

Furthermore, we are due to see a raise in the living wage and minimum wage. This raise will match our current staffing salaries in some cases. If we are to continue to expect the same level of quality workforce it is imperative that we consider how we can recruit and retain the caliber of staff required to work in these demanding roles. As we see it, we either need to increase salaries at the same rate as the 21% rise or we reduce the salaried hours to compensate for this which would reduce our overall activity levels and have an impact on performance KPI’s.

We have a duty of care to our clients to ensure that we are delivering the same quality and specialism of service that we understand to be effective, and evidence based and ultimately safe. We also have to manage this against the unprecedented rise in costs and our responsibility to our staff and their welfare. We are already a lean service, spending only that which we need, and supplementing our funded activities with our own generated income. At present this leaves us in an impossible situation, and we write this open letter to air these grave concerns we have in the hope that we find some collective solution.

Do our commissioners find the 21% raise to enable us to sustain the teams and their quality of work and allow us to recruit non-entry level staff?

Do we reduce the hours our teams work, thus essentially increasing their salary, enabling them to seek additional work to supplement their income if they so require?

There are some very difficult times ahead but as a service that holds some of those individuals who are most vulnerable and most likely to die by suicide it is critical that we find a way forwards before the crisis truly hits.

We would welcome your thoughts on these important issues.

Yours faithfully,

Caroline Harroe


Signed for and on behalf of the Harmless and Tomorrow Project Leadership Team and Directors