Peer Support Worker

Numbers reported in practice

• All Trusts reported employing PWs in a range of roles, with PSWs being the most common.

• We hold specific numerical data for 21 Trusts. 

• Numbers per Trust across all PW roles ranged from 1 to 112 (5 to 64 for PSWs). Six Trusts reported 10 or less people employed in PW roles, seven had between 2 and 50, and seven Trusts had over 50.  

• At least four Trusts had wholly or partially contracted the PSW role out to the VCSE sector, which may have affected our estimated numbers, as these staff are not directly employed by Trusts.

Insights from qualitative interviews and stakeholder reflection groups (i.e. what is reported to be happening in practice)

• The role was not seen as new in some Trusts, but was a fairly recent development in others.  

• Generally this is a growing role, with some Trusts now having large numbers: “a couple […] with about 140 PSWs now” [Stakeholder Reflection Group Participant 3-F].

• The response to the role was generally positive and its value recognised, being seen as an additional rather than a replacement role: “the peer support role actually isn’t about taking on tasks that have traditionally been done by someone else, it’s about saying this is a whole new set of tasks that we want to add in the sum total of work that gets done around hope and recovery and the sharing of personal experience as a therapeutic and recovery tool in itself” [Stakeholder Reflection Group Participant 3-C].

• However, Trusts reported a wide and confusing range of job titles – most common after PSW was LX Worker (11 Trusts) and Family or Carer PSW/Family Ambassador (11 Trusts). Job titles and descriptions were often not consistent, and from the data it was not possible to establish whether roles were different or only differently named.  

• Some LX roles were advisory/developmental/strategic rather than clinically focused. A number of Trusts also had senior PSWs or similar, up to executive level in one instance. The senior role included working with teams to prepare them for PSW introduction, developing career structures, ensuring co-production, influencing conversations and strategic direction, as well as supervisory responsibilities in some instances.

• The ‘PSW’ label could often be used as a catch-all but in practice included a wide range of roles and levels of responsibility that were not apparent within the label and needed to be identified separately. 

• Other kinds of lived experience roles could also be developed e.g., in relation to ethnicity there was mention of: “culturally focused workers” [Stakeholder Reflection Group Participant 3-F].

• Banding varied for what appeared to be the same role: some at 3, others at 4 with senior/lead roles at 4, 5, 6, 7, 8b.

Reported drivers for/advantages of implementing the role included:

• • • emphasising the recovery focus in MH services

    • the ability of role holders to empathise with and relate to service users, adding lived experience

    • helping Trusts to realise a commitment to the values of co-production

    • a potential contribution to diversifying the workforce

    • influencing the redesign of MH services.

Challenges to implementation

• • • Mixed success with inpatient PSWs as the environment was potentially more emotionally challenging, requiring boundary maintenance, distinctiveness of the role and appropriate support and supervision. Most role holders were therefore community based, across a range of settings.

    • Uncertainty around whether PSWs, particularly those at senior level, should be taking on key worker responsibilities as part of transformation of services (away from the care coordination model), at the same grade as others taking this responsibility but potentially with a very significant change in role.

    • Blurred role boundaries as some PSWs had joint roles, also working as Healthcare Assistants (HCAs) within the same Trust.

    • Variation in clear progression pathways for LX roles between Trusts. This was a key issue in some, particularly where all PSWs were on the same band; in other Trusts pathways were well established. 

    • Challenges around professional identity and where the roles fitted within organisational structures. In one Trust, LX roles were located with AHPs and included under their governance framework, which facilitated implementation.

    • Issues about parity/equity, as having lived experience was said to sometimes prevent people obtaining qualifications. While the importance of maintaining appropriate requirements was noted, especially for more senior roles, this could impact on developing person specifications for PW roles compared to others at similar bandings.

    • Concerns about the potential vulnerability of role holders and the need to ensure they were appropriately selected, inducted, trained, placed, supervised, and supported. Obtaining a balance between the genuine integration of PSWs into service delivery structures while ensuring an appropriate level of responsibility to avoid harm was important but challenging.

    • Finding the time to prepare receiving teams to understand and engage with the role amidst other pressures. While challenging this was seen as key to acceptance of the role: “some people in the NHS, their interpretation of a peer support worker was that they’re very unprofessional because they talk about their own life too often” [Stakeholder Reflection Group Participant 3-E].

    • A lack of diversity among role holders in some Trusts. Building strong links with VCSE organisations to increase awareness of lived experience work, encouraging people to begin as volunteers followed by PSW training was reported as one way to address this in one Trust. Other Trusts were contracting with the VCSE sector for all their PSWs which could help to build diversity.

    • Contracting/partnership with the VCSE sector. While the role was said to be better understood within these organisations and not subject to issues of trust and autonomy as it might be within statutory services, limits could be imposed on the role and flexibility reduced when the external agency determined the job description.

    • Potential tensions where Trusts had both directly employed and contracted out PSWs, due to issues of parity of terms and conditions. There was also some risk that role holders may become marginalised and to mitigate this, needed to be “fully embedded into the workforce as staff who are clearly on a par with other professions” [Stakeholder Reflection Group Participant 3-C].

    • Having the appropriate structures and leadership in place to support implementation, for example higher-level PSW roles were said to be essential to further development of the PSW workforce.