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DCP UK Clinical Psychology Workforce London 2nd December 2015

Dr Alison LongwillWoodcote Consulting

alison@woodcote-consulting.com@WoodcoteAlison

Tel: 0207 148 7170Mob: 07976 745396

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1) More accurate profile of the number and whole time equivalent (w.t.e.) profile of clinical psychologists in the UK◦ demography (age, gender, ethnicity), ◦ Pay band, type of contract/hours or work, employer type,

geographic location◦ Clinical psychology specialisms◦ Link to indices of need (e.g. social deprivation; population of

area, NICE guidance etc)

2) To identify and promote the clinical psychology skills in the delivery of health and care ◦ public and private sector, ◦ linked to national policies◦ increased public demand for high quality psychological services

Main aims

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Pressure in some Regions to cut clinical psychology training places

West Midlands workforce report in 2014 influential in halting further reductions in clinical psychology training places

Inaccurate baseline data at least 10% over-estimate of clinical psychology workforce

Nationally, demand for newly qualified Band 7 psychologists buoyant

Downbanding of posts- loss of 8c/8d/9: increase band 7/8a

Background

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1. Collation of UK statistics (e.g. HSCIC , Scotland, Wales, Northern Ireland) and local/Regional validation◦ Coding issues – over-estimates

◦ Inequities

2. Online survey (4558 respondents – 38% of UK HCPC Registered Clinical Psychologists)◦ Demographics, specialties, employers, contracts

◦ Narrative analysis – needs, gaps, issues

3. Forward view from◦ Clinical leaders

◦ Best evidence

Methodology

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HCPC data: 11,900 total

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Understanding geographic variations

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Similar profile to national data - representative 79% female respondents Average age 42

Online survey

88%

2%4%

2%1% 3%

Ethnicity of Clinical Psychologists: NHS England

White

Mixed/Multiple ethnic groups.

Asian/Asian British

Black/African/Caribbean/Black British

Other ethnic group

9

10

53

55

57

59

61

63

65

67

69

71

73

75 W

ould

ra

ther n

ot

say

0

5

10

15

20

25

30

0 0

11

12 2

1

19

1

3 3

1

12

2

4

10

3

01

0 0

2

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Planned age of retirement for clinical psychologists aged 50 years and over (n = 951): online survey

perc

enta

ge o

f sam

ple

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Number and pay bands (HSCIC England) NHS n = 8810

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Pay band

13

% psychologists with > 1 employer

3%

78%

17%

2% 0%

Survey respondents employer(s)

Missing

Main employer

Second employer

Third employer

Fourth employer

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Main Second Third42000

44000

46000

48000

50000

52000

54000

56000

47030

51010

55221

Mean salary (NB NHS scale data only)

Employer(s)

Mean p

ro-r

ata

sala

ry £

NB – no data on non-NHS salaries

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First Destination employment

Growing role: non NHS Range of specialties

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Buoyant demand for clinical psychology graduates

Just under 20% of qualified clinical psychologists currently undertake some work in non-NHS settings

This trend is likely to grow – training courses need to plan for this ◦ C. 15% newly qualified found jobs in

independent/third sector◦ C. 6 advertisements per month for PIV clinical

psychologists (mainly newly qualified) Increasing self-employment/portfolio careers

Trends

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Type of contract

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Hours of work

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Clinical psychologists by specialty

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Work in sectors

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64.5

2.82.2

13.5

29.5

20.1

Professional membership of survey respondents (%)

Full member of DCP Full member of DCP

In-Training member of DCP In-Training member of DCP

General Member of DCP General Member of DCP

Not a member of DCP Not a member of DCP

Member of BPS Member of BPS

Not a member of BPS Not a member of BPS

Professional memberships of survey respondents

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Some key themes and concerns

From online survey

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Downbanding of clinical psychology posts over the last 5 years

Posts lost ◦ downbanded after retirement◦ re-structuring/cost-savings targets

“Loss of the elders” Diffusion/lack of leadership in some

services Some lack of engagement with the wider

profession and professional bodies

Impact of austerity

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Same pay, expected to do more◦ Newly qualified staff doing more in junior roles than

in past◦ Consultant/senior psychologists managing

expanded services (e.g. psychological therapies), general service management

Non-clinical psychologists doing parts of clinical psychologist role for less money◦ Blurring of roles with other professions◦ Managed by non-psychologists – poor/limited

understanding of role and contribution of psychology

“More for less” demanded

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Preceptorships not used-limited support for newly qualified

Bands 7/8a career grade now, limited senior roles to apply to

Clinical psychologists moving to progress:◦ geographically◦ working part time/portfolios ◦ changing specialty◦ sector – more non-NHS

Not supported with Continuing Professional Development to progress

Lack of career progression

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Loss of Assistant Psychologist role Loss of senior posts limiting supervision Progression from undergraduate to

consultant clinical psychologist unclear in NHS

Guidelines needed for what each grade of psychologist does/key competences

Limited further training◦ E.g. Neuropsychology training - access limited for

many practising – but being addressed by BPS

Career structure issues

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Reduced funding, fewer clinical psychologists but waiting lists going up

Limiting targets reducing flexibility/creativity

High risk and complexity of case work increasing

“Too much pressure”

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Ongoing threats of service reviews and down banding

More temporary or fixed term contracts Future of profession in NHS unclear

Uncertainty about future

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Burn out, stress and demoralised by work pressures and bullying/blame culture

However, clinical psychologists well placed to lead to supporting others to be resilient and to promote employee wellbeing

Need protected time for reflection and resilience building

Resilience and well-being issues

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Need to broaden role from just therapy e.g. consultancy, teaching, research, management

Not enough time to use other skills e.g. research, service development

However - split in responses as some do not want to broaden their role from tier 4 therapy (complex case formulation and therapy)

Need individuals to show more leadership in systems of health and care

Need for broader working

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Creative work possible, can be more rewarding work outside NHS

Feeling forced out of NHS due to lack of career progression, the pressure etc.

Need more support for non-NHS clinical psychologists from DCP/BPS

Trainees should be trained for working in non-NHS sectors too

Other organisations filling gaps in NHS services – opportunities for psychologists

Non-NHS work in other public sector/independent and third sectors

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Inaccurate baseline data (>11% error) Need to account for:

◦ Part-time working ◦ Retirement◦ Attrition◦ Movement in and out of Regions◦ Projection of future demand: ALL sectors◦ Small changes in formulae make a big difference

to projections Limited involvement in workforce

planning and service development/planning and management

Lack of transparency and accuracy : workforce planning supply and demand models

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More training in leadership More clinical psychologists in leadership and

management roles, including as Board Members, Commissioners, Regulators etc

DCP needs to be stronger, advocate more and challenge more◦ Want clarity on “what DCP is for” and why

psychologists should join

◦ Want DCP to be like Royal College of Psychiatrists?

Leadership needed

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Some developing areas

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Demographic trends including a growing and more diverse, ageing UK population places increasing demands on health and care services. In addition, people wish to be more actively involved in self-management and co-creation of their healthcare

“The future’s digital “ http://www.nhsconfed.org/resources/2014/09/the-future-s-digital-mental-health-and-technology

Social media – practitioner profile also needs to develop

Demographic and social trends

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NHS England 5 year Forward view Mental Health Task Force No Health without Mental Health Future in Mind IAPT Public Mental Health Priorities NICE Guidance – mental and physical health Long term conditions CQC/Francis report Centre for Workforce Intelligence

The Bigger Picture: National Policy, Reviews, Guidance

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General/physical health◦ Prevention/wellbeing◦ Management of long term conditions◦ Acute care

Older adult/dementia services Psychosis/inpatient services Child/CAMHS services/Paediatrics Autism/Asperger’s Syndrome Neuropsychology/brain injury/rehabilitation services Forensic services Occupational health Training others/supervision Complex case formulation/Personality disorder Management and leadership of services Accreditation/regulatory bodies Commissioning and service development

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Recommendations for action

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1. Further development of workforce planning model for clinical psychology in conjunction with key partners from service provider, commissioning and training organisations

2. Addressing equity of provision

3. Development of effective integrated service models of psychological services and commissioning guidance

4. Leadership development in local health communities

5. Strong National voice needed from BPS to advocate, represent and support practitioners

Early priorities for action

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Robust Workforce Planning

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Develop robust supply and demand modelling for clinical psychology on a National basis linked to:◦ Needs analyses linked to sociodemographic population trends◦ National policy implementation & best practice ◦ 5-10 year time horizon

The workforce plans should include: ◦ realistic assumptions about workload◦ specification of outcome measures◦ Take account of trends to part-time, portfolio careers, non-NHS sector

demand, age and retirement profiles etc to ensure stability of service provision

The workforce plans should address career progression pathways and key competences for each level of work

Clinical psychology workforce plans should be integrated within an overall strategy and development plan for psychological services.

Developing a robust workforce plan and model for clinical psychology

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Accurate baseline data. ◦ Inaccuracies and coding anomalies addressed at national and local

level

◦ Misrepresentations in supply and demand modelling to be rectified.

Robust funded system for routinely and regularly collecting accurate information ◦ Analysed by demographic characteristics of the workforce,

locality, specialty and banding

◦ Routinely used for workforce planning by commissioners and service providers.

◦ Essential to identify trends in workforce supply and demand.

Linked to other applied psychology divisions Supported by the British Psychological Society, Health

and Care Professions Council and Health Education bodies in the UK.

Improving accuracy of baseline data

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Must be involved in workforce planning and check the accuracy of their local workforce information

Leadership and consultant clinical psychology posts maintained to develop services and ensure high quality and governance of psychological services.

Shaping current and future workforce plans for clinical psychology with senior managers, directors of their organisations and commissioners of service.

Engaging psychology leads in workforce planning

 

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Equity and Access

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 Geographic and socio-demographic inequities in provision of and access to clinical psychology services should be identified and addressed by those lead psychologists and those responsible for managing and commissioning services to ensure fair and equitable access to services

Robust needs analyses

Addressing equity of provision

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A more thorough analysis of the impact of down banding and loss of posts in service areas ◦ decreased quality of service delivery

◦ reduction in competency and resilience of workforce

◦ poorer outcomes

◦ more limited access to psychological intervention.

◦ impact on clinical psychology workforce morale and effectiveness

◦ loss of leadership

Addressing the impact of austerity

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 Strategies for improving the resilience and wellbeing of the clinical psychology workforce need to be developed

Ensuring access to appropriate supervision Continuing professional development Personal support and mentorship. Address issues of burnout and low morale

will improve the quality and effectiveness of service for service users and carers.

Resilience and wellbeing

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Effective, integrated, innovative services

All sectors

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The depth and breadth of clinical psychology undergraduate and postgraduate academic training

Broad role in health and care systems design, development and delivery

Innovative, integrated services to improve health and wellbeing and prevention of distress.◦ Research and development of scientific evidence base,

◦ Development of outcome and clinical standards

◦ Consultancy

◦ Service development and management

◦ Supervision, reflective practice, and teaching/ higher education

◦ Clinical risk management of quality of care and clinical outcomes

◦ Governance, quality assurance and accreditation of such interventions.

Need for a Chief Applied Psychologist post to influence National planning for the psychological professions?◦ ensure that psychological perspectives are fully embedded in the design and

delivery of health and care systems

Wider roles for clinical psychologists

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Increasing demand from non-mental health NHS services

An increased role in primary prevention of psychological distress and more engagement in early intervention/primary care services are under-developed areas for clinical psychology.

The British Psychological Society should collate and provide increased evidence of the cost-effectiveness of their service delivery for the health and care economy

Meeting expanding areas of need and demand

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Evidence of cost-effectiveness

Evidence Letting people know

Evidence for the cost-effectiveness of psychologically informed systems of health care and interventions should be developed and disseminated to provider—managers and commissioners of service.

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Other public sector (e.g. criminal justice, local authority, regulatory bodies, higher education)

Private, independent and voluntary sector organisations ◦ scoping need in PIV sector◦ inform future training commission provision

Scoping needs of non-NHS public and independent sector

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National government policies in health and care:◦ Contribution of psychological science in their development and

implementation requirements,

◦ Increased demand for clinical psychology skills and expertise

Evidence would suggest the need for around a 10% increase in training commissions rather than decrease◦ Psychology leads in a number of specialties report difficulties in

filling some psychology vacancies including at the most junior (Band 7) and senior consultant posts (Band 8c and above),

◦ Currently, only 1 in 6 applicants for clinical psychology training achieve a training place

◦ Robust supply of suitably qualified applicants for expanded training places.

◦ Particular focus on Regions with a low level of service and training provision.

Training and supply of clinical psychologists

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Development and evaluation of new models of integrated health and care

Potential for broader applied psychology services incorporating clinical, counselling, forensic, health and occupational psychologists offering flexible, tailored services to a variety of provider and commissioning organisations

New models of applied psychology in health and care?

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Leadership: National and local

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Improve the quality and development of services Manage clinical risk

◦ expert supervision

◦ guidance in psychological practice both within and outside the profession.

Develop extended clinical and leadership roles ◦ Management and commissioning of services

◦ Accreditation and training bodies

◦ Supported in accordance with recommendations of the Rose Review .

Form local, Regional and National alliances with users, carers, provider and commissioners to influence and develop systems of health and care

Strong National voice needed from BPS to advocate, represent and support practitioners

Leadership and support

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Over to you!

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DCP UK Clinical Psychology Workforce London 2nd December 2015

Dr Alison LongwillWoodcote Consulting

alison@woodcote-consulting.com@WoodcoteAlison

Tel: 0207 148 7170Mob: 07976 745396