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DCP UK Clinical Psychology Workforce

London 2nd December 2015


Dr Alison Longwill
Woodcote Consulting
alison@woodcote-consulting.com
@WoodcoteAlison
Tel: 0207 148 7170
Mob: 07976 745396

Main aims

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

Background

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% overestimate 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
3

Methodology

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

HCPC data: 11,900 total

Understanding geographic
variations

Online survey

Similar profile to national data - representative


79% female respondents
Average age 42

Planned age of retirement for clinical psychologists aged 50 years and over (n = 951): online survey
30
27
25

20

19

15
12

11

percentage of sample
10

0 0

2 2

3 3
1

1
0

0 0

10

Number and pay bands (HSCIC


England) NHS n = 8810

11

Pay band

12

% psychologists with > 1


employer

13

NB no data on non-NHS
salaries
Mean salary (NB NHS scale data only)
56000

55221

54000
52000

51010

50000
Mean pro-rata salary

48000

47030

46000
44000
42000
Main

Second

Third

Employer(s)

14

First Destination
employment

Growing role: non NHS

Range of specialties
15

Trends
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


16

Type of contract

17

Hours of work

18

Clinical psychologists by
specialty

19

20

Work in sectors

21

Professional memberships of
survey respondents

22

Some key themes and


concerns
From online survey

23

Impact of austerity
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

24

More for less demanded

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

25

Lack of career progression

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
26

Career structure issues

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

27

Too much pressure


Reduced funding, fewer clinical
psychologists but waiting lists going up
Limiting targets reducing
flexibility/creativity
High risk and complexity of case work
increasing

28

Uncertainty about future


Ongoing threats of service reviews and
down banding
More temporary or fixed term contracts
Future of profession in NHS unclear

29

Resilience and well-being issues


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

30

Need for broader working


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

31

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

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
32

Lack of transparency and accuracy : workforce


planning supply and demand models

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
33

Leadership needed
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?

34

Some developing
areas

35

Demographic and social


trends

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 futures digital
http://www.nhsconfed.org/resources/2014/
09/the-future-s-digital-mental-health-an
d-technology
Social media practitioner profile also
needs to develop
36

The Bigger Picture: National Policy, Reviews, Guidance

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

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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/Aspergers 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

38

Recommendations for
action

39

Early priorities for action


1.

2.
3.

4.

5.

Further development of workforce planning


model for clinical psychology in conjunction with
key partners from service provider, commissioning
and training organisations
Addressing equity of provision
Development of effective integrated service
models of psychological services and
commissioning guidance
Leadership development in local health
communities
Strong National voice needed from BPS to
advocate, represent and support practitioners
40

Robust Workforce
Planning

41

Developing a robust workforce plan and


model for clinical psychology

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.

42

Improving accuracy of baseline data

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.
43

Engaging psychology leads in workforce planning

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.

44

Equity and Access

45

Addressing equity of provision

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

46

Addressing the impact of austerity

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

47

Resilience and wellbeing


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.

48

Effective, integrated,
innovative services
All sectors

49

Wider roles for clinical psychologists

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

50

Meeting expanding areas of need and demand

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

51

Evidence of costeffectiveness

Evidence for the costeffectiveness of


psychologically
informed systems of
health care and
interventions should be
developed and
disseminated to
providermanagers
and commissioners of
service.

Evidence

Letting people know


52

Scoping needs of non-NHS public and independent


sector

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

53

Training and supply of clinical psychologists

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.

54

New models of applied psychology in health and care?

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

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Leadership: National
and local

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Leadership and support

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

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Over to you!

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DCP UK Clinical Psychology Workforce


London 2nd December 2015
Dr Alison Longwill
Woodcote Consulting
alison@woodcote-consulting.com
@WoodcoteAlison
Tel: 0207 148 7170
Mob: 07976 745396

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