Policy Into Practice How NHS priorities shape psychological therapies

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Policy Into PracticeHow NHS priorities shape
psychological therapies

• Prof. Ray Miller
• Professional Advisor for Psychology, NHS Lothian
• BPS President 2006-07

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Download

• PowerPoint presentation can be downloaded or
  viewed at
• www.raymiller.net/download

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History

• History is more or less bunk
  Henry Ford (1916)
• Those who cannot remember the past are condemned
  to repeat it George
  Santayana (1905)
• There is no cure for birth and death save to
  enjoy the interval.

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Growth in my time
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DCP
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BPS Annual Report
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Psychology in the NHS

• Milestones
• 1977 - Trethowan
• 1990 - MAS/MPAG Mowbray
• 1996 - Psychotherapy Services Parry
  Richardson
• 1999 - SCPMDE(NES) CAPISH
• 2006 - Lord (Richard) Layard
• 2007 - New Ways of Working for Applied
  Psychologists
• 2008 Improving Access (IAPT)
• 2009 Statutory Regulation (July)

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Some positive signs

• Workforce grown steadily but from very low
  baseline
• Training investment increased but may take 30
  years to reach adequate levels
• Greater input from Applied Psychology
• Innovations in training and service delivery
  (specialist flexible trainees, Clinical
  Associates)
• Investment in specific services (CAMHS, Older
  Adults?, Forensic?)
• Awareness of Psychology in the training of NHS
  professions
• Other professionals trained to use specific
  psychological techniques

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Current Policies
December 2006 December 2007
February 2008 December2008
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Current Policies
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Psychological Therapies
SainsburyReport onMentalHealth
Delivery (England) Psychol.Workforce2008(Sc
otland)
ImprovingAccess Toolkit (England)Increasin
gAvailabilityPhase 1(Scotland)
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Projected change in age structure of Scotland's
population, 2004-2031.
PERCENTAGE CHANGE
0-15 16-29 30-44 45-59
60-74 75
AGE (years)
Source GROS, http//www.gro-scotland.gov.uk/stati
stics/library/popproj/04population-projections/lis
t-of-figures.html 2004-based populations.
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Some negative signs

• Severe financial difficulties in NHS
• Fewer new posts, vacancies frozen, redundancies
• Cutbacks in training funding
• Reductions in partnership funding
• End of Specialist Flexible Traineeships?
• Lack of training funding for other than Clinical
• Trainee unemployment?
• Despite policy on increasing access
• Over-dependence of profession on NHS ?

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Statutory Regulationlegislation passed April 2009

• 1970s BPS press need for Statutory Regulation
• 1987 Register of Chartered Psychologists
• 1990s Attempts to introduce Psychologists
  Bill in Parliament or Lords
• 1999 Health Act regulation by Order
• 2001 HPC set up (operational 2002)
• 2002 John Hutton (Health Minister) says HPC
  is route for Psychologists
• 2003/4 BPS negotiates with DoH applies to HPC
• 2005 Consultation on HPC regulation
• 2005/6 Foster Review/ Donaldson Review
• 2007 White Paper Trust, Assurance and Safety
• 2008 HPC Threshold of Entry Standards of
  Proficiency Second Consultation on HPC
  Regulation
• 2009 Legislation passed. Register opened 1 July

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BPS Positionwww.bps.org.uk/statreg

• BPS is in favour of the principle
• Regulator should be independent, robust and
  effective
• Any new system must improve public protection and
  achieve registration of all who need to be
  regulated
• Entry threshold should be Doctorate (D/level 12)
• Concerns over Grandparenting
• Government agenda now NHS workforce management?
  
• Changes in HPC even less input from professions?

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White PaperFeb 2007
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Legislationpassed, April 2009
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HPCHealth Professions Council

• www.hpc-uk.org

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HPCwww.hpc-uk.org

• HPC only deals with the registration of Qualified
  Practitioner Psychologists
• It does not cover Assistants Trainees
  Clinical Associates Psychological Therapists
• There are special arrangements for Grandparenting
  and Overseas Qualifications

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HPCwww.hpc-uk.org

• Fees - 152 every 2 years
• Newly qualified - 76 for first 2 years
• Registration ONLY on graduation must be
  registered to be employed in NHS!
• What does HPC do for you ? It does
  NOT - promote psychology develop
  psychology defend psychology It
  DOES - police psychologists
• If you want a robust professional body that acts
  on behalf of psychology and psychologists
• join the BPS!

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HPC - Whos Next?
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Psychology Re-design

• New emphasis on psychology input to strategy and
  planning a seat at the table
• Ensuring psychological issues and opportunities
  are identified and pursued not icing on the
  cake
• New, flexible training routes (Kinderman model)
• Applied psychology not just Clinical
• Not simply a need for more psychologists
• Demand will continue to outstrip supply if we
  rely on psychologists alone
• Increasing psychological awareness of other
  professionals
• Training in specific therapies (CBT, IPT, CAT,
  Family Therapy, etc.)
• Need for safeguards and understanding
  limitations

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New Ways of WorkingJuly 2007
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Scottish ReviewDecember 2009
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The Workforce Context

• There is a need for the whole workforce in Health
  and Social Care to improve the level of
  psychological understanding and care.
• Psychological interventions should be provided by
  a whole range of professionals as well as applied
  psychologists.
• Applied psychologists can also make an important
  contribution to training, supervision, mentoring
  and to the development of psychological services.

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The Workforce Context

• There will be a fall in the number of young
  people nationally joining the workforce and
  available for Health and Social Care.
• If the demand for psychological interventions
  continues to grow and staff are required for the
  delivery, the large psychology graduate
  population could go a long way to meeting the
  likely staffing shortfall.
• Workforce planning for the Health and Social Care
  context has proved problematic and psychologists
  need to contribute actively to the initiatives
  designed to improve this state of affairs.

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Improving Access (IAPT)

• Guidelines agreed to help services develop in
  ways that improve access to psychological
  therapies and take account of important clinical
  governance issues
• Services redesign using a stepped care approach
  offers the best way forward
• Applied psychologists should play a major role in
  leading, developing, evaluating and commissioning
  psychological therapies services
• Applied psychologists have a strong role, with
  other staff, in ensuring clinical governance
  arrangements are in place

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Team Working(Capable Teams)

• Analysis, drawing on the theoretical literature
  and operational experience, of how teams work and
  how their effectiveness can be maximised.
• Applied psychologists have important role to play
  helping teams improve outcomes for carers and
  users.
• Applied psychologists need to integrate with
  teams, but also teams need to allow them to
  retain their unique identity and contribution.
• Psychologists should play a wider role, providing
  consultancy to organisations on organisational
  systems improvement.

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Creating Capable Teams
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Organisation Leadership

• Guiding principles for commissioners and
  organisations delivering psychological services
  include
• Board level representation is needed for delivery
  of psychological services
• Services must be aligned with the vision of
  future
• Psychological therapies and approaches should be
  organised in multi professional/disciplinary
  contexts
• Registered psychologists should aggregate
  together under the working title of Applied
  Psychologists

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Conclusion

• The End of the Beginning?

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No Health without Psychological Health

• Children and Education
• Health Promoting Schools
• Childhood obesity
• Immunisation uptake
• Parenting skills/ abuse and neglect
• Workplace
• Scotlands Health at Work
• Workplace stress
• Work/Life balance and retirement
• Absenteeism

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No Health without Psychological Health

• Lifestyle
• Smoking
• Alcohol
• Exercise
• Diet
• Mental Health and Wellbeing
• Mental Health (In)Capacity Acts
• Choose Life
• Doing Well by People with Depression
• Stigma (See Me)
• Mental Health Delivery Plan

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No Health without Psychological Health

• Physical Health
• Cardiac rehabilitation
• Diabetes
• Sexual health
• Chronic Illness and Rehabilitation
• Social wellbeing
• Social inclusion/ Fair for All
• Public Health
• Confidence and wellbeing
• Anger and violence

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Psychology in Scotland

• Heads of Psychology Services (HOPS)
• Scottish Medical and Scientific Advisory
  Committee (SMASAC)
• Psychology representation on ACF
• Positive relationship with NES
• Training and service innovation
• Input to consultations and advice
• Scottish BPS focus to meet Scottish needs
• Scottish BPS Office/ Parliament
• Devolved Divisions (DCP-S, DHP-S, etc.)

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The Future

• www.bps.org.uk

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Download

• PowerPoint presentation can be downloaded or
  viewed at
• www.raymiller.net/download