Scene settingClaire Lussignea - Professional Lead for Psychology
and Psychotherapy , Norfolk and Waveney
Time What Who
9.15am–10.00am Registration and refreshments All
10.00am–10.10am Introduction Director of Nursing, Quality and Patient Safety
10.10am–10.20am Scene setting Claire Lussignea - Professional Lead for Psychology and Psychotherapy , Norfolk and Waveney
10.20am–10.55am Presentation Anna Vizor - Professional Lead for Psychology and Psychotherapy, Suffolk
10.55am–11.05am General principles for the psychology and psychotherapy workforce - exercise 1
All
11.05am–11.25am Question 1 – your views All
11.25am-11.45pm Break All
11.45pm–1.00pm Questions 2, 3, 4, 5 - your views All
1.00pm–1.45pm Lunch All
1.45pm-2.45pm Questions 6,7,8 - your views All
2.45pm–3.15pm Overall view - Option 1, 2 or 3? - your views All
3.15pm – 3.45pm Questions and answers All
3.45pm – 4pm Summary and closing remarks Claire Lussignea and Anna Vizor - Professional Leads for Psychology and Psychotherapy
"If local NHS commissioners want to improve their budgets, they should all be expanding their provision of psychological therapy.”
"It will save them so much on their physical healthcare budgets that the net cost
will be little or nothing.”
Professor Lord Layard (2012)
Psychology (psychologists) demand and supply
• BPS 2005 recommended increase in clinical psychologists of 15% per year, yet commissioning has stayed stable
• DCP 2004 – need 7300 across NHS for adult and adult LD services: have 6900 in 2010 across all services
• E of E weighted population is 10.3%: population of psychologists is 8.5%
• CfWI 2012 – predict need for more psychologists
CfWI recommendations 2013
1. All providers of NHS commissioned psychological therapy services to gather workforce intelligence
2. Further work to be done to raise the profile and secure the future supply of the psychological therapies workforce
3. Employers and providers to undertake workforce capacity assessments for their psychological therapies workforce
Service users surveys – what’s the view?
• Strong public demand for psychological therapies yet many people still find it difficult to access them, therapy is not yet available to all those who may benefit from it, and that waiting times from referral to treatment are too long and vary significantly across the country MIND 2012
• One in five people had been waiting over a year, and one in 10 had waited over two years to receive treatment. In addition service users reported they did not always receive sufficient sessions to make genuine progress, and there was not always a real choice of effective treatments available MIND 2010
• Consultation questions – exercise – each question introduced for 5 minutes followed by 15 minute table top discussion
Psychology and psychotherapy strategy document: part one
Principles that underpin all our work and that stakeholders can assess us against:
The psychology and psychotherapy workforce should:
1. Be used to try to meet demand
2. Help to reduce or prevent problems
3. Help to develop practice based evidence
4. Be used to develop new ways of working that reduce distress
5. Demonstrate their cost effectiveness
6. Be accessible to others
7. Be clear about what they do
Question 1: Service users who need therapy should always be seen by a qualified psychologist or psychotherapist
Pros Cons
High standardAssessed practiceGoverned practiceFits with NICE guidelines
Expensive to deliverTakes a long time to develop workforceLong waitsRestricts available interventions
Question 2: We should see everyone who wants therapy
Pros Cons
Responsive to service usersEqual access to those who ask for it
Inverse care lawUnnecessary time in treatment
Question 3: How can we offer something to everyone who needs it
What the psychology workforce said:
1. Develop the workforce – use supervision and training more
2. Use technology to reach more people3. Make sure there is a psychological understanding of
everybody4. Understand the needs of hard to reach groups better5. Develop new and better psychologically informed
services6. Work with other agencies to reach more people
Model of role of psychologists/psychological therapists
Over focus: End point, most complex, skewed
Sometimes discussed, insufficient knowledge to prevent problems/address early need
Hardly discussed, poorly understood
Sometimes discussed but hardly ever doing interventions here
Psychologists/psychotherapists should assess and intervene at all levels
1. Referred clients receive services2. Caseloads are properly understood, what is not referred and should it be?3. Staff should be supported to work well4. Organisations are understood – what influences workers for the better or worse 5. Society – how can society be changed to reduce psychological distress
impact of inverse care law
Understood but poorly addressed
Society
Organisations
Staff teams
Caseloads
Referred cases
Question 4: We should improve our clinical and cost effectiveness
Pros Cons
Improve standardsReduce costsImprove outcomesReduce complaints
Takes time to collect and analyse dataRestricts expensive options
Question 5: We should spend some of our time testing new ways of doing things and finding out what works
Pros Cons
Develop new services/interventionsEvaluate new approachesAdapt to new presentations more successfully
Takes time to try new things outMight stop us using what already works for most
Psychology and psychotherapy strategy document: part one
Principles that underpin all our work and that stakeholders can assess us against:
The psychology and psychotherapy workforce should:
1. Be used to try to meet demand – Leading not trying. Need not demand
2. Help to reduce or prevent problems -
3. Help to develop practice based evidence
4. Be used to develop new ways of working that reduce distress
5. Demonstrate their cost effectiveness – Humanity over cost
6. Be accessible to others
7. Be clear about what they do
8. Across all people working within the Trust
9. Responsive to individual need
10. Co-production/Recovery/Integrated care
11. Service user and carer involvement
12. Workforce intelligence
Question 6: We should spend time supporting and developing the whole workforce
“…one in ten workers sought support from their doctors and 7 per cent started taking antidepressants for stress. Additionally, their mental health needs were directly caused by the effects ofthe recession on their workplace” CfWI 2013
Pros Cons
Improve mental and physical health of part of the communityImprove knowledge and skillsImprove working conditionsImprove recruitment and retentionsReduce staff sickness and temporary staffing costs
Time with staff is time away from service usersTime in training does not always change practice
Question 7: We should spend moretime preventing difficulties by intervening within our communities
Pros Cons
Reduce or prevent problemsIntegrated workingChange within other community settings to support mental wellbeingKnowledge and skill development in societyReduce stigmaCommunity cultural change
Time spent working with people who are not ill or having problemsTime spent with staff, not with service usersChange takes too long to evaluate the impact of us on itBuy in from other agencies might not be good enough to make changeCultural change is too complex for us to make much difference
Question 8: We should spend some of our time generating income to support the NHS services
A Foundation Trust can make money from others outside of the NHS budget, to support its ability to provide services paid for within the NHS budget
Pros Cons
Provide new and different servicesMotivating for staffMore money to provide existing services
Time spent doing this is time away from service usersMight lead to two tier systems and lack of equitable service
Final view:
There’s a lot to do within a small workforce – what shall we do?
Current model - Option 1
Some people do lots of some things, others do lots of other things – existing model
Everything gets done, and this is balanced across a well planned workforce
Nothing is clear enough, so some people do what is needed and other people do what they want
What would help to provide more clarity about who should do what?
Option 2 Everybody does everything
ProsEverything gets done in equal measure
ConsNothing gets done very well and everybody is overwhelmed
Option 3 Everybody does most things but a few things are left out
Most things get done without people being too overwhelmed
Not all things get done What should be left out? What are your priorities?
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