CHILD AND ADOLESCENT PSYCHIATRY

Transcription

1 MEDICAL SPECIALTY WORKFORCE FACTSHEET CHILD AND ADOLESCENT PSYCHIATRY This document sets out factors that will be considered when assessing the supply and requirement of the future medical workforce. The first section of the fact sheet focuses on the future requirement of the specialty; the second section focuses on the current supply. This information will form part of the body of evidence used to advise recommendations of future medical training numbers. At this stage it does not present conclusions or recommendations. This is a live document that represents work in progress; it will be updated on an on-going basis as information is located and made available to the CfWI. The CfWI welcomes relevant contributions to the content or interpretation of information within the medical specialty workforce fact sheets. As a guide, the document is set out in the following divisions. Some of the themes that have been identified may overlap several divisions. Considerations for future requirements Current Status of Specialty s Requirement Demographics Health and Lifestyle Prevalence and estimated future incidence of factors that affect requirement Changes in practice which may affect level of service Finished Consultant Episodes (FCEs) and Outpatient Attendances Weighted Capitation Historical and forecast supply Existing Workforce Consultant projections Geographic distribution Recruitment to further medical training Related healthcare workforce CfWI August

2 CONSIDERATIONS FOR FUTURE REQUIREMENTS Current Status of Specialty s Requirement A Royal College of Psychiatrists (RCPsych) workforce report by Lamb, Kelvin and Hall recommends a level of 1.5 FTE child psychiatrists per 100,000 total population to provide a core service for people aged 0-17 years that is adequately resourced with other professionals (Lamb, et al, 2008). It also recommends a further 0.75 FTE for full services up to the patients eighteenth birthday along with the appropriate balanced multidisciplinary team. This would equate to a consultant workforce of 1,174 FTE in England, based on the Office for National Statistics (ONS) population estimates for The Information Centre (IC) Census reports that there are 658 (583 FTE) child and adolescent psychiatry consultants employed in England as of September The Child and Adolescent Mental Health Services (CAMHS) faculty at the Royal College of Psychiatrists reports increasing workload pressures on the specialty due to factors including: greater recognition of mental health conditions such as Attention-Deficit Hyperactivity Disorder ADHD and Autistic spectrum disorders a reduction in stigma, leading to greater acceptance of mental health problems and the desire to seek treatment the impact of the economic downturn CAMHS also reports difficulty attracting trainees to the specialty. Vacancies and Locum Staff The most recent data available (ESR, extracted via iview, March 2010) records that 0.7% of the practising consultant workforce are locums (10 locums out of a total of 695 consultants). The IC vacancy survey (2008) records a three-month vacancy rate of 2.1% for child and adolescent psychiatry consultants in England. Geographically this is particularly high in the North East at 10.4% and the East Midlands at 6.9%. The only other SHAs reporting three-month vacancies are the North West at 4% and London at 0.7%. SAS grade posts are reportedly significantly more difficult to fill than consultant posts across the whole of psychiatry, due in part to fewer applicants from overseas. CfWI August

3 Demographics Figure 1 shows the age range served by Child & Adolescent Psychiatry services, and projected population changes between 2010 and 2031 which will drive future requirement for those services. It further indicates the age and gender of the population which relies most heavily on Child and Adolescent Psychiatry. The areas highlighted in blue and pink refer to the population which typically present for care in this specialty for males and females respectively. A grey area indicates a section of the population which is not typically served by the specialty. The bold lines indicate the level of the population in Figure 1: 2031 population estimate and indication of age and gender of the population which relies most heavily on Child & Adolescent Psychiatry Age Group Females most heavily reliant 2031 Females less heavily reliant 2010 Males most heavily reliant 2031 Males less heavily reliant Black outline population estimate Figure 1 shows growth of the population up to 2031 by age band as predicted by the ONS. It indicates that those aged up to 19 are most reliant on child and adolescent services. It also indicates that the greatest growth of the population is to be in the over 60s. 5% 4% 3% 2% 1% 0% 1% 2% 3% 4% 5% CfWI August

4 Figure 2: Demographic Summary all ages % 0.79% -0.01% 0.43% 0.01% 0.5% 2.03% 0.74% Time/years 2031 Figure 2 displays the relative population percentage growth per year broken down by age groups highlighting the variable rates over time and age. In, the age group which accounts for the most significant proportion of care required is generally the children's population. The average growth of the children's population is about 0.5%. CfWI August

5 Health and Lifestyle Lifestyle Influences The aim of information presented here is to suggest possible influences on the future requirement for services. These indicators have not been quantified but rather present intelligence from which future trends on the impact of requirements to the specialty may be ascertained. The information presented here does not constitute a complete list. Prevalence of disorder in mental health The 2004 survey carried out by the ONS gathered much information on prevalence of mental health disorders (Office of National Statistics, 2004). It found that the statistically significant odds ratios for the socio-demographic correlates of a child having any mental disorder (compared with no disorder) were: age, sex, ethnic group, family type, whether living in a reconstituted family, family s employment situation, socio-economic classification, household income, parental educational qualifications, type of area and country. These factors will influence the expected occurrence of mental health disorders in children in the future. Further research on factors that may influence future prevalence may be useful in areas where those factors may change, such as ethnicity patterns, family type, and stability of family group. This will inform whether any of these factors will change so significantly as to substantially alter the rate of mental health disorders in the young. Public awareness of mental health disorders There is a trend towards greater awareness and acceptance of mental disorders such as ADHD and autistic spectrum disorders. This trend is likely to continue in the future, which will increase the workload in child and adolescent mental health services. Further research could enable an estimate of whether the increases are continuing, or whether numbers are starting to plateau. Prevalence and estimated future incidence Some factors in a child s life that increase their likelihood of mental health disorders have been covered in the lifestyle section. It can be difficult to determine whether an increase is due to lifestyle factors, or independent increases in the prevalence of disorders. The prevalence of mental health disorders is also likely to increase in line with population growth, as discussed in the demographics section. CfWI August

6 Changes in practice which affect level of service Improving access to child and adolescent mental health services The joint Department for Children, Schools and Families and the Department of Health report on Improving access to child and adolescent mental health services makes the following recommendations on the need for: clearly signposted routes to specialist help an open door into a system of joined-up support timely access to this help available during any wait Child and Adolescent Mental Health Services Review In the 2008 CAMHS Report entitled Children and young people in mind: the final report of the National CAMHS Review it states that children s services will work effectively together to provide well integrated child- and family-centred services to improve mental health and psychological well-being. As part of this: Universal services will play a pivotal role in promotion, prevention and early intervention Specialist services will deliver support that is easy to access, readily available and based on the best evidence. Staff across these services will have a clear understanding of their roles and responsibilities and those of others, and will have an appropriate range of skills and competencies. Finished Consultant Episodes (FCEs) and Outpatient Attendances Finished Consultant Episode (FCE) data are not an appropriate measure of requirement for due to changing practices in this specialty in recent years. Changes in service provision location mean that FCE data from recent years are not comparable, partly due to a greater degree of community based service. CfWI August

7 Weighted Capitation Table 1: Table of six scenarios for each SHA based on weighted capitation for the possible requirements of junior doctors Strategic Health Authority Ratio of Actual: Weighted capitation Move all to average value Move all to median value Move all to min Move all to 2nd min Move all to 2nd Max Move all to Max North East North West Yorkshire & The Humber East Midlands West Midlands East of England London 2.80 max max Max max max max South East Coast 0.06 min min Min min min min South Central South West Total % change 1.7% -0.6% -42.1% -16.3% 25.8% 112.6% CfWI August

8 The table above displays six scenarios based on weighted capitation (WCAP) alone for the possible requirements of junior doctors in Child and Adolescent Psychiatry. Column 2 is the ratio of the actual capitation to the calculated theoretical capitation. Columns 3-8 are the scenarios where all except the most under capitated and the most over-capitated are moved to the mean, median, least, 2 nd least, 2 nd most and most capitated levels respectively. The values in the 2 nd row are the mean, median, least capitated, 2 nd least capitated, the 2 nd most and most capitated respectively. This analysis reveals that change in requirements range from an increase of 25.8% (2 nd most capitated) to a decrease of 16.3% (2 nd least capitated) on average when only weighted capitation is considered for CfWI August

9 HISTORICAL AND FORECAST SUPPLY The historical supply of child and adolescent psychiatrists (all medical grades) and the forecast supply of consultant psychiatrists are shown in Figures 3a-b. The figures are based upon the latest data available (SAS data only dates back to 2005). Figures 3a-b: (a) Workforce supply (FTE) and, (b) Workforce supply (HC) 1200 Cumulative historical workforce supply (FTE) and future consultant projections Cumulative historical workforce supply (HC) and future consultant projections SAS 1000 SAS 800 All Trainees 800 All Trainees FTE Consultants FTE (historic) Consultants FTE (forecast) HC Consultants HC (historic) Consultants HC (forecast) Year Year The chart above shows an expansion in the workforce since 1997 and that the supply of consultant psychiatrists is forecast to increase during the next decade. Trainees (which are defined as those in the F2, SHO and registrar groups) account for just under half the workforce in total. Data suggests that there has been an increase of 93 FTE consultants between 2004 and 2008, which is approximately 19% of the workforce recorded in The CfWI modelling suggests that the supply of consultant child and adolescent psychiatrists over the next 10 years is forecast to increase to 766 FTE in 2018 (861 headcount), an increase of approximately 30%, based upon the following assumptions: CfWI August

10 retirement occurs at 60 years of age 35% of current trainees are delayed in completing their training by one year, 10% are delayed by two years, 5% by three years and 5% by four years there are four international recruits per annum, no young leavers (non-retirements) per annum and no returners per annum, there is no conversion from staff grade or associate specialist posts to consultant posts there is a wastage rate amongst registrars of 2%. In the past, the accuracy of WRT s projections in this specialty have been true to within approximately 7%, based upon records published by the IC from 2005 to Existing Workforce Supply According to the 2009 IC census there are 583 FTE (658 headcount) consultants, while Electronic Staff Records (ESR) from September 2009 record 590 FTE (665 headcount). This is a difference of less than 5% in comparison to census records. The latest available data records 600 FTE members of staff (685 headcount) (extracted via iview from ESR, March 2010). The age profile of the current consultant workforce as at September 2009 is shown in Figures 4a-b. CfWI August

11 Figures 4a-b: (a) Age profile (FTE) and, (b) Age profile (Headcount) consultants FTE Consultant age profile (FTE) - Headcount Consultant age profile (Headcount) - Child and Adolescent Psychiatry ` Under Age bracket (years) and over Under Age bracket (years) and over The charts show a typical age profile with a strong supply of younger staff, and also that a number of staff are working beyond typical retirement age. However, as most consultants have Mental Health Officer status, any change in public sector pensions could result in significant numbers retiring within a short time period. The IC three-month vacancy rate for all psychiatry consultants is 1.6% as of March 2008 (the latest available data); the three-month vacancy rate for child and adolescent psychiatry consultants is higher at 2.1%. Geographic Distribution Tables 2a and b below show the geographic distribution of doctors and trainees in absolute values and in relation to the weighted capitation of each Strategic Health Authority (SHA). A definition of weighted capitation is given below*. CfWI August

12 Tables 2a-b: (a) Number of doctors minus the weighted capitation, b) Actual number of doctors, by grade and SHA for Number of doctors minus the weighted capitation, shown for by SHA - Based on latest data available as at April 2010 Actual number of doctors by grade and SHA, shown for - Based on latest data available as at April 2010 Table (a) Table (b) SHA Weighted Capitation Junior Doctors Staff Grade Specialty Doctor Associate Specialist Consultant Junior Doctors Staff Grade Specialty Doctor Associate Specialist Consultant North East 5.9% North West 15.2% Yorkshire & The Humber 10.8% East Midlands 8.6% West Midlands 11.2% East of England 10.2% London 14.1% South East Coast 7.6% South Central 6.6% South West 9.8% Total 100% CfWI August

13 Tables 2a and b suggest that three SHAs namely London, South Central and the North East take a greater proportion of England s junior doctors and consultant grade doctors than if provision were to follow weighted capitation. *The Department of Health uses a weighted capitation formula (WCAP) to distribute resources to primary care trusts (PCTS) based on the relative health needs of each PCT s catchment area. If qualified doctors and trainees were equitably distributed according to the formula, all other columns in Table 2a would be zero. Values greater than zero indicate that the SHA has more doctors and trainees than would be included by WCAP; values less than zero indicate evidenced room for growth of the workforce. Recruitment 2009 The level of recruitment to further medical training is shown in Table 3. The table illustrates the situation at point of entry in The data corresponds only to posts openly advertised but not those training posts secured by run-through trainees, who represented the majority of ST4 posts filled in 2009: CfWI August

14 Table 3: 2009 specialty recruitment for at ST4 (data as of October 2009) Deanery Available Posts Accepted Posts Fill Rate East Midlands % East of England Kent, Surrey and Sussex London 6 0 0% Mersey The table shows that there is an uneven distribution in recruitment to specialty training geographically. The East Midlands and Peninsula deaneries recruited to all the posts available in their local area and three deaneries namely Severn, North West and London did not recruit to any post available in In CfWI s view, the extent to which the current number of available posts are filled together with geographic distribution are essential factors in evaluating the requirement for additional consultant posts. North West 1 0 0% Northern Oxford Peninsula % Severn 2 0 0% West Midlands Wessex Yorkshire and the Humber Total % CfWI August

15 Related Healthcare Workforce Child and adolescent psychiatrists commonly work alongside nurses with mental health, paediatric or learning disabilities expertise, social workers, clinical psychologists, paediatricians, general practitioners, health visitors and less sizable workforce of occupational therapy and speech and language therapy CfWI August

16 REFERENCES CAMHS. Children and young people in mind: the final report of the National CAMHS Review" Department for Children, Schools and Families and the Department of Health. Improving access to child and adolescent mental health services, Available at: Information Centre for Health and Social Care. (2008). Vacancy Survey. Lamb, et al. (2008). College report on workforce. Roayl College of Psychiatrists. Mental Health Foundation. (2010). The Lonley Society? New Ways of Working. (2010). Retrieved from NHS Workforce Review Team. (2008). Workforce Summary. OCD-UK. (2010). Retrieved from OCD UK: Office for National Statistics. (2005). Health Statistics Quarterly. Office of National Statistics. (2004). Mental health of children and young people of great Britain in Patient.co.uk. (2010). Poverty-and-Mental-Health. Retrieved 2010, from TNS UK for the National Mental Health Development Unit, Department of Health. (2010). Attitudes to mental illness 2010 research report. CfWI August

17 OTHER SOURCES Department of Health (2010) Foresight, (2007) NHS Information Centre (2010) Office of National Statistics Workforce Review Team CfWI August