WORKFORCE RISKS AND OPPORTUNITIES CLINICAL PSYCHOLOGISTS, PSYCHOLOGICAL THERAPISTS AND RELATED APPLIED PSYCHOLOGY DIVISIONS

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1 WORKFORCE RISKS AND OPPORTUNITIES CLINICAL PSYCHOLOGISTS, PSYCHOLOGICAL THERAPISTS AND RELATED APPLIED PSYCHOLOGY DIVISIONS EDUCATION COMMISSIONING RISKS SUMMARY FROM 2012 SEPTEMBER 2012

2 Welcome to the 2012 CfWI workforce risks and opportunities: education commissioning risks summary (WRO ECRS 2012) for applied psychologists. The WRO ECRS 2012 reports cover all professions across health and social care, except the medical profession, which was covered in a report in 2011 ( /medical-shape-2011). Each report describes the key issues facing the different professions over the next three years, and aims to support local decisions on future education and training commissioning. The reports do not make specific recommendations for local commissioning decisions as these decisions are made through consultation between the education and training commissioner and employers. The reports will be submitted to the Department of Health in several tranches between November 2011 and the end of September This is a time of great change in the NHS. Employers are considering how best they can transform their services to maximise the quality of patient care, improve productivity and release the 20 billion savings to be reinvested in front line clinical care. This work could have a major impact on the future shape of the workforce and so needs to be considered alongside education and training commissioning decisions that are being made now. Financial allocations are a pivotal component of the overall education and training annual process across England. Presently the Department of Health secures funding to invest in the workforce through the Multi-Professional Education and Training (MPET) levy which is around 4.9bn for 2011/12. This funding is currently allocated to Strategic Health Authorities (SHA) largely based on historic patterns of training. The Department sets out key priorities and holds SHAs to account through a Service Level Agreement. SHAs develop plans for education commissions based on local workforce plans and then commission and fund training from education and clinical placement providers. Looking towards 2012/13, a flat cash settlement for MPET is likely. This allocation will have to accommodate a range of cost pressures which will include new costs, price increases and volume changes. In setting local investment priorities for the MPET allocation, SHAs are encouraged to consider the evidence presented within the WRO ECRS 2012 and the medical specialty training numbers reports. We hope you find the reports useful, and as always, appreciate your constructive feedback. Professor Moira Livingston Commissioning Director CfWI CfWI September

3 Purpose This information has been collated to inform decisions on education commissioning over the next three to five years. It considers key factors influencing the estimation of future need of applied psychologists and gives an assessment of the current workforce supply. It includes regional perspectives and a summary of risks in education commissioning. Summary of professions: this document primarily covers clinical psychologists, psychological wellbeing practitioners and high intensity therapists, due to the availability of data on staff employed in the NHS. Clinical psychologists are one staff group in the applied psychology field. Other applied psychologist divisions include forensic, health and counselling psychologists, among others. Psychological therapists commonly work alongside applied psychologists. Psychological therapists have a range of professional backgrounds including applied psychology in addition to mental health nursing or social work, for example. In the main section, a summary of supply figures for all applied psychology divisions is given, where data is available. Not all applied psychology divisions are covered by this report due to data limitations, and because it is recognised that other divisions can be involved in care of NHS patients, a brief summary of supply factors and demand issues regarding Occupational psychologists, Health psychologists, Forensic psychologists, Education psychologists and Counselling psychologists are presented in an appendix where information and data is available. Funding for pre-registration training for clinical psychologists is available via the NHS through NMET. Pre-registration training funding for psychological therapists is also available, via NMET. Pre-registration training for related applied psychologists, including forensic, educational, health, occupational and counselling psychologists, are not directly funded by the NHS. Information not specifically attributed to a division can be considered to be general. Psychological therapists, namely high-intensity therapists (HITs) and psychological wellbeing practitioners (PWPs) are reported in as much detail as is currently available. KEY FINDINGS The number of recorded NHS clinical psychologists appears to be greater than the number of all applied psychology staff registered with the Health Professions Council (HPC). This suggests significant limitations in data and potential for misrepresentation. The Improving Access to Psychological Therapies (IAPT) programme is set to increase the number of psychological therapists. A risk to the workforce is that skill-mix and supply pipelines are not discernible for different groups of staff involved in IAPT. CfWI September

4 Calls for growth in research may increase demand for the services of clinical academic psychologists in the future. Roles including Approved Mental Health Professional and both Approved and Responsible Clinicians have extended the activity of applied psychologists. Next steps Commissioners to monitor skill mix occurring through the IAPT programme and consider how this may affect future commissioning. Health and Social Care Information Centre (HSCIC) and the British Psychological Society (BPS) to confirm and adopt a solution to accurately identify applied psychologists together with psychological wellbeing practitioners, high-intensity therapists and other developing roles in the NHS, in discussion with other associated professional bodies as necessary so that In-depth data can be collected on all applied psychology divisions. The Department for Health (DH) to work with the profession to devise a method for recording workforce information in the private and independent sectors because qualified staff may transfer in or out of the public sector at any point in their career. Employers to work with the CfWI, through Strategic Health Authorities (SHAs) now and in the future through the Local Education Training Boards (LETBs) to investigate levels of demand from the perspective of service providers in addition to population demand and in the context of mental health strategy such as IAPT. CfWI September

5 CONSIDERATIONS FOR FUTURE REQUIREMENTS Policy drivers Table 1 summarises the key policy drivers and the relevant references. Table 1: Policy drivers affecting the workforce applied psychologists Key drivers 1.Cross-Government outcome strategy Public Health England is charged with raising mental health as a key workforce priority. The benefits of early intervention are acknowledged and this strategy aims to further promote mental health. 2.Improving Access to Psychological Therapies As part of the outcome strategy outlined above, investment is pledged for the Improving Access to Psychological Therapies (IAPT) programme to increase the workforce to approximately 6000 cognitive behaviour therapy staff and expand access to children and young people, older people, carers, those with long-term physical conditions and severe mental health needs. This is the second stage in this national programme that originally focused on adults of working age. It continues to affect the type of staff typically involved in delivering cognitive behaviour therapies in the NHS. Relevant policy No health without mental health: a cross-government mental health outcomes strategy for people of all ages - a call to action (DH, 2011a) Talking therapies: A four-year plan of action - A supporting document to No health without mental health: A crossgovernment mental health outcomes strategy for people of all ages (DH, 2011b) Applied psychologists continue to be involved in both designing and delivering the IAPT programme. Strategic health authority (SHA) perspective SHAs work in partnership with employers (service providers), service commissioners, education providers and each other to assess workforce requirements. This then informs education commissioning plans in each region. SHAs work with local employers to inform their decision making. This is a requirement of service level agreements between SHAs and the Department of Health (DH) for the investment of education and training funds. The CfWI has therefore engaged primarily with SHAs as the agreed route to ensuring the views of employers are considered, as part of this work. Following NHS reform, it is likely that the CfWI will engage with employer-led Local Education and Training Boards to gain this perspective. Discussions with SHAs indicate that across all regions that, despite a small reduction planned for 2012/13, there is a need to maintain a steady state of training commissions and make minor adjustments to commissions informed by regional reviews and IAPT guidelines. CfWI September

6 Profession s view A demand-supply gap was identified in 2005 by the British Psychological Society (BPS) according to a survey carried out in England (British Psychological Society, Department of Health and Home Office, U.K. government, 2005). The gap was forecast to worsen between 2005 and In 2005 the BPS recommended that the typical annual growth in posts of 9 per cent in clinical psychology should be increased to 15 per cent per annum to remedy any gap. Historical data shows that planned commissioning has stayed relatively stable since 2005/06 and 2010/11 academic years with about the same number planned in 2010/11 as was planned in 2005/06. The BPS have estimated a requirement of 7300 full-time equivalent (FTE) staff, which covers only clinical psychologists working in adult mental health and adult learning disabilities services (Division of Clinical Psychology Workforce Planning Advisers, 2004). This is in comparison to a total FTE of all clinical psychologists across all services of about 6900 in The BPS estimation is based on a service model which itself is based on the mental health National Service Framework for Mental Health. The framework covers activity including preventative care, services in primary care, and services for severe mental health needs and impact for carers, suicide prevention, residential and community settings. The service model is not held up as ideal, instead that a model of service is required to create a model of demand and this one was selected. It should also be noted that new roles have been developed and as a result service delivery has also changed since the BPS estimate was made. Demographics Clinical psychologists in general work with people across all ages. The Office for National Statistics (ONS) forecasts that the population in England will increase by over 7 per cent in the next 10 years, and the proportion of people aged over 65 in England will increase from 17 per cent of the total population in 2011 to 22 percent in The 0 19 population will grow from 12.4 million in 2011 to 13.8 million in As a percentage of the whole population, this age group will account for 22.8 per cent in 2031, which is a slightly lower proportion than the 2011 figure of 23.5 per cent (ONS, 2010). Changes in activity Approved Mental Health Professional and both Approved and Responsible Clinicians New roles have extended the activity of psychologists. Specifically, two roles have developed as a result of the 2007 revision of the Mental Health Act in England (National Mental Health Development Unit, 2007). These include Approved Mental Health Professional, which allows mental health professionals to undertake roles traditionally delivered by Approved Social Workers, on completion of suitable training (National Mental Health Development Unit, 2007). The second role is that suitable psychologists are also now among the group of healthcare professionals eligible to act as both Approved and Responsible Clinicians, titles which relate CfWI September

7 to competence in the Mental Health Act and previously only related to medical staff. These changes in activity may increase demand for staff. Research in psychological therapies Clinical research has been highlighted as an important area of growth in the NHS in general. In particular, the National Institute for Health and Clinical Excellence (NICE) guidance repeatedly highlights the lack of good quality outcome trials in the field of psychological therapy (NICE, 2011). Clinical academic psychologists are one of a number of professional mental healthcare staff who may be involved in undertaking this activity in the future. This may affect demand for staff in the future. CURRENT AND FORECAST SUPPLY Existing workforce According to the BPS, approximately 95% of clinical psychologists are employed in the NHS (British Psychological Society, 2007). Supply Clinical psychologists are the only applied psychology staff group with a formal NHS occupation code in the Electronic Staff Record (ESR). Their recorded supply is shown in table 2. Table 2: Current qualified NHS clinical psychologist workforce Staff type Headcount (HC) Full-time equivalent (FTE) FTE/HC Consultant therapist Manager Therapist Scientist Technician Tutor Qualified staff Source: Health and Social Care Information Centre (HSCIC) Non-medical Census September 2010 published in March 2011 Based on corresponding data, there were 25 more staff members in 2011 than in the previous year, and the FTE recorded in 2010 was 6706, which is a difference of 205 in comparison to the number recorded in 2011 (HSCIC, 2011b). Based on the NHS IC census data, over the past ten years, the degree of participation in the workforce, represented by a division of FTE by HC, ranged between 0.78 and 0.83, remaining stable at 0.81 for most years. The data shows that there were 8289 qualified clinical psychology staff working in the NHS in However, there are limitations to this data. CfWI September

8 Data limitations Significant limitations have been identified by the BPS among others surrounding the number of clinical psychologists recorded in the NHS. Typically staff members are recorded in the NHS via The Electronic Staff Record (ESR). Currently there is a limited range of occupation codes for psychologists, which do not cover all current divisions of applied psychology distinctly, which can result in any type of applied psychologist being recorded by an NHS organisation specifically as a clinical psychologist (which is the most common applied psychology field in the NHS and the only division with an occupation code). This issue affects both the records of clinical psychologists and those of other applied psychology divisions. It is likely that the number of clinical psychologists recorded in the ESR may be inflated because any other divisions of applied psychologists working in the NHS may be recorded as clinical psychologists in the absence of a specific occupation code for their division (BPS, 2011). An illustration of this is available in the supply projection in this document which indicates that there are more clinical psychologists recorded in the NHS than recorded with the HPC. As registration with HPC is required in order to practice as a psychologist in the NHS, the reverse would be expected (or at least for the number of HPC records to equal those NHS ones), suggesting a data issue. Risks to the workforce include: the number of clinical psychologists may be inflated, which would affect workforce planning as the numbers may mislead commissioners on the current baseline workforce. the number of all other psychologists would remain disguised. The BPS (BPS, 2011) reports a number of issues with the current method of recording staff, including: No occupation codes are available to distinguish between clinical psychologists and other practitioner psychology divisions. No occupation codes are available to distinguish psychological therapists such as IAPT therapists, who are, for example, put into clinical psychology or psychotherapy or nursing, so they cannot be accurately mapped. The developing roles of mental health professionals does not map well to traditional groupings of clinical psychologist, psychotherapy [among others]. Proposed solutions from the BPS include: creating a new main category: U for the psychological workforce. Potentially this could include: Psychotherapists, Counsellors, IAPT Practitioners, Art/Music/Drama therapists. and/or creating two new sub-categories within category S for practitioner psychologists and psychological therapists only, with single occupation codes for relevant sub-divisions (BPS, 2011). That is, four groups into the S category, namely: CfWI September

9 a. Practitioner psychologists (Clinical Psychology, Educational Psychology, Health Psychology, Counselling Psychology, Forensic Psychology, Occupational Psychology, Psychology Assistants) b. Psychological therapists (Psychotherapists, Counsellors, IAPT Practitioners, Art/Music/Drama) c. Allied Health Professions (unchanged from current) d. Other qualified scientific and technical staff (Pharmacy, Dental Other, Operating Theatre, Social Services, Other) It would be beneficial for any issues surrounding these pragmatic proposals to be discussed and a consensus reached and put into practice at the earliest opportunity. Additional data from the British Psychological Society In 2010, the BPS recorded: Table 3 British Psychological Society membership Staff division Headcount Clinical psychologist 9554 Counselling psychologist 2892 Educational psychologist 2227 Occupational psychologist 3872 Forensic psychologist 2148 Health psychologist 1654 Clinical neuropsychology ( a sub-division of clinical psychology) 984 Total Source: data extracted from BPS 2010 annual survey supplied to CfWI via CWI Workforce Summaries and Recommendations 2011 Stakeholder Response Template The data shows that 23,331 applied psychologists (including all recorded divisions) were registered as members with the BPS in 2010 and the clinical psychology division is the largest. The health psychology division is the smallest. Chartership The society currently has 17,912 chartered members as at September 2011 (Workforce Planning Advisors Standing Committee, BPS, 2011). Chartership is considered to be the gold standard for practice. Data limitation Chartered members of the BPS may or may not be actively employed. They may have retired, for example, and records of chartership may not represent the available workforce accurately. Official estimates of how many people are actively employed within BPS membership are currently unavailable. The BPS is considering conducting a survey of its members on this in CfWI September

10 Psychological therapists Improving Access to Psychological Therapies Two new staff roles have developed as part of the national IAPT programme. Psychological Wellbeing Practitioners are typically Agenda for Change (AfC) band four trainees and employed at AfC band five when qualified. They deliver low-intensity, step 2 interventions including assisted self help and signposting. High Intensity Therapists work generally at step 3 delivering face-to-face therapies, including cognitive behaviour therapy, interpersonal psychological therapy, counselling for depression, couple-counselling for depression, and brief dynamic interpersonal psychotherapy (National Programme Director, Finance, Operations and Delivery Lead, National Advisors for Workforce, Education and Training Project Manager, Improving Access to Psychological Therapies, 2011). According to IAPT programme leaders, all but six primary care trusts in England provide one form or another of IAPT services, as at November 2011 (National Programme Director, Finance, Operations and Delivery Lead, National Advisors for Workforce, Education and Training Project Manager, Improving Access to Psychological Therapies, 2011). As at November 2011, data on supply is unavailable, however, at time of writing, IAPT programme directors are intending to carry out a staff survey to collect information on the workforce. A risk to the workforce is that skill mix options and supply pipelines are not distinct or identifiable for different groups of staff. For example, it would be useful to be able to identify applied psychologists as well as psychological therapists where both work on IAPT. This clarity would help facilitate workforce planning and aid decisions in future education commissioning. Additionally, this may help prevent the development of unclear career frameworks, which may lead to trainees entering the profession without a clear route of progression, and would have implications for both the trainee and workforce planners. CfWI September

11 Education commissioning risks summary Age profile The age profile of clinical psychologists employed in the NHS in 2010 is shown in figure 1 (the latest available data). It is possible that the discrepancies in data described above are also present in this data used also. Figure 1: NHS Clinical psychologists HC and FTE age profile by 10-year age bands, 2010 Source: NHS IC Non-medical Census 2010 (head count) and Department of Health (FTE data) Figure 1 shows an asymmetrical profile, with fewer older and younger staff, and a peak in the distribution at the age bracket, with the age bracket being the next largest group. There are few if any staff under the age of 25 due to the length of postgraduate training programmes, which typically span 2 7 years. Only a handful of staff are working over the age of 65. Staff aged 55 and over (1075 staff, 13 per cent of all NHS clinical psychologists in 2010), who have been employed 20 years in mental health services, are eligible to retire as a result of their Mental Health Officer status. There is potential for changes to pension entitlement in the public sector to affect the number of retirements in the future. The age profile of chartered members of the BPS is shown in figure 2. CfWI September

12 Figure 2: age profile of chartered members of the BPS as at November 2011 Age profile of chartered BPS members - all divisions Total headcount Source: The British Psychological Society (Workforce Planning Advisors Standing Committee, The British Psychological Society, 2011). The chart shows a peak in the distribution at the age bracket. There are significant numbers of staff working in both the and 61+ age brackets, which incorporate staff that may be entitled to retire under their Mental Health Officer status. The age profile shown here is similar to that recorded by the NHS. Current vacancies and employment The NHS IC (2010) three-month vacancy rate as at March 2010 for clinical psychologists in England was 1.1per cent. This is a slight increase on the previous years figure of 0.9 per cent, which is in contrast to the annual decrease in vacancy rate from 2.7 percent in 2005 to the 0.9 per cent figure in There are regional variations in these figures. A vacancy rate of zero per cent was recorded in six areas: South West, South East Coast, North East, East of England, East Midlands and West Midlands SHAs. Rates in the London and North West SHAs of 2.3 per cent and 2.2 per cent respectively were recorded. The South Central SHA recorded 1.5 per cent and the Yorkshire and the Humber SHA was 0.9 per cent. In comparison, a vacancy rate of zero per cent was recorded in the same SHAs except for South Central and East of England in Students 20 and under This section sets out typical training paths for both applied psychologists and psychological therapists Age bracket (years) Unknown CfWI September

13 Training of applied psychologists The primary route to qualification as an applied psychologist in the United Kingdom is via a doctoral level three-year postgraduate training course, or its equivalent. It must be formally accredited by the BPS as conferring eligibility for chartered status of the society. All applicants have to be psychology graduates and be eligible for the graduate basis registration of the BPS. Since many trainees acquire several years relevant experience prior to successfully gaining a place on a course, the overall duration of applied psychology training from undergraduate degree onwards is typically at least six years. From 2007 to 2011 there were intakes of approximately 600 people per year, with 1800 trainees in all years of their courses at any one time (Workforce Planning Advisors Standing Committee, BPS, 2011). Training of psychological therapists Following undergraduate study in a relevant discipline: Psychological wellbeing practitioners: 25 days based in higher education and 20 days in directed learning in NHS service. This leads to a postgraduate certificate to provide step 2 intervention in the stepped-care model. High intensity therapists: one-year course consisting of study for two days per week and three days supervised practice in IAPT services. This leads to a postgraduate diploma. An undergraduate certificate is also available. High Intensity therapist for cognitive behavioural therapy provide step 3 intervention in the stepped-care model. Four modalities training modules has been developed for qualified staff to enhance the NICE compliance of the therapies that they are delivering for counselling, brief psychodynamic therapy, couples therapy and interpersonal therapy. Qualified therapists delivering the four modalities have bespoke training days and specified supervision cases in IAPT services. Figure 3 shows the historical actual and planned commissions for clinical psychologists. Data on other divisions is not currently recorded nationally in the NHS. CfWI September

14 Figure 3: National clinical psychologist planned and actual commissions, 2002/ /12 Source: Multi Professional Education and Training (MPET) 02B - Non Medical Education and Training (NMET) Commissions, 2002/ /12 The chart shows that the range of commissions made between the academic years 2002/2011 was approximately places. There appears to be a current downward trend in planned commissions, though the number planned in 2011/12 remains in the typical range, and figures representing actual 2012 commissions would be required in order to confirm any change. Actual commissions broadly follow the original numbers planned each year, suggesting little difficulty in recruitment to the speciality. Health psychology trainees According to the BPS, it is thought that limited availability of supervised clinical placements and lack of trainee funding are potential barriers to training and therefore securing future supply workforce planning (Workforce Planning Advisors Standing Committee, BPS, 2011). Recruitment of academics Historically there has been a shortage of clinical academic staff, especially in clinical psychology. According to the BPS, this trend does not support treatment and intervention innovation in the NHS (Workforce Planning Advisors Standing Committee, BPS, 2011).The profession requires academic staff to spend at least one day per week in clinical practice. Geographical distribution Figure 4 shows the headcount of clinical psychologists in each SHA in September 2011 (NHS IC, 2011), the actual commissions for training in clinical psychology in the academic year CfWI September

15 2010/11 and planned commissions for 2011/12 (DH, 2011), and weighted capitation (DH, 2011c). Data on other divisions is not currently available. Figure 4: Map showing NHS staff, planned and actual commissions in relations to weighted capitation by SHA Comparison of weighted capitation, headcount, and commissions by SHA - clinical psychologists Comparison of weighted capitation, headcount, and commissions by SHA for clinical psychologists Weighted capitation Headcount 2010 Actual commissions 2010/11 Planned commissions 2011/12 North East 5.8% North West 15.0% Yorkshire & the Humber 10.7% East Midlands 8.6% West Midlands 11.0% East of England 10.3% London 14.2% South East Coast 7.7% South Central 6.8% South West 9.9% Total 100.0% North West North East Yorkshire and The Humber KEY Weighted capitation (%) Headcount 2010 (%) Actual commissions 2010/11 (%) Planned commissions 2011/12 (%) Data by SHA as % of national total Weighted capitation Headcount 2010 Actual commissions 2010/11 Planned commissions 2011/12 East Midlands North East 5.8% 4.8% 5.3% 5.3% North West 15.0% 13.3% 13.0% 13.6% Yorkshire & the Humber 10.7% 7.9% 8.5% 8.9% East Midlands 8.6% 6.0% 6.0% 6.4% West Midlands 11.0% 10.0% 11.0% 10.4% East of England 10.3% 8.5% 8.5% 8.5% London 14.2% 28.3% 21.5% 21.7% South East Coast 7.7% 6.1% 13.2% 11.5% South Central 6.8% 6.8% 5.9% 5.3% South West 9.9% 8.3% 6.9% 8.3% Total 100.0% 100.0% 100.0% 100.0% South West West Midlands South Central London East of England South East Coast Using occupation codes: SAL, S0L, S2L, S4L 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. The weighted capitation formula determines PCTs' target shares of available resources to enable them to commission similar levels of healthcare for populations with similar healthcare need, and to reduce avoidable health inequalities. Headcount data source: NHS Information Centre for Health and Social Care non-medical workforce census Excludes staff from Special Health Authorities and other statutory bodies. Commissioning data source: Department of Health NMET (non-medical education and training) Monitoring. Quarter 4, Source: HSCIC Census 2011 (headcount); DH NMET Monitoring Quarter 4, 2010/11 (commissions); DH 2011 (weighted capitation). The 2011/12 planned commissions should be regarded as indicative. The data are also presented by SHA as percentages of the total for England, thereby allowing for comparison with the weighted capitation for each SHA. The CfWI recognises that it is also important that all training posts are of high quality, and high-quality training placements may not be equally available across England. Figure 4 is intended to be used in conjunction with local knowledge. Figure 4 shows: CfWI September

16 A small reduction in commissions in 2010 and those planned for 2011 in the South Central, South East Coast and West Midlands SHAs. The South West, Yorkshire and the Humber and North West SHAs plan an increase. The North East, London and South East Coast SHAs appear to have the same commissioning intentions for 2011 as those actually made in The London SHA is the only region with headcount (28.3 per cent) over capitation (14.2 per cent). This may be due to movement of staff into the area from surrounding regions. Supply projection Figures 5a and 5b show the forecast supply of clinical psychologists based on available data. Data for other divisions of applied psychology is currently unavailable. Considering potential data limitations, it is possible that the historic NHS data presented on these charts represent information relating to staff other than clinical psychologists, such as counselling, forensic, health, occupation and sport and exercise psychologists who may be employed in the NHS. Figures 5a and 5b show that the workforce expanded by 16 per cent between 2005 and The supply of clinical psychologists is forecast to increase to about 6405 FTE in 2016 (8405 headcount). The chart suggests that more staff were employed in the NHS than were registered with the HPC in As HPC registration is mandatory for this staff group, this suggests a significant issue with data quality. CfWI September

17 Figure 5a: Historical and projected workforce supply by HC clinical psychologists Summary of available workforce headcount - Clinical Psychology 12,000 High and low scenarios of supply forecast 10,000 8,000 Historic NHS headcount Headcount 6,000 4,000 Forecast of those registered and available to practice including non practitioners and those working without direct patient contact (HC) 2,000 Weighted change in demand based on population growth Year Other demand drivers exist, but they have not been shown on this graph Source: Historical Supply Data is from the NHS IC (2011); Supply forecasts are based on Health Professions Council and workforce assumptions. Estimates of requirements use population projections (ONS, 2010). Figure 5b: Historical and projected workforce supply by FTE clinical psychologists Summary of available workforce FTE - Clinical Psychology 12,000 High and low scenarios of supply forecast 10,000 Historic NHS FTE 8,000 FTE (Full Time Equivalent) 6,000 4,000 2,000 Forecast of those registered and available to practice including non practitioners and those working without direct patient contact (FTE) Weighted change in demand based on population growth Year Other demand drivers exist, but they have not been shown on this graph Source: Historical Supply Data is from the NHS IC (2011); Supply forecasts are based on Health Professions Council and workforce assumptions. Estimates of requirements use population projections (ONS, 2010). If requirement is modelled from a baseline of the supply in 2010 and increases at the rate of population growth alone, it will increase to 6256 FTE in 2016 and constantly remain below the level of supply predicted of the clinical psychology workforce. It may be beneficial for service provider models to be investigated, in the context of mental health strategy such as IAPT, to help improve demand estimation. CfWI September

18 The graphs in figures 5a and b may include non practitioners and those working in the clinical psychology scope of practice without direct patient contact, for example: those that have retired but remain on the HPC register those in management both in the NHS and other national or professional bodies those providing education to students in England those working in planning those working in research roles those working in other clinical roles. CfWI modelling 1 from 2010 onwards is based on current commissions, assumptions reached by analysing past trends, and engaging with the profession to identify other indications. The most likely scenario (black line) indicating the estimate of future supply uses the agreed baseline assumptions in table 5. The darker shaded area on the right of the graph shows the forecast range of clinical psychologists in the NHS and the private sector estimated to provide direct clinical care in the future, and is based on the low and high scenario assumptions in Table 5. Table 5: Summary of assumptions used in the supply forecast clinical psychologists Variable Low scenario Baseline High scenario Training pipeline 95% 3 years, 5% 4 years 100% 3 years As baseline Trainee commissions Commissions 5% lower As current Commissions 5% higher Training attrition 3.75% 3% 2.25% Trainees registration on graduation 92.5% 95% 97.5% International recruits 0 per year 0 per year 0 per year Future return to practice 0 per year 0 per year 0 per year FTE/HC ratio 99% of baseline % of baseline Retirements Retirement profile offset by 2 years earlier, and 50% greater Retirement profile as (retirement age range 54-70) Retirement profile offset by 2 years later Interplay with related groups Clinical psychologists provide supervision and training for IAPT services. There is continued growth in the number of HITs, which affects clinical psychologists both directly and indirectly. Though many people using IAPT services may not be seen directly by a clinical psychologist, the large increase in the overall volume of people using psychological therapy may lead to an increase in the numbers of individuals identified with more complex difficulties who require input by clinical psychologists (Workforce Planning Advisors Standing Committee, BPS, 2011). Clinical psychologists typically provide supervision, training and clinical management in psychological therapy services, so an increase in the psychological 1 Further details of the modelling used in the CfWI workforce risks and opportunities education commissioning risk summaries (WRO ECRS) can be found in the WRO ECRS methodology report. CfWI September

19 therapy workforce may create additional demand for indirect input from clinical psychologists (Workforce Planning Advisors Standing Committee, BPS, 2011). A risk to the workforce is that this is not planned for. According to the profession, there is an overlap between the work of education psychologists and advisory teachers and clinical psychologists (Workforce Planning Advisors Standing Committee, BPS, 2011). Psychological assistants work closely with forensic psychologists. Traditionally, school leavers are entrants to this profession. However, psychology graduates may take up these roles in increasing numbers to gather work experience. A risk to the workforce is that any change to entry requirements for applied psychologists could affect the established psychological assistant workforce. CONCLUSION The risks to the workforce include a lack of precise records of the number of applied psychologists both employed inside and outside the NHS and the number of staff in each division. This may affect the identification of workforce supply in each division and across different employers thereby hindering workforce planning. As the IAPT workforce continues to develop, there is an opportunity to support both the identification of applied psychologists and developing staff groups such as psychological wellbeing practitioners and high-intensity therapists by identifying the established workforce in each group and their skill mix. An increase in the number of psychological therapists in the workforce is likely to continue as the IAPT programme becomes more widely available. This increase is likely to affect the demand for clinical psychologists due to their involvement in designing and delivering services as well as supervision. There is no evidence to suggest that the supply trend of clinical psychologists will change significantly in the short term. Further work is required to understand more about the demand for mental health services and within the context of national strategies including IAPT. CfWI September

20 APPENDIX RELATED APPLIED PSYCHOLOGY DIVISIONS Counselling psychologists: They work in both the private and public sectors across primary and secondary health care. The BPS considers staff to be equally distributed across public and private sector employers according to BPS membership surveys (Workforce Planning Advisors Standing Committee, BPS, 2011). There is an estimate of requirement according to the BPS of FTE staff (Division of Clinical Psychology Workforce Planning Advisers, 2004). The training route requires completion of a BPS accredited undergraduate degree or conversion course that gives eligibility for the Graduate Basis for Registration. There are two routes to train: (1) Take an accredited course to fulfil the Qualification in Counselling Psychology. (2) Take the independent route to training: building up a plan of training with the help of a coordinator of training to fulfil the requirements of the Qualification in Counselling psychology. There are approximately , full or part time persons in training as at Training is typically self-funded. Education psychologists: The majority of educational psychologists are commonly employed by local authorities. According to the BPS, there is no current agreed ratio of requirement of educational psychologists to the size of the population, which is in part due to the different activity educational psychologists may undergo when employed in different sectors such as private or public services. Training is only available as a three-year full-time doctorate programme. Candidates are required to have a degree in psychology, recognised as conferring Graduate Basis for Chartered Membership to the BPS, and relevant work experience. In practice, the minimum time from start of undergraduate studies to qualification is seven to eight years. There are currently 120 trainees as at According to the BPS, the Department for Education Review of Educational Psychology may have implications for profession in the future. Forensic psychologists: There is no specific measure used to estimate future requirements of the workforce (Workforce Planning Advisors Standing Committee, BPS, 2011). In addition to working in the NHS, a significant number of forensic psychologists work in the prison service, which also provides some funding for their training. Training involves: Completion of a BPS accredited undergraduate degree or conversion course that gives eligibility for the Graduate Basis for Registration. Completion of a Society accredited MSc in Forensic Psychology (1 year full time or 2 years part time), Or Stage 1 of the Society's Diploma in Forensic Psychology. Two years practical experience under the supervision of a Chartered Forensic Psychologist. To achieve the correct competencies during supervision, students need to complete Stage 2 of the Society's Diploma in Forensic Psychology. 425 trainees were recorded in 2011 by the BPS. CfWI September

21 Health psychologists: there is evidence of regular national workforce planning carried out in Scotland, but no evidence of a formal workforce planning process in the rest of the UK (Workforce Planning Advisors Standing Committee, BPS, 2011). A risk to the workforce is that the availability of stage 2 training placements or capacity of existing clinicians to supervise trainees may affect workforce supply in the future (Workforce Planning Advisors Standing Committee, BPS, 2011). In addition, in response to changing needs, a second risk is that health psychologists are increasingly delivering behaviour change and chronic disease management interventions, which may also affect demand for the workforce (Workforce Planning Advisors Standing Committee, BPS, 2011). Completion of a BPS accredited undergraduate degree or conversion course that gives eligibility for the Graduate Basis for Registration. Completion of a Society accredited MSc in Health psychology (Part I of the training) or Stage 1 of the Society's Qualification in Health Psychology. Two years supervised experience under the supervision of a Chartered Health Psychologist. This will be assessed by the Division of Health Psychology following the guidelines for competencies laid out in the regulations for the Qualification in Health Psychology (Part II of the training). The latest available data shows 280 trainees in Occupational psychologists: according to the BPS, nationally, since 2001, the workforce requirement has been in the region of between 15 and 20 posts annually (Workforce Planning Advisors Standing Committee, BPS, 2011). Occupational psychologists typically treat those of adult working age. Occupational psychologists work across mental health services in both public and private settings. Training involves: completion of BPS accredited undergraduate degree or conversion course that gives eligibility for the Graduate Basis for Registration. Completion of an MSc in Occupational Psychology or Stage 1 of the Society's Qualification in Occupational Psychology. Two years practical experience under the supervision of a Chartered Occupational Psychologist. To achieve the correct competencies during supervision, students need to complete Stage 2 of the Society's Qualification in Occupational Psychology. Training lasts on average 2-7 years, taking into account primary, post graduate and supervised practice time. The BPS recorded 216 trainees in CfWI September

22 REFERENCES British Psychological Society. (2006). A survery of the diversity and variability of employment of health psychologists in t he U.K. [online] Available at: _summary.pdf [Accessed March 2012] British Psychological Society. (2011). The Psychological Workforce in the NHS: Categories in Current Use and Options for Change. Personal Communication, 3/10/11 British Psychological Society. (2007). New Ways of Working for Applied Psychologists in Health and Social Care Models of Training. [online] Available at: c_view/gid,228/itemid,412/ [Accessed April 2012] British Psychological Society, Department of Health and Home Office, U.K. Government. (2005). English Survey of Applied Psychologists in Health and Social Care and the Probation and Prison service. Retrieved December [online] Avilable at: [Accessed March 2012] Department of Health, UK Government. (2011a). No Health without mental health: a cross- Government mental health outcomes strategy for people of all ages - a call to action. Crown Copywrite. Department of Health, U.K. Government. (2011b). Talking Therapies: a four year plan to action. Crown Copywrite. Department of Health (2011c) Weighted capitation values are for , published 8/03/11 on DH website. Division of Clinical Psychology Workforce Planning Advisers. (2004). Estimating the applied psychology demand in adult mental health. [online] Avilable at: [Accessed March 20121] Health and Social Care Information Centre (HSCIC) (2011) Non-Medical Staff Census as of 30 September [online] Available at: [Accessed March 2012]. Health and Social Care Information Centre (HSCIC) (2011b) NHS Staff Numbers. [online] Available at: [Accessed: March 2012] CfWI September

23 Health and Social Care Information Centre (HSCIC) (2010) Vacancies survey March [online] Available at: HYPERLINK " collections/workforce/nhs-and-gp-vacancies/nhs-vacancies-survey-england-31-march- 2010" [Accessed March 2012]. National Institute for Clinical Excellence. (2011, February). Cash boost for psychological therapies to treat mental health. [online] Available at: ntalhealth.jsp [Accessed March 2012] National Programme Director, Finance, Operations and Delivery Lead, National Advisors for Workforce, Education and Training Project Manager, Improving Access to Psychological Therapies. (2011). CfWI Workforce Summaries And Recommnedations 2011 Stakeholder Response Template. Unpublished. Office for National Statistics (2010) 2008-based subnational population projections by sex and quinary age; England and Government Office Regions. [online] Available at: [Accessed March 2012]. Workforce Planning Advisors Standing Committee, British Psychological Society. (2011). CFWI Workforce Summaries and Recommendations 2011 Stakeholder Response Template. Unpublished. CfWI September

24 DISCLAIMER The Centre for Workforce Intelligence (CfWI) is an independent agency working on specific projects for the Department of Health and is an operating unit within Mouchel Management Consulting Ltd. This report is prepared solely for the Department of Health by Mouchel Management Consulting Ltd, in its role as operator of the CfWI, for the purpose identified in the report. It may not be used or relied on by any other person, or by the Department of Health in relation to any other matters not covered specifically by the scope of this report. Mouchel Management Consulting Ltd has exercised reasonable skill, care and diligence in the compilation of the report and Mouchel Management Consulting Ltd's only liability shall be to the Department of Health and only to the extent that it has failed to exercise reasonable skill, care and diligence. Any publication or public dissemination of this report, including the publication of the report on the CfWI website or otherwise, is for information purposes only and cannot be relied upon by any other person. In producing the report, Mouchel Management Consulting Ltd obtains and uses information and data from third party sources and cannot guarantee the accuracy of such data. The report also contains projections, which are subjective in nature and constitute Mouchel Management Consulting Ltd's opinion as to likely future trends or events based on i) the information known to Mouchel Management Consulting Ltd at the time the report was prepared; and ii) the data that it has collected from third parties. Other than exercising reasonable skill, care and diligence in the preparation of this report, Mouchel Management Consulting Ltd does not provide any other warranty whatsoever in relation to the report, whether express or implied, including in relation to the accuracy of any third party data used by Mouchel Management Consulting Ltd in the report and in relation to the accuracy, completeness or fitness for any particular purposes of any projections contained within the report. Mouchel Management Consulting Ltd shall not be liable to any person in contract, tort (including negligence), or otherwise for any damage or loss whatsoever which may arise either directly or indirectly, including in relation to any errors in forecasts, speculations or analyses, or in relation to the use of third party information or data in this report. For the avoidance of doubt, nothing in this disclaimer shall be construed so as to exclude Mouchel Management Consulting Ltd 's liability for fraud or fraudulent misrepresentation. CfWI September

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