Evolution of Clinical Psychology & NHS: Past and Future Perspectives

1. The Development of Clinical Psychology Past and Future Perspectives: Monte Shapiro’s LegacyProfessor Tony LavenderFriday 2 December 2011

4. BIRTH OF THE WELFARE STATE No satisfactory scheme for social security can be devised [without the] following assumptions. • A national health service for prevention and comprehensive treatment available to all members of the community. • Universal children’s allowances for all children up to 14 or if in full-time education up to 16. c) Full use of powers of the state to maintain employment and to reduce unemployment to seasonal, cyclical and interval unemployment, that is to say to unemployment suitable for treatment by cash allowances.

5. “This is the biggest single experiment in social service that the world has ever seen or undertaken” (AneurinBevan, 7 October 1948) “It was the first health system in any Western society to offer free medical care to the entire population. It was, furthermore, the first comprehensive system to be based not on the insurance principle, with entitlement following contributions, but on the national provision of services available to everyone. It thus offered free and universal entitlement to State-provided medical care. At the time of its creation, it was a unique example of the collectivist provision of health care in a market society.” (Klein 1986) BIRTH OF THE NHS (Tackle Disease)

6. BIRTH OF CLINICAL PSYCHOLOGY: UK/US CONTRAST APA (1948) “The need for clinical psychologists with a combination of applied and theoretical knowledge in three major areas: diagnosis, therapy and research.” Eysenck (1949) “Clinical Psychology demands competence in diagnosis and/or research” Clinical Psychology should not involve a training in therapy “therapy is something essentially alien”

7. Personal Therapy APA, which advocated that: “some kind of intense self-evaluation and that whenever possible that should be psychoanalysis” Eysenck was at his most strident in his response: “It is proposed that the young and relatively defenceless student be imbued with the ‘premature crystallizations of spurious orthodoxy’ which constitute Freudianism through the ‘transferences and counter-transferences’ developing during this training. Here, indeed, we have a fine soil on which to plant the seed of objective, methodologically sound, impartial, and scientifically acceptable research”

8. BIRTH OF CLINICAL PSYCHOLOGY APA (1948) “Unmet social needs for more and better mental hygiene services, including research. The task before clinical psychologists lies in adopting such policies in their training institutions that are best calculated to provide services that can demonstrate social usefulness.” Eysenck (1949) “Psychology can not go where social need requires. A science must follow more germane arguments than the possibly erroneous conception of social need.”

9. CLINICAL PSYCHOLOGY & NHS – 1950-1960 • First NHS Whitley Council Circular 1952 recognises profession and publishes pay scales • Three courses developed 1952-1957 (Maudsley, London; Tavistock, London; Crichton Royal, Edinburgh) • Whitley Council Circular 1957 recognises three courses and allows entry ‘to pay scales’ for their students • Queen’s University, Belfast, Course established 1959 • Whitley Council in 1960 uplifts clinical psychology pay scales to align with other Scientific Officers in NHS

10. CLINICAL PSYCHOLOGY & NHS – 1960-1979 • Embraces therapy • Increases range of client groups • 1965 – BPS secures Royal Charter – Privy Council • 1966 Division of Clinical Psychology formed • 1967 The NHS Zuckerman Committee Report • 1960-1976 Training programmes grow by approximately one a year

11. TRETHOWAN REPORT 1976 Started in 1973: Report in 1976 Conclusions & Recommendations: • Contribution potentially great but this was limited by numbers in service and training • Clinical Psychologists should have full professional status – full responsibility for their work, also acknowledged continuing ‘medical responsibility’ of doctors • Stressed the importance of multi-disciplinary team work • All employed by the NHS required to have a Post Graduate Degree or BPS Diploma (end of independent route)

12. TRETHOWAN REPORT 1976 Started in 1973: Report in 1976 Conclusions & Recommendations: • Psychology services organised into the tiers of the first (1974) NHS reorganisation • Regional Health Authorities manage training • Area HAs departments created with a base led by top grade • Principal psychologists head all specialties (mental illness, mental and physical ‘handicap’, neurology, geriatrics, community, general practice) • Clinical psychologists should have the opportunity to undertake research • Clinical psychologists should be supported by psychology technicians • Department of Health should carry a full ‘manpower’ review

13. PRECIPITANTS & CONTEXT OF MAS REVIEW • Increasing demand for clinical psychologists in the service • Accelerated by move to community care • Reflected in growing vacancy rates • The plateau in numbers of training places – funding course capacity, government cynicisms with professions, fears of trainee loss

14. MAS REPORT 1989: LEVELS AND MODEL Identified a skills framework with three levels of activity: • Level 1 Establishing and maintaining supportive relationships • Level 2 Protocol driven circumscribed psychological interventions (simple BM and manualised therapy) • Level 3 Use of multiple theory and evidential analysis to tackle complex problems – individually tailored solutions (characteristic of CPs) Shared care model • Equal status with medical practitioners • Oversee psychological component of care of all professionals • Support doctors in assessment, diagnosis and treatment • Offer alternative psychological interventions

15. MAS REPORT 1989: WORKFORCE Recommend increase in psychologists including training place from 173 to 300 by 2000 (actually hit 450) Recommended enlarging clinical psychology workforce from just under 2500 to 4000 by 2000 (actually hit 4052 fte) Should move to statutory registration (BPS granted power to set up voluntary register in 1987)

16. CLINICAL PSYCHOLOGY TRAINING PLACES 1980-2011

17. Clinical Psychology: FTE in the NHS (1995-2010)

18. New Ways of Working for Applied Psychologists (2007) Organising, Managing and & Leading Psychological Services – Tim Cate Career Pathways – Tina Ball Teamworking – Steve Onyett New Roles – Tony Lavender and John Taylor Improving Access to Psychological Therapies – Graham Turpin & Roslyn Hope Training Models – Jan Burns & Mike Wang New Ways of Working

19. New Ways of Working for Applied Psychologists (2007) PURPOSE OF THE APPLIED PSYCHOLOGIES “to improve the psychological well being of the population through working with individuals, teams, organisations and communities.” New Ways of Working

20. NEW WAYS OF WORKING:OUTPUTS & RECOMMENDATIONS • Developed leadership competencies based on NHS leadership Qualities Framework (training to Band 9) • NHS Trusts should have a named lead for psychological services, ideally at Board level • Psychologists should be active in the design, operation and evaluation of teams – help crate effective teams • Psychologists should develop the role and improve the effectiveness of services through process consultancy at a systems level, peer consultation and supervision • Psychologists should become involved in service redesign and in IAPT take up active roles in the commissioning and quality monitoring of training as well as leading and delivering those services New Ways of Working New Ways of Working

21. NEW WAYS OF WORKING:OUTPUTS & RECOMMENDATIONS • Develop a broader base of prequalification training at three levels, Trainee Psychology Assistant, Psychology Assistant and Senior Psychology Assistant • The established three-year doctoral training model is robust and has a proven track record: alternatives should not be a substitute for doctoral training • Existing applied psychology training courses should explore shared, common modules with other applied psychology training courses within their host institution New Ways of Working

22. CHALLENGES & WAY FORWARD Economic downturn – ‘cold wind of debt’ – standing still we feel like cuts • Lead, think and work strategically • Keep purpose and vision clear • Maintain and enhance work with key partners, Department of Health, Centre for Workforce Intelligence, Health Professions Council, NHS Confederation, Commissioners • Develop and invest in current and future leadership • Value your work – its scientific base and demonstrate its utility to service users, service providers and commissioners, policy makers and research community • Maintain psychological stance in medicalised contexts • Psychological (theory & research) formulation is key • Applying psychological theory and research (science) is the key to dealing with complexity – breadth of theories

23. CHALLENGES & WAY FORWARD • Embrace new roles • Mental Health Act (responsible clinicians) • Participate, lead in, Improving Access to Psychological Therapies • Re-visit Assistants roles in delivering psychological interventions • Think globally – foster development internationally (including in terms of recruitment)

24. MB SHAPIRO SMILE • Psychological science is still at the core • Numbers in training and the workforce • Doctorate – high quality training is the norm • Psychological formulation - key to embrace complexity • Influencing Government and policy • Much achieved but still much to do on our journey

25. Thank you for listening and the award