Health Psychology in Scotland

1. Health Psychology in Scotland Dr Vivien Swanson, Senior Lecturer, Health Psychologist University of Stirling Programme Director (Health Psychology) NHS Education Scotland

2. Health Psychology in Scotland-Stage 2 Training Motivation • Context… health challenges in Scotland • The NHS in Scotland • Public Health • NHS Education Scotland The Action Plan: • The set-up – developing the stage 2 training pilot Maintenance • Evaluation, achievements, current progress, issues and challenges, sustainability

7. Key priorities? What ….. areas of work? health inequalities . maternity care . early years . healthy weight . parenting . self-management . addictions . patient safety . long-term conditions . re-ablement . anticipatory care . How……. to deliver? asset approaches . co-production . skilled workforce . collaboration . equality and diversity . sharing best practice. inclusive learning . fitness to practice . quality clinical learning environments “Mutually beneficial partnerships between patients, their families and those delivering healthcare services. Partnerships which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making” (NHS Quality Strategy)

8. Revised targets for HEAT 2007-8

9. The action plan for Stage 2 training Set-up

10. Goal: To develop effective, sustainable, fully funded Stage 2 training posts for health psychologists in the NHS in Scotland To ‘add value’ to the health improvement agenda (HEAT Targets) in Scotland

13. Key features : Support structure • Health psychology trainees have BPS/DHP Approved Stage 2 Supervisor, and NHS based supervision from their line manager or Head of Psychology services as appropriate. • Regular face to face meetings with DHP supervisor, and joint supervision meetings • Peer support crucial for trainees - 4 informal meetings a year • Regular group networking meetings (quarterly - bi-annually) • Shared space on NHS Knowledge Network

14. Key features : Funding • Trainee Salary Costs : • Agenda for Change Band 6 (Equivalent to years 2 and 3 of Clinical Psychology Training) [employment costs not included • Supervision : • Fee per student per annum (including University Overheads @FEC) • ½ Day per month academic supervision • Administrative Costs: • ½ day per week administrative support   • Consumables : Telephone, photocopy, stationery • Travel Expenses: • Supervision (Trainee and Supervisor) • + 4 peer support meetings per annum) • BPS Registration Costs : • Enrolment and supervisory approval • Annual Maintenance Fee • Examination of Portfolio Fee • Estimated Total Costs per Trainee : Year 1 : £28K, Year 2 : £30K

15. Aims to address government health targets • Stage 2 ‘Independent route’ • Joint funding ( NHS Boards. NHS Education for Scotland) • Workplace and DHP Stage 2 supervision • Collaborative network • Small scale ‘Programme’ from 2010 • 2007 – 4 trainees • 2008 – 3 trainees • 2010 - 3 trainees • 2012 – 3 joint funded + 2 fully funded SummaryThe NHS Education for Scotland Programme

16. Maintenance : From pilot to programme …outputs, strengths and challenges

17. Successes : Programme outputs….

19. Other benefits • Developing links and sharing best practice between NHS health boards in the programme • Linking expert supervisors with experience of behaviour change and Universities with the NHS via collaboration on specific projects • Joint supervision develops shared understandings • Introducing theory into practice • Showcases how health psychology can ‘add value’ • Going beyond the NHS – opens other career routes - 2 trainees from Change Fund ( Local Authority 100% funded)

20. Location of posts Trainees preferred psychology base because of support from psychology colleagues (only one of the four trainees from yr 1 was based within psychology). Or split working with a main base in psychology and a day or two a week in a public health or other department? • Supervision Better role definition with regard to supervision and line management arrangements. Trainees reported to many different people - responsibilities of each should be explicit from the outset. • Skill-sets Some trainees would have liked more opportunity to develop clinical/therapeutic skills which the original design (tasks) of their posts did not incorporate. • Stress and Pressure: A lack of ground work at the start of the scheme meant that the setting up the projects was slower in some areas than others. Being a ‘sole health psychologist’ was demanding in terms of workload, responsibility and expectations Challenges (interim evaluation)

21. Need ‘local champions’ at a senior level to push for NHS posts • Health psychologists may need to apply for posts which allow them to apply health psychology skills - may not be ‘framed’ in terms of psychology. • Using a mixed psychology skill-set could be explored in health board departments which have traditionally only employed clinical psychologists. • Leverage by the Scottish Government might be required to highlight the value of health psychology to the wider NHS. • In one area, additional short-term funding was secured for continuation of the trainee • Need to build a critical mass of health psychologists working in practice in the NHS Scotland which could increase the awareness of this skill-set more widely. • NES funding could support fuller implementation of the interventions designed by trainees. • Trainees leaving before the end of the two-year post to take up other posts - with their work remaining unfinished. • Time ‘lag’ between end of post and completion of portfolio More Challenges

22. Summary and future plans… Health Psychology Stage 2 Training Programme Successes: National programme, unique in UK - 10 + 5 trainees to date - high level of output contribution to Govt health targets – network of trainees and supervisors – raises awareness of applied psychology in NHS Boards Challenges: Expand across Scotland – increase awareness outside NHS – commissioning – identifying funding streams – network of trainees and supervisors – increase supervision skills – BCTs training – CPD - NHS posts for health psychologists Applied psychologists Links with clinical health psychology CPD - BCT Skills

23. Further outcomes….Health Psychology into Government • Creation of 2 Health Psychology Programme Director posts in the Psychology Directorate of NHS Education for Scotland • Aims : • Add value to existing government programmes • Further develop extent and sustainability of Stage 2 training (including NHS posts for health psychologists) • Develop training in health psychology theory and BCTs for other health professionals • Develop integrated working with other applied psychologists

24. Contact : vivien.swanson@stir.ac.uk vivien.swanson@nes.scot.nhs.uk Tel : 01786 467685

25. Scottish Government Secondment • 2009: Health Psychologists seconded into Scottish Government • Secondment negotiated by Chair DHP-S (Ronan O’Carroll) • Joint funding from DHP and Scottish Government • Interviews held by a combined committee of representatives from DHP, DHP-S and Government Health Directorates • Diane Dixon and Marie Johnston (University of Aberdeen) were seconded to Health Improvement Strategy Division (HISD)

26. Negotiating the HP remit • After consulting with policy staff • offered to deliver the following: • An evidence based health behaviour change competency frameworkfor use across different health behaviours • A series of 3 briefing seminars on key topics relevant to health behaviour change • Comment on policy and other documents as required

27. Framework is available at: http://www.healthscotland.com/uploads/documents/14543-HBCC_framework1.pdf