Uncertain future for workers in the NHS
Psychologists working in the NHS are facing an uncertain future of redundancies, competitive tendering and cuts to training places. But could there be hope and new challenges on the horizon?
Tim Cate, Chair of the British Psychological Society’s Division of Clinical Psychology (DCP), says: ‘The picture is complex at the moment. There are a number of key drivers which are having an adverse effect on services. Most notably, the financial imperative to balance the books is affecting all services and, in some areas, psychology services. Secondly, mergers have led to a number of services being restructured with gradings of staff being lowered. Thirdly, Primary Care Trust commissioners, as they begin to take on their new roles, are either planning or actually carrying out competitive tendering for providers – especially where there are politically unacceptable long waiting lists.’
Overall, vacant posts have been slashed and many posts have been frozen for this financial year. Training places have been cut by 5 per cent for this year’s intake and there may be further cuts next year. But it’s not all doom and gloom – DCP Vice Chair Graham Turpin points out that ‘there are also positives such as Improving Access to Psychological Therapies [see www.bps.org.uk/tlba] and Lord Layard’s plans, which – if supported by the Treasury – would result in increased demand for psychologists! The Society is heavily engaged and meeting with the Department of Health regularly.’
According to Tim Cate, psychologists have to face an increasingly competitive market place. ‘Third sector, independent and voluntary agencies are competing to deliver psychological therapies. I have said a number of times at national and regional events that it is quite possible that the majority of clinical psychologists will not be directly employed by the NHS in five years’ time.’ JS
An NHS worker’s perspective
The current problems in the NHS could affect our clients, ourselves as members of the public and our profession.
I am extremely concerned by emerging stories of service cuts in both general and specialist NHS services. In my view, reform in health care is happening too swiftly, with too little consultation with the public. If change continues unabated and un-debated, Britain could return to a system of health care where the poorest in society are unable to get care because they cannot pay for it.
Psychologists have a role and responsibility to raise concerns about reforms that potentially disadvantage the more vulnerable in Society. For an online-only article by me, with more about what is happening and what I think you can do about it, see this month’s issue at www.thepsychologist.org.uk.
- Khadj Rouf is a consultant clinical psychologist working in Oxfordshire in adult mental health.
OLD WARDS AFFECT RECOVERY
OLD, shabby NHS hospital wards are not only perceived as threatening environments, but can actually hamper patient recovery and could be more costly, research has found.
Dr Angeli Santos and Dr Phil Leather (University of Nottingham) studied psychophysiological responses to two different ward environments and found that patients recuperating from surgery on an old hospital ward were more stressed, needed more drugs and had slower recovery times than those who were recuperating on a newly-refurbished ward.
Resolving the issue would not only mean that patients would be healthier, happy and more satisfied but more money would be available for patient care.
RESEARCH TRAINING SHAKE-UP
WITH the rising number of postgraduate research students in psychology – there were 3655 in 2003/4 compared with 2980 in 1988/89 – has come the need for greater formalisation of research training.
That’s according to a Higher Education Academy (HEA) Psychology Network report, which compared available teaching resources and coordinators listed by the HEA website with the training requirements laid out by the ESRC – the research council with the most detailed postgraduate training requirements. The report found a wealth of resources are available but that subject specific and generic gaps do exist, for example in the areas of cognitive science, research management and language skills. The report concludes: ‘The Psychology Network would welcome access to or information about any additional appropriate postgraduate training resources.’
- See tinyurl.com/y243kz.
Face transplants: science fiction to science fact
FACIAL transplantation has moved from science fiction to science fact in just a few years, says the clinical psychologist on the British team which has been given the go-ahead to carry out the world’s first ever full facial transplant.
Clinical and health psychologist Dr Alex Clarke is part of the multidisciplinary team at the Royal Free Hospital in Hampstead, which has been granted permission by their research ethics committee to carry out four transplants as a clinical trial. No assessments have yet taken place, although 34 people have approached the team, led by surgeon Peter Butler.
Dr Clarke, whose background is in preparing patients for reconstructive surgery within the team at the Royal Free, predicts the number of people who will choose facial transplantation will be very small, although its impact on each individual will be enormous. ‘We need to ask ourselves, have we tried all the non-invasive interventions, are we then still left with someone who understands the risks, which are considerable, but is able to make this decision?’ she told The Psychologist. ‘The issues are similar to those for people considering kidney transplants: should they manage their condition using alternatives such as dialysis, or is quality of life so impaired that the risks of having the transplant still make it worthwhile?
‘I worked for many years with Changing Faces, who promote psychosocial treatment of disfiguration. The problem is never the physical scarring, it’s the psychological implications of it. Some people lead successful lives and some don’t. We are talking about sections of the population with very severe burns or scarring who have significant functional impairment – no eyelids for example – although many of these people may feel their quality of life is fine.’
Dr Penny Furness (Sheffield Hallam University) who researches the psychological impact of disfiguring facial surgery (see archive article at www.bps.org.uk/bvex), said she still had concerns for the potential of rejection and psychological problems. ‘If the operation were successful in a few carefully selected and supported individuals and thus made all the difference to their well-being, it would be hard to argue against it. The ‘if’ remains, however, and that uncertainty is what makes this issue so concerning and yet so fascinating to people, and also what makes careful consideration and ongoing research absolutely vital.’
Three years ago the Royal College of Surgeons categorically said that face transplants should not take place without further research. In November, the working party laid down a list of 15 minimal requirements before such experimental surgery should go ahead, ranging from the skills of the surgical team to psychological counselling, care for donors’ families and plans for the aftermath (see tinyurl.com/yh8jn4). CB
We need to talk
THE NHS is failing millions of people by ignoring clinical guidelines on psychological therapies, according to a report commissioned by The Mental Health Foundation, MIND, RETHINK, The Sainsbury Centre for Mental Health and Young Minds.
We Need to Talk (see tinyurl.com/y6pa42) argues that evidence-based talking therapies such as cognitive behaviour therapy are as important for the nation’s health as any cancer drug or surgical procedure. Yet the report claims that for three years the NHS has failed to act on recommendations from the National Institute of Clinical Excellence to offer psychological therapies to people with depression, anxiety and schizophrenia.
Although there is no explicit reference to clinical psychology/ psychologists, the report recommends that the Department of Health (DoH) should make a realistic assessment of the workforce and training implications of delivering psychological therapies; the DoH and regulatory bodies should ensure substantive measures for public protection from malpractice; and that it should support more research into psychological therapies.
British Psychological Society representative Graham Turpin commented: ‘It is good to see that the Society is working towards each of these goals, via our workforce planning through Improving Access to Psychological Therapies [see www.bps.org.uk/tlba], our drive for statutory regulation, and the work of the Society’s Centre for Outcomes Research and Effectiveness.’
Meanwhile, a circular from Louis Appleby, National Director for Mental Health (tinyurl.com/yl6ko8), reminds PCTs that they are expected to be able to offer computerised CBT packages by 31 March 2007. They are advised to ‘explore any local flexibility to fund this from their capital budgets’. JS
PTSD AND SOCIAL SUPPORT
SOCIAL support from staff and family could protect intensive care patients from developing post-traumatic stress disorder (PTSD). Maria Deja and colleagues at the Charité Hospital in Berlin followed the progress of 65 patients who had been in intensive care suffering from acute respiratory distress syndrome. An average of four and half years later, 29 per cent of the sample reported experiencing traumatic memories of their time in hospital and they scored highly on a measure of PTSD symptomatology. This in turn was linked with a poorer quality of life. Crucially, the patients showing signs of PTSD reported receiving less social support from family and staff while in intensive care and during subsequent rehabilitation, compared with the patients who reported little or no PTSD symptomatology.
- The findings are published in Critical Care: see tinyurl.com/vx2rk.
HE’S A JOLLY GOOD FELLOW
THE Reverend Canon Professor Leslie Francis, a fellow of the British Psychological Society and Professor of Practical Theology at the University of Wales, has received the William C. Bier Award from the American Psychological Association.
The award is offered once in five years to recognise advances in psychological research in the service of Christian ministry. Professor Francis has applied his psychological research to help in the training of clergy, and to understand professional burnout and psychological work-related health among the clergy.
PILOT TAKES OFF
A DONCASTER pilot scheme to improve access to talking therapies for people with mental health problems has seen 1000 clients in its first three months of operation.
The scheme, one of only two pilots in England set up earlier this year, was established to improve access to treatment for people with common mental health problems. It is now taking on up to 100 new clients a week.
Formula for success
WHAT was the most thrilling sporting event ever to watch? According to Business psychologists Robertson Cooper Ltd, the answer can be found by applying the formula [(V x P x R) + A] x (VFM), which allocates points according to a game’s visual excitement (V), the performance of the players (P), whether the rules of the game were upheld (R), the atmosphere (A), and the game’s value for money (VFM).
Robertson Cooper chose the first four factors from the sports psychology literature and added value for money as a fifth factor. Tesco Sport, who commissioned the work, then tested the equation on a small sample of volunteers using 50 events, before issuing a press statement announcing Great Britain’s gold medal at the Sydney Olympics coxless four as the most thrilling event ever.
This is not the first time psychologists have produced such equations on behalf of commercial companies – working for ice cream maker Walls, Dr Cliff Arnall of the University of Cardiff has previously developed equations for calculating the happiest and worse days of the year.
So why do psychologists become involved in these collaborations? Society Fellow, Professor Cary Cooper of Lancaster University, is Director of Robertson Cooper. He said the sporting equation was not a study, but was a way of getting kids to talk about and involved in sport, getting them excited and understanding the dimensions that make up a thrilling game. He also claimed that the exercise was good for psychologists. ‘It says we can think about these things – what are the motivators, what are the drivers, in making a really interesting sporting event? It shows that we deal with things other than people who’ve got emotional problems – that we do positive things. I like the notion of trying to get kids to think positively about sport… It’s part of the whole movement towards positive psychology.’ CJ
Training places saved
Campaigners are celebrating after plans to axe more than half of training places for educational psychologists (EPs) have been shelved.
Under a shake-up of funding, the Local Government Association had planned to end pooled budgets leading to a drop in the number of training places from 150 to just 62 a year. Against a backdrop of high staff vacancies in local authorities, campaigners predicted it would have devastating effects on children with learning difficulties.
Official figures show nearly three per cent of pupils now receive comprehensive support from educational psychologists, while a further 20 per cent may require some expert contact during their school career.
A review commissioned by the Department for Education and Skills found that EPs contribute positively to all aspects of the Every Child Matters agenda, and found room for expanding their work into other areas if they could be freed up from statutory assessments (see www.bps.org.uk/dnmf). Despite this government approval for the role, a select committee reported earlier this year that there were ‘significant cracks’ in the government’s special educational needs strategy and urged it to ensure training was properly funded so the ‘existing shortfall of educational psychologist is not exacerbated’.
Despite campaigns by a range of special needs and expert groups including the Division of Educational and Child Psychology (DECP) at the British Psychological Society, the government had refused to intervene. But the LGA has since announced that, subject to government approval, it will retain central pooled budget for 2007/08 and has made a commitment to ensure there is a longer-term approach to funding EPs training.
Sandra Dunsmuir, chair of the DECP, said the announcement had generated ‘enormous relief’ and thanked all those involved in the campaign, which had included lobbying government ministers and writing to MPs.
‘I remain convinced that that the mounting pressure to find a resolution at the LGA has been helped by raising the profile of this issue which
is of major importance to a small, but significant profession that all too easily get overlooked,’ she said. CB
Concerns over funding shake up
GOVERNMENT proposals to base future assessment of research quality largely on the basis of standardised quantitative measures – such as research income – have been widely criticised.
The Joint Committee for Psychology in Higher Education (which includes the British Psychological Society, the Association of Heads of Psychology Departments and the Experimental Psychology Society) responded to the recent consultation, stating that it was ‘extremely concerned’ over the proposals and their ability to sufficiently measure research quality. It also warned against the introduction of a flawed ‘metrics-based’ assessment process that could have serious long-term implications.
The committee said that a single ‘basket’ of metrics cannot be applied fairly across varied disciplines, even within science. It also warned against simply counting up studentships, publications and grants as a basis for judging the quality of future or current work.
The committee recommended that all of the Research Assessment Exercise (RAE) panels employ a range of metrics in making their assessments, but only in combination with other information (such as research supervision, applied research impact and impact on discipline). Importantly, it was emphasised that the assessment of research excellence must take into consideration the context in which the research was conducted (including the intended audience; the career stage of the researchers; the proportion of time available to conduct research; and rapid verses long-term outputs). ‘We believe that the aim of the research assessment process ought to be to recognise excellence in research – whether it be produced by groups, individuals, departments or institutions’, said Professor Dominic Abrams, Chair of the Joint Committee.
The Academy for Social Sciences also expressed very strong reservations regarding the proposals, as traditional metrics-based approaches rely heavily on bibliometric data which do not fully capture the range of research activity within the social sciences.
Moreover, Research Councils UK echoed these concerns regarding the four proposed metrics-based models of assessment, questioning the ability of any of the models to fully meet the intended improvements to the system of research assessment.
The British Academy urged against a ‘hasty move to metrics’ as the adoption of such an approach could discourage long-term research and destabilise funding for research in the humanities and social science.
The action group, Universities UK, shared similar fears. President Drummond Bone said ‘We have real concerns about the models outlined in the consultation. In particular, we are worried about an approach that is based solely on research income, and which excludes peer involvement entirely’.
The 2008 RAE will proceed largely as planned with a shadow metrics exercise conducted simultaneously. A response to the concerns is awaited.
o See tinyurl.com/ydg4dp for more.
Boost for functional imaging laboratory
THE Functional Imaging Laboratory at UCL has been awarded £6.7m of funding over five years by the Wellcome Trust, and so becomes the Wellcome Trust Centre for Neuroimaging at UCL. The Centre, which has three state-of-the-art fMRI scanners and a MEG scanner, has been made famous by research showing taxi drivers have enlarged hippocampi, and more recently by studies showing brain images can be decoded to identify the content of a participant’s perception.
Dr Sohaila Rastan, Director of Science Funding at the Wellcome Trust, said ‘Research at the laboratory has provided valuable insights into our understanding of the basic processes of perception and cognition which will undoubtedly impact on the development and assessment of effective therapies for common human neurological and psychiatric disorder’.
The Centre is also set to receive an additional grant of £1.2m from UCL. CJ
Jon Sutton with the latest from BPS journals
Having a similar-aged brother or sister is beneficial to executive functioning in the preschool period. That’s according to a study by Anna McAlister and Candida Peterson (University of Queensland, Australia), who measured skills such as forward planning, attention to relevant features, resistance to distraction, and response inhibition. This extends previous research which has found a similar ‘mental playmate’ effect for theory of mind. (BJDP, November)
Few studies have examined support perceptions in societies undergoing rapid social transition. Now Robin Goodwin (Brunel University) has assessed age, support and mental health in 2672 participants in four former Soviet nations. Results suggest a small but significant decline in overall support across age, although this was not found in the more religious Georgia. Mental health also declines with age, with tangible (as opposed to emotional) support acting as a protective buffer. (BJSP, December)
Missing out on a bargain causes people considering a subsequent one to focus their attention on regret considerations – that they will be reminded of what could have been – at the expense of the financial value of the item. Nick Sevdalis (Imperial College) and colleagues suggest that this is a major contributor to ‘inaction inertia’. (BJSP, December)
Children’s ability to accurately predict drivers’ intentions improves with age between 7 and 11 years, according to a study by Hugh Foot and colleagues at the University of Strathclyde. Training children of all ages to be more aware of drivers’ options when signalling a manoeuvre improved their accuracy in predicting drivers’ intentions. Sensitising children to the cues by which to judge drivers’ intentions clearly shifted their focus away from contextual cues (such as roadsigns), suggesting what drivers ought to do, to cues associated with characteristics of the vehicle itself – its movement, positioning and signalling dynamics. (BJDP, November)
A meta-analysis by Karsten Ingmar Paul and Klaus Moser (University of Erlangen-Nuremberg, Germany) has found that having a job when one has a low commitment to work, as well as being out of employment when one’s commitment is strong, is associated with impaired mental health and reduced well-being. The authors believe that intervention programmes, which often seem to assume that the unemployed person is just not looking hard enough, risk increasing work commitment – and therefore distress. Instead they should focus on skill building; for example, by teaching job-search techniques. (JOOP, December)
In a study of nearly 52,000 school teachers, Shirom Arie (Tel Aviv University) found that the higher the level of the supervisory position that a teacher was promoted to, the more pronounced the year-to-year decline in the number of absence spells and the total time lost in absences. The effect was less pronounced for veterans than for the newly appointed. (JOOP, December)
In a study of the importance of setting ‘personal bests’ in an educational setting, Andrew Martin (University of Western Sydney) suggests that schools should set tasks/goals that are (1) specific, (2) challenging, (3) competitively self-referenced, and (4) self-improvement based. This model structure, when applied to high school students, significantly predicted persistence, class participation, educational aspirations, and enjoyment of school. (BJEP, December)
o For more information and to subscribe, see www.bpsjournals.co.uk.
Walking here and there
We never travel alone, we always have our memories for company, an idea being explored by artist Simon Pope and psychologist Dr Vaughan Bell of the Institute of Psychiatry. In October, they invited people to recall their previous experiences viewing art as they walked through an empty gallery in Cardiff (www.chapter.org/7768.html). Visitors to the empty space were asked to experience a contrast between their memories and their current location, highlighting a delusion known as reduplicative paramnesia, where individuals believe a certain place has been duplicated.
Experiments are also planned based on methods from the psychosis literature. Volunteers will walk clockwise around Ruskin Park before walking blindfolded down a corridor of the Maudsley Hospital, recalling their experience in the park as they do so. The act of remembering the earlier experience is predicted to affect their walking behaviour – causing them to swerve to the right – but also to affect how they feel. ‘Sometimes patients at the Maudsley are granted half an hour leave, and they often want to use this time to visit Ruskin Park,’ Dr Bell explained. ‘So while this will be an experiment on actual walking behaviour, it will also get people thinking about what it’s like to have one’s experience of the Maudsley affected by memories of being in the park. It’s meaningful on a scientific and a personal level – it says things about how mental illness is treated in society, and how people’s experiences of a psychiatric hospital are affected by their desire to leave and go somewhere more pleasant.’
For another part of the project Bell and Pope plan to use case notes from the Bethlem Royal Hospital Archives to create an audio guide to London with a difference. The commentary will describe psychotic experiences people have had at different locations around the city. ‘Psychosis is thought of as being all in the mind,’ Bell said. ‘But it happens to real people all around us. This is a way of literally locating these experiences – both to give people an insight into what these experiences are like and to make them more real. We can go to the place and say it happened here.’ If ethical approval can be gained, the guide will also be created using more contemporary psychotic experiences.
Bell and Pope are working together as part of a Wellcome Trust SciArt project called Walking Here and There. ‘It’s helped me think about science not only in terms of its immediate meaning, but also in terms of its social meaning – something artists do all the time,’ Bell said. CJ
o For details see: http://walkinghereandthere.org.
Helping people back to work
APERSON’S ability to work is to be assessed differently following a review by the Department for Work and Pensions (see tinyurl.com/yjkg8g).
Professor Geoff Shepherd, a psychologist and Director of Partnerships and Service Development at Cambridgeshire and Peterborough NHS Mental Health Trust, was a member of the technical group charged with reviewing the Personal Capability Assessment (PCA). He says more weight will now be given to assessing a person’s confidence, motivation and ability to work with their colleagues and supervisors. This contrasts with the old assessment, which focused on a person’s task performance – their speed and concentration – without considering how they will cope in the workplace.
Identifying hidden problems with motivation and socialising will help inform interventions aimed at helping people back to work. ‘You should listen to what people tell you’, Shepherd explains. ‘If they tell you adamantly that they’re really not interested in work, then there’s little point trying to get them to change their mind. But the research shows such people are in the minority. Most people on long-term benefits and out of work say “I would be interested in getting back to work, but… I’m worried about losing benefits/about facing people at work/that my job skills are out of date/that it will be so stressful I’ll get ill again…’’. Shepherd says the new PCA will make it easier to identify and address these kinds of anxieties.
Shepherd warns (perhaps contrary to the views of governmental adviser Lord Layard) that just because a person’s psychological health has improved doesn’t mean they will also be ready for work. In fact, the workplace could well have been the source of their psychological problems in the first place. Instead, Shepherd favours combining psychological interventions with a model known as ‘Individual Placement and Support’, which seeks to get people back to work as quickly as possible, and to focus on developing their skills in situ.
One organisation that does just that is WorkDirections, a welfare-to-work provider based in London, Nottingham and Birmingham, that receives referrals from a range of sources, including from GPs and community mental health teams. Chartered psychologist Rina Jelenkovic works for the organisation helping clients identified as needing more support with their mental health condition. However, she says she doesn’t offer therapy as such, but rather her approach is solution-focused. ‘Our clients have already gone through the health system and have talked about their problems, so they’re often pleased to hear that I’m not focused on that, but on helping them to move forward – for example, looking at how to better manage their condition, such as their negative moods or thoughts, and ensuring that they have coping mechanisms in place to support the change of going back to work.’
The voluntary programme that Ms Jelenkovic works on, ‘New Deal for Disabled People’, is managed by Christopher Blackwell. Consistent with the views of Professor Shepherd, Blackwell says his team tend to see the biggest recovery in their clients once they are back at work. ‘It can often be the routine, the social interaction, increased self-esteem, having more money and structure associated with work that helps people recover from mental and physical illness – and it’s the lack of these things when people are out of work that can exacerbate their symptoms’ he says, adding that such a view is contrary to the traditional view of recovery which is purely about the removal of symptoms.
Coinciding with the Department of Work and Pensions review of Personal Capability Assessment, the Department of Health has recently launched its own initiative ‘Action on Stigma’ (see www.shift.org.uk/employment.html), which seeks
to ensure that employers treat staff with mental health problems fairly. CJ
From the digest
Christian Jarrett with a taster from the Society’s free Research Digest service.
You’ve probably been there – waiting for an interview, palms sweaty, heartbeat pounding… or perhaps not, maybe you don’t tend to hear your heartbeat. It’s increasingly being recognised that people differ in how much attention they pay to their internal bodily sensations, and that people who suffer from panic attacks probably pay more attention than most.
In a study reported in Behaviour Research and Therapy (see tinyurl.com/y6ry67), Rachel Pollock and colleagues recruited 136 participants and identified 34 of them who reported being particularly afraid of anxiety-related symptoms and 31 who were unbothered by them. They played the participants the sounds of either normal or abnormal, palpitating heartbeats against varying degrees of background white noise.
In trials containing normal heartbeats only, the more anxious participants were, as expected, just as good at detecting them, but crucially, they also tended to report hearing a heartbeat when there wasn’t one – far more often than the non-anxious participants did.
Less expected was the observation that the more anxious participants were actually poorer a
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