Healthcare in Scotland is a devolved matter. The budget for NHS Scotland is £13 billion which accounts for more than 40% of Scottish Government spending. Patient services are delivered by 14 ‘territorial’ Health Boards (much of this managed in conjunction with local government authorities under integrated health and social care arrangements), and there are 7 Special Health Boards which have a particular nation-wide function. Some services, for example care homes, are commissioned but the vast majority of healthcare in Scotland, including mental healthcare, is delivered by the NHS. With 16,3000 employees, the NHS in Scotland is the second biggest employer after local government. No cuts have been made to the funding allocation since the financial crash but it has not kept up with inflation so substantial savings have to be made every year.

Information on the clinical psychology workforce in Scotland is readily accessible from Information and Statistics Division (ISD), part of National Services Scotland which is one of the Special Health Boards. Every three months, ISD publishes detailed information on the psychology and psychological therapies workforce in NHS Scotland, including the numbers and type of staff in post – whole time equivalents (WTE) and a headcount – their age bands, their area of clinical specialty and the numbers of vacancies. This allows comparisons between Boards and of the relative provision for particular population groups, as well as useful information for workforce planning. The latest figures for WTE show that there are 831 applied psychologists of whom 770 are clinical psychologists. Of these, 405 work in mental health (26.1 per 100000 children and young people; 21.6 per 100000 working age adults; 7.8 per 100000 older adults), 65 in services for people with learning disabilities, 95 in physical health, 46 in forensic services, 48 in neuropsychology, 16 in alcohol/substance misuse services and 94 in other clinical areas (some of these numbers are approximate). There are also 169 clinical psychology trainees on the two training courses in Scotland (one based in Edinburgh and one in Glasgow), each employed by one of the Health Boards and all fully funded by NHS Education for Scotland, another of the Special Health Boards..

The numbers of clinical psychologists employed in non-NHS organisations or working in private practice, either solely or in addition to NHS employment is not readily available, but is likely to be tiny compared to those solely in the NHS.

A rough estimate from the headcount figures indicates that about 10% of the total number of clinical psychologists and trainees employed in NHS Scotland are ACP-UK members. A few members are known to be retired.

The Scottish Government has instructed Boards not to reduce spending on mental health services and it has long recognised the importance of psychological therapies. It sets Boards a standard of 18-weeks referral-to-treatment-time for psychological therapy for all who need it and allocates funding specifically to increase capacity for the delivery of psychological therapies.

To count towards the target, therapies are to be delivered in line with guidance contained in a publication called ‘The Matrix – A Guide to Delivering Evidence-based Psychological Therapies in Scotland’ (http://nes.scot.nhs.uk/education and training/by discipline/psychology). Thus, therapies must be evidence-based and delivered by appropriately qualified and trained staff who are supervised by properly qualified and trained supervisors.  Delivery and supervision competencies are specified according to the intensity level of a therapy, with intensity levels designated as low, high, specialist or highly specialist. The critical role of Clinical Psychologists in the delivery of highly specialist interventions and in the supervision of staff delivering at lower levels of intensity is enshrined in the policy. As well as promoting quality, undoubtedly, there have been other benefits: increased access to therapy, better awareness of psychological therapies amongst managers, clinicians and the public; more psychologically-minded staff; cascading of therapy skills to a wide range of clinical staff and so on. However, as with any target, there are drawbacks. This one has brought criticisms of a focus on the target at the expense of quality, reduced time for CPD/research/service development work, and inconsistency in recording and reporting methods in different parts of the country, as well as concerns that services are discouraged from efforts to access hard-to-reach patient populations and pressurised into raising the bar for suitability for therapy.

As time goes on, it is likely that more and more staff from a range of disciplines will develop and extend their therapy skills and supervision competencies. In this respect, the specialist skills of clinical psychologists will become less specialist. However, if the result is better access to psychological therapies and quality is maintained through upholding effective governance standards, this should be welcomed.

The challenge for clinical psychologists will be to prove our worth way beyond the delivery of therapies. This should be easy, there is a long list of skills to draw on: the development of new therapies and system-based approaches to improve outcomes, the adaptation of interventions and models to deal with complex presentations where no evidence-base exists, the application of doctoral level research skills, expertise in behaviour change and so on. However, we need to get better at speaking up and to promote ourselves in ways that are meaningful to decision-makers, demonstrating the value we can bring in terms of economic benefits and population health. A strong professional body can pave the way for us to do this.

Ruth Stocks, ACP-UK
ACP-UK Director and Scotland Representative

Click here to read our post on issues facing clinical psychologists in Northern Ireland by Geraldine Scott-Heyes, ACP Director and Northern Ireland Representative.

Click here to read our post on issues facing clinical psychologists in Wales by Beth Parry-Jones, ACP Director and Wales Representative.