Wales became a devolved nation in 1999, with the Welsh Assembly having key responsibilities for health, social care, education and the environment. The budget for Wales (and Scotland and Northern Ireland) is decided by the Barnett Formula, which was established in the late 1970s as a means of proportionally allocating grants for public spending to the nations. Of the £14.5bn allocated to Wales, the largest amount (£6bn) is spent on the NHS in Wales. However, four out of the seven health boards have a combined recurrent deficit of £163M for 2015-18 (BBC News, 28 March 2018) and one is in special measures. The health boards’ recurrent financial issues are compounded by the reliance on locum and agency staff to bridge the medic and nurse recruitment problem in Wales (BBC News, 28 March 2018).

Recruitment is also an issue for clinical psychology, with many vacant posts in most specialisms and at different bandings across Wales. Despite requests from heads of psychology in Wales for an increase in commissioned training places on the North and South Wales Clinical Psychology Programmes, the numbers qualifying for the last five or more years has been insufficient to replace staff retirements, career progression and the development of new psychology posts. The recruitment issue, combined with the relatively low level of clinical psychology posts in Wales (12.76 per 100,000 population in Wales as opposed to 17.30 and 17.19 in Scotland and England, respectively; DCP commissioned report, Longwill 2015), means there are typically long waits to access psychology (such as in mental health). In addition many patient populations have no access to psychology or there is inequitable provision across Wales (e.g. in stroke, diabetes, cardiac, COPD/asthma, and older adults services).

The need for increased commissioning of training places and gaps in service provision has recently been brought to the attention of Ruth Crowder, Chief Therapies Advisor to Welsh Government, by the Applied Psychologists in Health National Special Advisory Group (APHNSAG). APHNSAG consists of practitioner (mainly clinical) psychologists representing the different health boards, different specialisms, the two clinical psychology programmes in Wales and includes Wales representatives of the British Psychological Society’s Divisions of Clinical and Counselling Psychology and ACP-UK. APHNSAG sits under the Welsh Therapies Advisory Committee (WTAC), which advises Welsh Government on workforce issues related to AHPs and psychologists in Wales. APHNSAG has been tasked with producing a paper for Ruth so that she can share the details with WTAC, Health Education Improvement Wales (HEIW – commissioners of health professional education) and the Cabinet Secretary for Health and Social Care, Vaughan Gethin. APHNSAG are busy collecting psychology vacancy data for all health boards, up-dated information on the number of HCPC registered psychologists in Wales as compared to the other UK nations, and a mapping exercise in physical health psychology is underway to assist in identifying where inequity and gaps in provision exist in different parts of Wales.

Despite the financial difficulties, we remain optimistic. Welsh Government is listening more to experts such as clinical psychologists working with, for instance, people with dementia and in children and young people’s mental health; national delivery plans and guidance often now recommend that clinical psychologists are embedded within multidisciplinary teams, such as in weight management, diabetes and critical care; and some Assembly Members (AMs), such as Lynne Neagle, AM for Torfaen, are asking questions of the Cabinet Secretary for Health and Social Care about what the Welsh Government is doing about psychological care for specific populations (e.g. people living with diabetes, and people with dementia, in Wales) and, indeed, about the sufficiency of training places for clinical psychologists in Wales. The group Psychologists for Social Change, South Wales, has been particularly active in communicating with AMs. Additionally, we have maintained the full agenda for change range of pay scales for clinical psychologists, meaning opportunities for career progression exist across Wales.

With the recent budget announcement of an extra £550M for Wales, bringing the overall budget for Wales to £16.1bn by 2020, it is not yet clear how much of the extra funding will make its way to healthcare. However, we are hopeful that the impact clinical psychologists are making will continue to help shape health care service delivery in Wales.

Dr Beth Parry-Jones,
ACP-UK Director and Wales 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 Scotland by Ruth Stocks, ACP Director and Scotland Representative.