English Survey of Applied Psychologists in Health & Social Care and in the Probation & Prison Service

English Survey of Applied Psychologists in Health & Social Care and in the Probation & Prison Service February 2005

The British Psychological Society 2005 The views presented in this book do not necessarily reflect those of The British Psychological Society, and the publishers are not responsible for any error of omission or fact.the British Psychological Society is a registered charity (no. 229642). All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical,or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to The British Psychological Society. ISBN 1 85433 403 4 Printed in Great Britain. This report was written by Tony Lavender, Centre for Applied Social and Psychological Development, Salomons, Canterbury Christ Church University College, Ian Gray. Lancaster University Doctorate Programme in Clinical Psychology Anne Richardson, Head of Mental Health Policy, Department of Health. Published by The British Psychological Society, St Andrews House, 48 Princess Road East, Leicester LE1 7DR. www.bps.org.uk Policy HR I Workforce Management Planning Clinical Document purpose Estates Performance IM & T Finance Partnership Working For information Gateway ref: 3389 Title: Author: English Survey of Applied Psychologists in Health and Social Care & in the Probation & Prison services The British Psychological Society, Department of Health and Home Office Publication date: Feb 2005 Target audience: Circulation list: Description: Cross Ref: Superseded docs: Action required: Timing: PCT CEs, NHS Trust CEs, SHA CEs, Care Trust CEs, Foundation Trust CEs, Directors of HR, Directors of Finance PCT CEs, NHS Trust CEs This report contains results of the first national survey in England of applied psychologists. Commissioned in support of the modemisation of mental health services, it provides a platform to take forward work to strengthen access to effective psychological services. It parallels work undertaken in Scotland and Wales. NSF for mental health, NIMH(E) workforce programme plan None None None Contact details Anne Richardson 312 Wellington House 133 155 Waterloo Road London SF1 8UG www.dh.gov.uk www.bps.org.uk

Contents Foreword...3 Executive Summary...4 Section 1: Background...6 1.1 The Policy Framework...6 1.1.1 Introduction...6 1.1.2 Care group workforce teams...6 1.1.3 Access to effective treatments...6 1.1.4 Modernising mental health services...6 1.2 The Survey...7 Section 2: The Survey Results...9 2.1 The Sample...9 2.2 Age profile...9 2.3 Gender and age profile...10 2.4 Ethnicity...10 2.5 Specialists profile: Total and by gender...12 2.6 Service role...12 2.6.1 Overall...12 2.6.2 Service role by age...13 2.6.3 Gender...14 2.7 Part-time/Full-time profile...14 2.7.1 Overview...14 2.7.2 Gender and age part-time profile...15 2.7.3 Spine points/grade profile...16 Section 3: Workforce Supply Clinical Psychology...18 3.1 Applicants and Trainee Numbers...18 3.1.1 Courses...18 3.1.2 Numbers...19 3.1.3 Age...19 3.1.4 Gender...20 3.1.5 Ethnicity...21 3.2 Statement of Equivalence...21 3.2.1 Numbers and gender...22 3.2.2 Age...22 3.2.3 Ethnicity...23 3.3 Retention/Attrition...23 3.3.1 Annual attrition from training...23 3.3.2 First job on qualifying...23 3.3.3 Retention in service...23

Contents (continued) Section 4: Workforce Demand Clinical Psychology...24 4.1 Introduction...24 4.2 Current vacancies...24 4.2.1 Department of Health Statistics for Clinical Psychology...24 4.2.2 Managers Special Interest Group Survey December 2002...24 4.2.3 Vacancies advertised in the BPS Appointments Memorandum...24 4.2.4 Summary of vacancy rates and current shortfall...26 4.3 Future demand...26 4.3.1 Funded growth...26 4.3.2 Projected growth...27 4.4 The demand and supply gap...27 Section 5: Recommendations...29 References...31 Appendix 1: Steering Group Membership and Acknowledgements...32 Appendix 2: Department of Health, English Survey of Applied Psychologists in Health & Social Care and in the Probation & Prison Service (July 2002)...33 Appendix 3: Ethnic Origin Categories...40 Appendix 4: Percentage of English Population by Minority Group 2001 Census...41 Appendix 5: Sections from Applied Psychology Divisions...42

Foreword The Government is committed to build high quality patient-focused services. In order to achieve this the NHS Plan recognises the commitment that needs to be made to increasing the number of qualified staff and the quality of their training. Only with appropriately trained and updated staff will the NHS meet the expectations of the public. The Government, in its efforts to drive up the quality of care, has published National Service Frameworks which detail the standards to be achieved by services. Many of these standards can only be achieved by ensuring greater access to psychological services and improving the quality of the psychological care offered. In order to support these aims a study was commissioned to assess the profile and activities of the new and rapidly developing Applied Psychology Workforce. This report provides the results of the first National Survey of the Applied Psychology Workforce in England, and parallels surveys undertaken in Scotland and Wales. Policy initiatives and service developments require the formation of collaborative partnerships. It is, therefore, particularly important that this survey was produced as a result of a partnership between the Department of Health, the Home Office and The British Psychological Society. The information gathered provides an excellent platform for considering how best to take forward the government s intention to improve access to psychological services. The recommendations offer both short-term practical solutions and raise some longerterm issues that need to be addressed. I welcome this report and look forward to hearing about the progress of the work that will follow. PROFESSOR LOUIS APLEBY National Director for Mental Health 3

Executive Summary Successive Health & Social Care policy initiatives have resulted in an increased demand for applied psychologists. A survey was undertaken in July 2002 to establish the numbers and patterns of work of the applied psychology workforce in the NHS and Prison and Probationary Service. This Report includes the results of the survey and an analysis of the current supply and demand issues. The major findings and recommendations are summarised below. The Survey A total sample of 3360 from the NHS and Prison and Probation Service returned forms. This constitutes approximately 65 per cent of the NHS and almost all of the Prison and Probation Services applied psychology workforce. The workforce is relatively young (only 18 per cent over 50) and predominantly female (72.9 per cent). The ethnic mix shows 6.8 per cent were non-white in the 25 44 age group and 4.0 per cent non-white in the 45 and over group. The service role data indicated that 62 per cent of the available sessions were spent in user and carer service delivery, 13 per cent managing staff and in service development, 10 per cent developing other staff, and 7 per cent in both research and audit, and continuing professional development. Overall, 31 per cent of the workforce were working part-time. In terms of gender, 19.3 per cent of the males and 35.8 per cent of the female workforce worked part-time. Supply A detailed analysis of the supply-demand issues for clinical psychologists was undertaken as this was the largest group of applied psychologists in the survey, the vast majority of whom work in the NHS. The report does not contain a supply-demand analysis for Applied Psychologists in the Prison and Probation Service. There had been an approximately annual 9 per cent growth in numbers of clinical psychologists on training courses over the last decade (537 in 2003). There are approximately 40 people qualifying via the Statement of Equivalence route (i.e. overseas applicants following a conversion programme) every year. Attrition rates from courses are low and average approximately 3 per cent. Of those qualifying, over 97 per cent take first jobs in the NHS or in teaching posts in clinical psychology training. The data available indicates long-term retention is high, with over 90 per cent of qualifiers still working in the NHS 10 years after qualification. Demand The vacancy rates for clinical psychologists appear a source of some contention. The Department of Health 2002 annual survey indicated approximately 4 per cent vacancy whilst two British Psychological Society surveys of psychology managers indicated rates of 11 and 12 per cent. The demand for psychological care has grown significantly and this is likely to increase with the implementation of the National Service Frameworks. There has been an historic annual growth in posts in the services of approximately 10 per cent and it can be predicted that this will rise in the future. Even at the historic growth rates (in demand and supply) the demand-supply gap, that is already evident, will continue to grow without an increase in the supply of clinical psychologists. Recommendations The Report s recommendations are briefly summarised below. The annual growth in clinical psychology training commissions should be increased to 15 per cent. The profession should increase the diversity of the workforce. Plans to expand training should be developed in a manner that maintains the current low course attrition and high NHS retention rates. More robust models to estimate workforce demand for applied psychologists should be developed. The employment of staff from other branches of applied psychology should be considered to both benefit services and help close the demand-supply gap. The Department of Health and the profession need to work more closely to produce more robust estimates of vacancy rates. 4

The profession, the Department of Health and the Modernisation Agency need to work together to improve access to psychological services for all client groups. Further work on the supply and demand issues for the non-clinical applied psychologists, that is; health, counselling, neuropsychology and forensic psychology, is required. Training schemes to facilitate the qualification of overseas candidates via the Statement of Equivalence should be developed. Local psychology service heads should be more involved in the development of Local Delivery Plans and workforce planning at a local level. Regular workforce and supply side data should be continuously collected. The high level of part-time working should be taken into account when estimating demand and commissioning training. The demand for clinical psychology trainers should be fed into the Strategic Health Authorities/ Workforce Development Confederations workforce demand estimates. Ways of encouraging staff who could retire early to continue to work in the services should be developed. 5

Section 1: Background 1.1 The Policy Framework 1.1.1 Introduction Improving the quality of, and access to, trained staff in NHS and Social Care services is a strategic priority for the Department of Health. The Department of Health Public Service Agreement 1 (July 2002), and the White Paper 2 setting out the conclusions of the 2002 Spending Review elaborates a range of targets. For mental health, these are designed to fast forward the National Service Framework 3 (1999) and highlight issues for people across the spectrum of need. A Workforce Action Team (WAT) (2000) was established by the Department of Health to develop thinking about the workforce numbers, competencies and skill mix needed. The WAT concluded that significant growth in applied psychology, alongside growth in the existing workforce, including psychiatrists, nurses, etc., was needed in order to meet demand and deliver NSF and NHS Plan targets. 1.1.2 Care group workforce teams NHS re-organisation (2001), together with development work being undertaken for children s services, prison services, older people and people with long-term conditions, led to the establishment of a series of national Care Group Workforce Teams (CGWT). In addition to the provision of advice on staff numbers, and in partnership with the Modernisation Agency, they support thinking on new or extended roles for staff. They help to ensure that local Workforce Development Confederations (WDC)/Strategic Health Authorities (SHA) have all the information they need to implement national guidance. Accurate baseline information about the number of applied psychologists is very limited. The 2002 census indicates 4846 WTE clinical psychologists in the NHS (compared to 4400 in 2001) but no information was available about their focus, their clients, or their employment arrangements. No information was available about what has come to be called the family of applied psychologists including counselling, educational, forensic and health psychologists 4. In the following sections, some of the main reasons why this was important to the Department of Health are explained. 1.1.3 Access to effective treatments Demand for effective talking treatments is high. Such treatments are popular with service users and carers, and are commonly preferred to drugs. The evidence suggests 5 that such approaches are effective. The NHS Executive Review 6 (1996) described the variety of psychological therapies used to treat adults and children in primary, secondary and tertiary care. It collated evidence for effectiveness and offered advice to commissioners, providers, employers and trainers about how to drive forward the agenda to provide evidencebased services. The review acknowledged that access to psychological therapies is commonly problematic. The reasons include long waiting lists, poor co-ordination of services between counsellors, psychologists and psychotherapists and a lack of partnership with the non-statutory sector. Staff shortages mean services are patchy in some parts of the country, especially in relation to primary care, services for older people, children s services, services for people with learning disabilities and physical health care, including cancer care and diabetes. Implementation of National Service Frameworks 7, 8, 9, 10, 11, 12, 13, 14, 15, is highly likely to affect demand for applied psychologists in health and social care. CGWTs established to support strategic workforce planning for children, older people, coronary heart disease cancer and people with long-term conditions require information to help them plan. The developments planned for mental health services provide an illustration of why demand is likely to arise and why workforce information is required to help with this planning. 1.1.4 Modernising Mental Health Services The strategy for mental health services 16 (1998) outlined Government policy for mental health services, and new investment for the period 1999 2001/2002. The document reinforces the importance of ensuring high quality, evidence-based services. It sets out some of the evidence for the effectiveness and appropriateness of counselling and psychotherapy. The mental health National Service Framework 3 (1999) sets out how people should be able to get quicker access to more effective treatments in primary care, 6

with support from specialised services where necessary. Psychological therapies, counselling and psychotherapy are listed among the range of effective treatments for people with mental health problems, including those with severe and enduring mental illness. There are seven standards covering: mental health promotion (standard one); primary care and access to services (standards two and three); effective services for people with severe mental illness (standards four and five); caring about carers (standard six); the action necessary to achieve the suicide target in Our Healthier Nation (standard seven). The NHS Plan 2 took these proposed reforms a step further and provided extra annual investment of over 300 million by 2003/2004 to fast forward the NSF. Specific targets were set out relating to the development of the workforce, including targets to employ 1000 new graduate workers trained to deliver effective services in primary care to support people with common mental disorders. Targets were also set for new teams and services for those with the most severe conditions, including those in high secure and prison settings. Workforce planning guidance has been developed to assist local services to develop robust workforce planning processes 17. Prison mental health and policy for people with personality disorder. The 1997 ONS survey of psychiatric morbidity among prisoners in England and Wales (65,000 prisoners, on average, within 136 prisons) showed that 5000 have a severe mental illness. Levels of neurotic disorder are also very high (up to 58 per cent of remand prisoners and almost 40 per cent of those sentenced compared to a rate of around 12 per cent for the general population). Suicide risk is high for both groups. A joint programme between the Department of Health and the Home Office has been established to improve access to effective health care. Better information is needed about the training and qualifications of applied psychologists working in this setting in order to plan for the future. Policy on personality disorder 18, 19, 20, is also developing, and consideration is being given to the development of effective psychological therapies, especially for the small group of people with PD who are dangerous. Applied psychologists are likely to be required for the development of the assessment, treatment and research components of programmes for both Local Personality Disorder, and Dangerous and Severe Personality Disorder Services. 1.2. The Survey This survey represents a development of a longstanding collaborative relationship between The British Psychological Society (BPS) and the Department of Health in the field of workforce planning. The project was jointly funded by The British Psychological Society, the Department of Health and the Home Office. A Steering Group (Appendix 1) was, therefore, established to collect information: to assist workforce planning; to assist commissioning of education and training (for Workforce Development Confederations/ Strategic Health Authorities and the mental health Care Group Workforce Team following recommendations to increase the number of clinical psychology training places); to assess the outcomes from investment in training places; to inform prison mental health policy development and the development of childrens National Service Framework; to assist The British Psychological Society respond to policy intiatives concerning new ways of working. The Steering Group drew on the work of NHS Education for Scotland (NES) who next carried out a similar survey in Scotland 21. Their work developing a survey proforma and being able to learn from their experience proved invaluable. After considerable consultation a survey proforma was agreed (Appendix 2). Inclusion and exclusion criteria were agreed by the steering group. All applied psychologists were included, as well as those who specialised in psychotherapy, in health and social care and in prison and probation. 7

Section 1: Background (continued) Excluded were trainee psychologists for whom data was available, counsellors and psychology graduates not delivering psychology care. Also excluded were nurses, occupational therapists, etc., whose background in psychology was not directly linked to their then current employment. The survey was confined to England as separate surveys were being carried out in Scotland, Northern Ireland and Wales. The initial survey date of April 2002 was moved to July 2002 because of major NHS Trust reconfiguration. Survey forms were distributed through Human Resource Departments of NHS Trusts. The initial response rate was relatively low, around 30 per cent, probably because of Trust reconfiguration. With the support of the Group of Trainers in Clinical Psychology, contact was made directly with Heads of Psychology Services to ask them to urge staff to reply in October 2002. This second request resulted in a significant increase in returns. The Statistics Division of the Department of Health carried out the survey and commissioned data input services. The results of the survey are presented in the bulk of this report. 8

Section 2: The Survey Results 2.1 The Sample The total sample comprised of 3360 applied psychologists. Of these 379 worked in the Prison and Probation Service and 2981 worked in the NHS. Data from the Department of Health indicated that in 2002 there were 6092 (4846 wte) applied psychologists in the NHS of whom approximately 1200 1300 were trainees. As the survey excluded trainees this means in 2002, there were approximately 4800 qualified applied psychologists in the NHS. This means the return rate for NHS applied psychologists was approximately 62 per cent. The return rate from the Prison and Probation Service was over 90 per cent. This return rate is reasonable, given the nature of the survey, and the age, gender and ethnicity profile indicates that the sample is broadly representative of the population of applied psychologists. It will be evident in the following survey report that not all aspects of the 3360 forms were completed. This means that there is missing data on some variables and consequently not all totals add to 3360. In terms of BPS membership, 89.6 per cent of the sample were members. Table 1 shows the numbers of these BPS members, in each of the Divisions (BPS, 2001a). It is important to note that BPS members can be registered within more than one Division and that a reasonably large number (472) were not Division members. It is also highly likely that many members of other Divisions will also be members of the Division of Clinical Psychology. Table 1: BPS Members by Division. BPS Division Number Division of Clinical Psychology 1905 Division of Counselling Psychology 149 Division of Forensic Psychology 303 Division of Health Psychology 115 Division of Neuropsychology 193 Divisions other 60 Not Division Members 472 Not stated 154 Table 1 indicates, not surprisingly, that members of the Division of Clinical Psychology had the highest numbers included in the sample. The Forensic Division was the second largest group, and reflected the fact that 379 applied psychologists on Prison and Probation Service contracts were included in the sample. 2.2 Age profile Table 2 provides basic age profile information and indicates that 68 per cent of the workforce is under 45, and 81 per cent under 50. This means that, the profession has a relatively young profile and unless there is a significant level of early retirement, the percentage of people approaching retirement age over the next 10 years is likely to be relatively modest. The proportion of psychologists with Mental Health Officer (MHO) status is unknown, and this may have an impact on judgements about the numbers retiring at 55 as opposed to 60/65. Table 2: Age profile of Applied Psychology workforce. Age band Number % Age of workforce Under 24 173 5.2 25 29 442 13.4 30 34 697 21.1 35 40 520 15.7 40 44 402 12.1 45 49 455 13.8 50 54 369 11.2 55 59 177 5.3 60 and over 60 1.8 Unstated age band 14 Total 3309 100 9

Section 2: The Survey Results (continued) It is important to note that trainee clinical psychologists have been excluded from this survey. If they were to be added this would involve a potential additional 1245 participants (see Section 3.1.2). Given that the average age of entry to training is 27, if 65 per cent (current survey response rate) of these were added the 25 29 bands would be boosted by approximately 800 respondents. Finally, given that trainee clinical psychologists have been excluded, it means that the two youngest age bands include a large number of unqualified psychology/research assistants working in the NHS. In summary, applied psychology is a relatively young profession, which is continuing to grow as the size of intakes to courses increase (see Section 4). 2.3 Gender and age profile Table 3 shows that 72.9 per cent of the applied psychologists were female and 27.1 per cent male. Across the age bands it was clear that, up to the 50 54 age band, the percentage of males increased, with a corresponding decrease in the percentage of females. The percentage of males and females over 50 (i.e. the last three age bands) was 43.5 per cent male and 56.5 per cent female. These data show that in the oldest age bands approximately half are male and half females, whilst in the younger age bands the profession is over 80 per cent female. The current bands indicate that applied psychology is set to become, numerically an increasingly female profession. 2.4 Ethnicity Table 4 shows the ethnicity data by age band. The definition of white and non-white is detailed in Appendix 3. At the time of the survey 94.2 per cent of applied psychologists were white. There was, however, variation across the age bands. In general terms there was a larger percentage of non-white psychologists in the younger bands. Thus the average percentage of non-white in the 25 44 bands was 6.8 per cent, whilst in the 45 60 and over bands it was only 4.0 per cent. The under 24 band, however, which had a large proportion of non-qualified psychologists, had only 4.6 per cent non-white. These figures can usefully be compared with the results of the 2001 national census that indicated in England, 9.08 per cent of the population were from ethnic minority groups. There was, however, considerable regional variation, from 28.85 per cent in London, to 2.3 per cent in the South West (see Appendix 4 for 2001 national census breakdown by region). Thus the general picture from the survey is that, whilst the number of psychologists from ethnic minorities show an increase in lower age bands, it is still in these bands, 2.2 per cent below the population levels. Table 3: Applied Psychologists by gender and age band. Male Female Age Band Number Percentage Number Percentage Total Under 24 18 10.3 156 89.7 174 25 29 65 14.7 377 85.3 442 30 34 123 17.6 574 82.4 697 34 39 138 26.5 382 73.5 520 40 44 130 32.3 272 67.7 402 45 49 157 34.5 298 65.5 455 50 54 168 45.5 201 54.5 369 55 59 67 37.9 110 62.1 177 60 and over 28 47.5 31 52.2 59 Unstated age band 4 10 14 Total 898 27.1 2411 72.9 3309 10

Table 4: Ethnicity ( white and non-white ) by age band. White Non-white Age Band Number Percentage Number Percentage Total Under 24 166 95.4 8 4.6 174 25 29 410 92.8 32 7.1 442 30 34 659 94.5 37 5.5 696 34 39 474 91.7 43 8.3 517 40 44 374 93.3 27 6.7 401 45 49 432 95.2 22 4.8 454 50 54 357 96.7 12 3.3 369 55 59 171 97.2 5 2.8 176 60 and over 58 95.1 3 4.9 61 Unstated age band Total 3101 94.2 189 5.8 3290 Table 5: Detailed breakdown of ethnicity by age band. Age Band White Mixed Asian/British Black/Black British Other Total No. % age No. % age No. % age No. % age No. % age Under 24 166 2 5 1 0 174 25 29 410 12 13 6 1 442 30 34 659 8 18 8 3 696 35 39 474 17 19 4 3 517 40 44 374 7 7 10 3 401 45 49 432 10 4 4 4 454 50 54 357 2 5 1 4 369 55 60 171 1 3 1 0 176 Over 60 58 0 2 0 1 61 Total 3101 93.8 59 1.8 76 2.3 35 1.1 19 0.6 3290 Table 5 provides a more detailed breakdown of the ethnic backgrounds of the sample by age band. Due to the low numbers, percentages have not been calculated for all the groups within each age band. This shows that Asian British population have the highest percentage of psychologists from across the different ethnic groups. 11

Section 2: The Survey Results (continued) 2.5 Specialists profile: Total and by gender Table 6 provides a breakdown of the number of sessions worked in a four-week period in each speciality. This provides an analysis of the proportion of time spent in each speciality by gender, and as a total. It is important to note that the forensic speciality is high because it includes all those applied forensic psychologists working in the Prison and Probation Service. This group of psychologists number 379 in total. In terms of the percentages, most applied psychologists work in Adult Mental Health (31 per cent) followed by Forensic (16 per cent, including prison and probation staff), followed by Child and Adolescent (15.9 per cent), Learning Disability (10.9 per cent), Physical Health (8.1 per cent) and Older People (6.3 per cent). There were few differences in the proportion of males and females in each speciality. The largest differences in gender split were in Forensic (4.8 per cent more females), Adult Mental Health (5.2 per cent more males) and Child and Adolescent (4.1 per cent more females). 2.6 Service Role 2.6.1 Overall The survey allowed the categorisation of service role into five broad categories: User and carer service delivery; Managing staff and service development; Professional development and supervision of other staff; Research and service audit; Own continuing professional development. Table 7 shows that approximately 62 per cent of the work involved the delivery of services to users and carers. The second two major roles were the Management of Staff (13 per cent), and the Development of Other staff (10 per cent). The third two categories were, Research and Service Audit (7 per cent), and Continuing Professional Development (7 per cent). Table 6: Speciality profile: Sessions in a four-week period totals and by gender. Male Female All Sessions % Sessions % Total sessions % Total Professional Training 878 3.6 1535 2.6 2393 2.8 Alcohol and Substance Abuse 498 2.0 608 1.0 966 1.1 Children 3145 12.7 10,118 16.8 13,651 15.9 Forensic 3329 13.5 10,970 18.3 14,286 16.6 Adult Mental Health 8637 35.0 17,900 29.8 26,717 31.1 Learning Disability 2951 11.9 6331 10.5 9398 10.9 Older People 1427 5.8 3855 6.4 5384 6.3 Physical Health 2272 9.2 4726 7.9 6966 8.1 Neuropsychology 1245 5.0 3060 5.1 4658 5.4 Occupational Health 12 0.1 230 0.4 273 0.3 Health Promotion 63 0.3 32 0.1 92 0.1 Other 255 0.9 717 1.1 1128 1.3 Total 24,712 100% 60,082 100% 85,912 100% 12

Table 7: Service role undertaken by applied psychologists. Service Role Total Sessions Percentages User and Carer Service Delivery 61,417 61.8 Managing Staff/Service Development 12,689 12.8 Professional Development of other staff 10,324 10.4 Research/Service Audit 7102 7.1 Continuing Professional Development 6881 6.9 Other 1051 1.0 Total 99,464 100 2.6.2 Service role by age It is important to note that this is a cross sectional rather than a longitudinal study. Therefore, caution must be exercised in assuming the patterns that emerged across the age bands represent a true picture of how they developed or will develop in the future. However, the changing role profiles across the age bands is of interest, and is shown in Tables 8 and 9. Table 8: Service role by age band sessions. Age Band 20 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65+ Total User and Carer Service Delivery 3606 9389 14653.5 9052 6894 7197.4 6496 2898 700 114 60999.9 Managing Staff/Service Development 104 939 1872.5 1993 1952.5 2524.6 2257.5 894.5 223.5 13 12774.1 Professional Development of others 135 786 2064 1885 1532 1840 1463 702.5 247.5 19 10674 Research/Service Audit 891 1368 1321.5 835.5 718.5 786.5 699.7 267.5 89 8 6985.2 Own CPD 404 1134 1685.5 1003 815.5 784.5 664.3 284 61.5 4 6840.3 Other 50 48 73 21 19 24 12 13 3 0 263 Total 5190 13664 21670 14790 11932 13157 11592 5060 1325 158 98536.5 The total number of sessions in this table is different to that in Table 6 because some participants did not include their age so their sessions could not be assigned to an age band. Table 9: Service role by age band: Percentage in each age band. Age Band 20 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65+ User and Carer Service Delivery 70% 69% 68% 61% 58% 55% 56% 57% 53% 72% Managing Staff/Service Development 2% 7% 9% 13% 16% 19% 19% 18% 17% 8% Professional Development of others 3% 6% 9% 13% 13% 14% 13% 14% 18% 12% Research/Service Audit 17% 10% 6% 6% 6% 6% 6% 5% 7% 5% Own CPD 8% 8% 8% 7% 7% 6% 6% 6% 5% 3% Other 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 13

Section 2: The Survey Results (continued) Table 9 indicates that psychologists at early points in their careers spend a higher proportion of time in User and Carer Service Delivery (68 61 per cent), and that this drops to approximately 55 per cent after the age of 40. As the proportion of direct service delivery decreases across the age bands, so the involvement in Management and Service Development increases from around 10 per cent in the age bands 30 39, to 18 to 20 per cent in the age bands 45 60. For the staff who are highly likely to be qualified (i.e. age bands above 30) the Professional Development of Others remained fairly constant at between 10 and 14 per cent. As far as Research and Service Audit is concerned this was highest across the two youngest bands. The higher levels of activity for the two younger bands probably reflects the employment of assistants for specific research and audit projects. This role, however, remained fairly constant, taking between 5 7 per cent of the sessions, in all the over 35 age bands. 2.6.3 Gender Table 10 provides information about the percentage of time spent in each of the service roles by gender. The percentages are reasonably close for most roles although males spend just under 3 per cent more time spent in Management and Service Development roles. This difference may be partially accounted for by the greater number of younger females in the profession because junior staff spend less time in management and there are more females at this level. 2.7 Part-time/Full-time Profile 2.7.1 Overview Overall 31 per cent of staff in the workforce were working part-time. Table 11 provides information about the number of sessions worked part-time per week. A session was taken as a period of 3 1 /2 hours (equivalent to a morning or afternoon) with a full-time post being recorded as 10 sessions. The overall average was 5.65 sessions. Continuing Professional Development showed a very small and gradual pattern of decline across the age bands moving from 8 per cent in the early bands to 5 per cent in the 55 64 bands. Table 10: Percentage service roles by gender. Service Role Male Female User and Carer Service Delivery 60.6 62.5 Managing Staff/Service Development 14.8 11.9 Professional Development of others 10.8 10.1 Research/Service Audit 7.0 6.9 Continuing Professional Development 5.9 7.4 Other 0.9 1.1 Total 100 100 14

Table 11: Average part-time sessions per week by age and gender. Age band Not stated Male Female Under 24 5.8 25 29 5.9 5.4 30 34 7.0 5.1 5.9 35 39 8.0 6.0 5.7 40 44 9.0 5.8 5.6 45 49 5.9 5.7 50 54 4.8 5.8 55 59 4.5 5.7 60 64 5.0 5.2 65 and Over 4.4 6.0 Average part-time sessions 5.65; Average male part-time sessions 5.41; Average female part-time sessions 5.70. Table 12: Part-time staff by age and gender and percentage part-time within each age band by gender. Age band Male p/t Male total % p/t Female p/t total Female total % p/t Under 24 0 18 0 4 156 2.6 25-29 10 65 15.4 34 377 9.0 30-34 19 123 15.5 158 574 27.5 35-39 28 138 20.3 203 382 53.1 40-44 24 130 18.5 149 272 54.8 45-49 30 157 19.1 151 298 50.7 50-54 26 168 15.5 79 201 39.3 55-60 23 67 34.3 56 110 50.9 Over 60 12 28 42.9 22 32 68.8 Unstated age 1 4 25.0 7 9 77.8 Total 173 898 19.3 863 2411 35.8 2.7.2 Gender and age part time profile Table 12 provides a detailed analysis of the part-time profile by age and gender. This indicates that overall 19.3 per cent of the males and 35.8 per cent of females were working part-time. The age band and gender analysis provides more information about the pattern of parttime working. For males, the percentage of part-time working remained fairly constant between 15 and 20 per cent up to the age of 54, and then climbed to 34 per cent in the 55 59 age band, and reached a peak of 43 per cent in the over 60 s. For females the percentage rose in the 30 34 age band to 28 per cent, but then to 53 per cent in the 35 39 band and remained fairly constant across all subsequent age bands at between 50 and 55 per cent (the exception being age band 50 54 where it dropped to 39 per cent), until it rose again to 69 per cent in the over 60 s. In summary, the percentage of female staff working parttime was considerably higher than males across all age bands except the 25 29 band. The actual number of sessions worked part-time was, however, very similar. In future, given that an increasing percentage of the workforce will be female, it is likely that there will be an increasing proportion of the total workforce working part-time. There is some evidence that although women are working part-time they are staying in the workforce. This maybe a result of the public sector offering more flexible working arrangements. The process of commissioning training places assumes that if you have a 15

Section 2: The Survey Results (continued) demand for one FTE, one training place will need to be commissioned. If a significant proportion of the workforce is part-time, this simple equation is clearly inadequate, and a ratio of 1.5 2 training places to every one FTE required, would be more appropriate. 2.7.3 Spine points/grade profile Table 13 provides an analysis of the overall grade distribution by gender and age for NHS staff. Prison staff are not included in this analysis as they have a different system of grading to the NHS. Table 13 also shows the distribution across the grades for all staff (full- and parttime) overall and by gender. This indicates that the B grade (point 42 48) includes the greatest proportion of staff, with relatively few staff in the lower bands and highest band. The gender analysis in Table 13 indicates a higher proportion of males in the two highest bands. The difference is 8.2 per cent for points 42 48, and 13.9 per cent for points 49 53. There were also 10.8 per cent more females at points 31 36, which represents the more junior banding for qualified staff. Table 14 indicates that among the full-time staff the difference in the percentage from each gender at the two highest bands is considerable (15.4 per cent at points 49 53 and 13.3 per cent at points 42 48). As would be expected this means that the percentage of women at the lower bands (points 31 36) is considerably (15 per cent) higher. Table 15 indicates that among the part-time staff the differences in the percentage from each gender at each grade is similar up to band 49 53. The differences are never more than 5 per cent at these bands. However, at the highest band (49 43) there were 6.4 per cent more males graded at this level. In summary, the data does indicate a gender effect in terms of grading, particularly for staff currently working full-time. Table 13: All NHS staff grades distribution overall and by gender. Grade point Male % Male Female % Female Total % Overall 13 19 19 2.5 154 28.3 173 6.9 20 30 42 5.5 164 18.9 206 7.9 31 36 139 18.2 536 29.0 675 25.9 37 41 142 18.6 383 20.7 525 20.1 42 48 275 36.1 515 27.9 790 30.3 49 53 145 19.1 97 5.2 242 9.2 Totals 762 100 1849 100 2611 100 16

Table 14: Full-time NHS staff grades distribution by gender. Grade point Male % Male Female % Female Total % Overall 13 19 18 3.1 143 14 161 10 20 30 37 6.4 120 11.7 157 9.8 31 36 99 17.1 329 32.1 428 26.7 37 41 96 16.6 144 14.1 240 15 42 48 202 35 222 21.7 424 26.5 49 53 126 21.8 66 6.4 192 12 Totals 578 100 1024 100 1602 100 Table 15: Part-time NHS staff grades distribution by gender. Grade point Male % Male Female % Female Total % Overall 13 19 1 0.5 11 1.3 12 1.2 20 30 5 2.7 44 4.3 49 4.9 31 36 40 21.7 207 25.1 247 24.5 37 41 46 25.0 239 29.0 285 28.3 42 48 73 39.9 293 35.5 366 36.3 49 53 19 10.2 31 3.8 50 4.8 Totals 184 100 825 100 1009 100 17

Section 3: Workforce Supply Clinical Psychology The following two sections, supply and demand, focus on Clinical Psychology as this was the largest group of the applied psychologists in the survey and has the most robust supply side data. A brief analysis of the supply and demand issues for health, counselling, forensic, occupational and clinical neuropsychologists is included as Appendix 5. It is important to note that the vast majority of clinical psychologists work in the NHS and consequently the supply-demand analysis reported here has most relevance for that service. A supply and demand analysis for Applied Psychologists in the Prison and Probation Service was not undertaken for this report although a strategic framework for the development of psychological services in prisons and probation has been published 22. 3.1 Applicants and Trainee Numbers 3.1.1 Courses The primary route to qualification as a clinical psychologist in the UK is via a university training course which has been formally accredited by The British Psychological Society as conferring eligibility for Chartered status of the Society. These three-year postgraduate training courses also lead to a Doctorate in Clinical Psychology. There are currently 30 accredited training courses in the UK, of which two are in Scotland, one in Northern Ireland, two in Wales and 25 in England. Of the 30, most (27) participate in the Clearing House for Postgraduate Courses in Clinical Psychology. Approximately 1700 people apply for Clinical Psychology courses each year which means that each year approximately 1000 do not gain a place. A number of these go on to re-apply but there are undoubtedly some who are put off continuing with applications. How to retain this pool of people and find them other routes into the services may be important to consider. The data below is routinely collected by the Clearing House and permits a historical perspective and the monitoring of trends. It should be noted that the three courses not in the Clearing House currently have a total annual intake of approximately 40 trainees. Data from these courses were not included in the analysis below. However, these three courses are based in England and have annual intakes approximately equivalent to the numbers on the courses in Scotland, Wales and Northern Ireland. As this report presents an analysis of applied psychologists in Table 16: Number of applicants and candidates accepted to training courses. Clearing House for Postgraduate Courses in Clinical Psychology Numbers accepted Annual % Year Applicants N Percentage increase in accepted number of training places 1994 1224 222 18.1 1995 1398 263 18.8 18.5 1996 1645 289 17.6 9.9 1997 1642 314 19.1 8.6 1998 1597 347 21.7 10.5 1999 1556 378 24.3 8.9 2000 1538 413 26.9 9.3 2001 1486 454 30.6 9.9 2002 1670 489 29.3 7.7 2003 1968 537 27.3 9.8 18

England it, therefore, seemed reasonable to use the Clearing House numbers. 3.1.2 Numbers Table 16 indicates that the number of training places on courses participating in the Clearing House in the UK has increased by approximately 9 per cent per annum over the last decade. The percentage of applicants accepted has shown a steady increase from around 18 per cent in 1994 to 30 per cent in 2001/2002. This is largely due to increased training places and a static number of applicants until 2003 where a substantial increase in the number of applicants occurred. 3.1.3 Age Table 17 provides data on the number of applicants to training,by age since 1994. Data prior to 1999 are incomplete but are included for illustrative purposes. The age distribution of applicants has remained very consistent over the past five years with approximately 75 per cent of applicants in the 20 29 age group. The information for earlier years suggests a shift around 1998/1999 to a slightly older cohort of applicants. Table 18 gives the age profile of candidates accepted into training since 1994. Data prior to 1999 are incomplete but are included for illustrative purposes. These data indicate a tendency for courses to accept an increasingly higher proportion of applicants in the 20 29 age group over the decade. It is of note that no applicants over the age of 50 were accepted on to courses. Two candidates who were accepted did not provide age data. Table 17: Age profile of applicants to training courses. Clearing House for Postgraduate Courses in Clinical Psychology Number of applicants by age Age 20 29 30 39 40 49 50+ Year Number % Number % Number % Number % Total 1994 82.0 14.0 4.0 0 1224 1995 86.0 13.0 1.0 0 1398 1996 86.0 13.0 1.0 0 1645 1997 80.0 18.0 2.0 0 1642 1998 81.0 17.0 2.0 0 1597 1999 1129 72.6 330 21.2 91 5.8 6 0.4 1556 2000 1124 73.0 321 20.9 91 5.9 2 0.1 1538 2001 1095 73.7 299 20.1 85 5.7 7 0.5 1486 2002 1252 75.0 336 20.1 76 4.6 6 0.4 1670 2003 1481 75.3 391 19.8 92 4.7 4 0.2 1968 19

Section 3: Workforce Supply Clinical Psychology (continued) Table 18: Age profile of applicants accepted to training courses. Clearing House for Postgraduate Courses in Clinical Psychology Number of acceptances by age Age 20 29 30 39 40 49 50+ Year Number % Number % Number % Number % Total 1994 77.6 17.0 6.0 0 222 1995 76.0 18.0 6.0 0 263 1996 79.0 18.0 4.0 0 289 1997 77.0 20.0 5.0 0 314 1998 74.0 21.0 5.0 0 347 1999 296 78.0 73 19.3 9 2.4 0 0 378 2000 335 81.1 67 16.2 11 2.7 0 0 413 2001 376 82.8 67 14.7 11 2.4 0 0 454 2002 403 82.4 76 15.5 10 2.0 0 0 489 2003 497 83.6 80 15.0 8 1.5 0 0 535 3.1.4 Gender Table 19 provides information about the gender profile of applicants and those accepted since 1999. Data prior to 1999 are incomplete but are included for illustrative purposes. The proportion of males applying for training has been declining steadily as has the proportion of males being accepted. The growth in the number of training places over the past five years has been entirely taken up by females. Table 19: Gender profile of applicants and accepted candidates to training courses. Clearing House for Postgraduate Courses in Clinical Psychology Male Female Totals Applicants Accepted Applicants Accepted Applicants Accepted Year Number % Number % Number % Number % Number % 1994 23.0 25.0 77.0 75.0 1224 222 1995 19.0 18.0 81.0 82.0 1398 263 1996 21.0 17.0 79.0 83.0 1645 289 1997 22.0 19.0 78.0 81.0 1642 314 1998 22.0 21.0 78.0 79.0 1597 347 1999 311 20.0 77 20.4 1245 78.7 301 79.6 1556 378 2000 305 19.8 71 17.2 1233 80.2 342 82.8 1538 413 2001 288 19.4 87 19.2 1198 80.6 367 80.8 1486 454 2002 321 19.2 75 15.3 1349 80.8 414 84.7 1670 489 2003 337 17.1 79 14.7 1631 82.9 458 85.3 1968 537 20

3.1.5 Ethnicity Table 20 provides information about the ethnic profile of applicants and those accepted since 1994. Data prior to 1999 are incomplete but are included for illustrative purposes. Whereas approximately 10 per cent of applicants are non-white, only 7 per cent are accepted on to courses. There is no strong evidence of any movement towards a more ethnically diverse workforce, with the proportion of non-white applicants remaining remarkably stable. Table 20: Ethnicity of applicants and candidates accepted to training courses. Clearing House for Postgraduate Courses in Clinical Psychology White Non-White Totals Applicants Accepted Applicants Accepted Apps Accept Year Number % Number % Number % Number % Number Number 1994 93.0 97.0 7.0 3.0 1224 222 1995 91.0 92.0 9.0 7.0 1398 263 1996 92.0 95.0 8.0 5.0 1645 289 1997 91.0 97.0 9.0 3.0 1642 314 1998 89.0 92.0 11.0 8.0 1597 347 1999 1414 90.9 360 95.2 142 9.1 18 4.8 1556 378 2000 1378 89.6 386 93.5 160 10.4 27 6.5 1538 413 2001 1326 89.2 419 92.3 160 10.8 35 7.7 1486 454 2002 1494 89.5 452 92.4 176 10.5 37 7.6 1670 489 2003 1774 90.1 501 93.0 194 9.9 35 7.0 1968 536 3.2 Statement of Equivalence The alternative route to qualification as a Clinical Psychologist in the UK is by being awarded a Statement of Equivalence (SOE) by The British Psychological Society. Foreign nationals with a clinical psychology qualification and UK nationals who have a recognised qualification in another branch of applied psychology can apply to the Society for a Statement of Equivalence which entitles them to work and be recognised as a clinical psychologist in the UK. Granting of this Statement frequently involves a requirement to undergo further training. The Committee for the Scrutiny of Individual Clinical Qualifications (CSICQ) determines the further training requirements of psychologists who hold a qualification which partially fulfils the qualification requirements for registration as a Chartered Clinical Psychologist and, therefore, for the practice of Clinical Psychology in the UK. Such psychologists may: (i) be seeking lateral transfer from another branch of applied psychology; (ii) hold a research degree in a clinical subject; or (iii) possess a qualification in clinical psychology obtained overseas which does not fully meet UK training requirements. The further requirements of these psychologists may be fulfilled by completing the relevant Parts described in the Society s Regulations. Their work is assessed by the Board of Examiners in Clinical Psychology and successful candidates are issued with a Statement of Equivalence in Clinical Psychology. 21

Section 3: Workforce Supply Clinical Psychology (continued) The Board of Examiners in Clinical Psychology has supplied the following information. 3.2.1 Numbers and Gender It is clear from Table 21 that the SOE route is a significant contributor to the UK Clinical Psychology workforce. It is roughly equivalent to the output of two of the larger accredited training courses. Table 21, indicates that approximately 36 percent of SOE qualifiers are male in contrast to approximately 20 percent from accredited courses. The Statement Of Equivalence is contributing to a more gender-balanced workforce. Table 21: Number and gender of candidates awarded the Statement of Equivalence. Number of Statements of Equivalence Awarded Male Female Year N % N % Total 1998 18 45.0 22 55.0 40 1999 11 34.4 21 65.6 32 2000 11 28.9 27 71.1 38 2001 16 37.2 27 62.8 43 2002 18 34.0 35 66.0 53 Totals 74 35.9 132 64.1 206 3.2.2 Age Table 22, indicates that there are very few SOE candidates in the youngest age group in contrast to the accredited training courses where approximately 80 per cent of candidates are in the 20 29 age group. In marked contrast to the accredited programmes, where no applicants over the age of 50 were accepted, 20 per cent of successful SOE candidates were in the 50+ age group. As SOE candidates already have a qualification in clinical psychology or applied psychology, it is expected that they would be an older group than those on accredited programmes. The SOE is contributing to a more age-balanced workforce. Table 22: Age distribution of candidates awarded the Statement of Equivalence. 20 29 30 39 40 49 50 + Totals Year N % N % N % N % N 1998 1 2.5 11 27.5 16 40.0 12 30.0 40 1999 0 0 14 45.2 7 22.6 10 32.3 31 2000 0 0 21 55.3 11 28.9 6 15.8 38 2001 2 4.7 22 51.2 11 25.6 8 18.6 43 2002 0 0 30 56.6 17 32.1 6 11.3 53 Totals 3 1.5 99 48.3 62 30.2 42 20.5 205 * Age data was not available for one candidate. 22