Memorandum by The British Psychological
Society (WP 79)
SUMMARY
1. The British Psychological Society welcomes
the opportunity of providing written evidence to the House of
Commons Health Select Committee regarding the Government's Public
Health White Paper.
2. Applied psychologists are currently active
within the spheres of service delivery as envisioned in the White
Paper. Given the prominence of psychological factors in terms
of primary prevention of ill-health and secondary prevention and
rehabilitation following the development of long term conditions,
we use this opportunity to strongly support the strategic shift
in the delivery of public health and offer additional recommendations
to assist this change in emphasis.
INTRODUCTION
3. The British Psychological Society is
the learned and professional body, incorporated by Royal Charter,
for psychologists in the United Kingdom. The Society has a total
membership of over 40,000 and is a registered charity. The key
Charter objective of the Society is "to promote the advancement
and diffusion of the knowledge of pure and applied psychology
and especially to promote the efficiency and usefulness of members
by setting up a high standard of professional education and knowledge".
As acknowledged in the White Paper, applied psychological science
has a central contribution to make to the successful implementation
of the objectives set out in this strategy.
Will the proposals enable the Government to achieve
its public health goals?
4. The British Psychological Society welcomes
the strategic shift in emphasis from the treatment of ill-health
to the prevention of disease and active promotion of health choices.
The theoretical underpinnings of the strategy appear well considered.
We strongly support the understanding and therefore, the core
requirement to consider psychological factors in advancing the
framework for public health as described in the White Paper.
5. The six key priorities for action are
well rehearsed. The methods that are conceptualised to enable
change at the various levels of individual, social network, community
and from the national level, but matrixed through collaboration
across agency are welcomed. The structural configuration to facilitate
delivery appears to be synergistic, but is dependent upon developing
a shared view of the strategic vision and its implementation at
a national level.
6. Primary prevention parameters appear
to have been well considered in the White Paper and reflected
in the requirement to develop the roles of the public health workforce
to deliver these objectives seem highly relevant. The British
Psychological Society supports the development of health trainers
skilled in behavioural change principles to work to prevent ill-health.
Whilst we are supportive of this community role, we would wish
to strengthen the psychological skill base within public health
overall. We would therefore suggest that further consideration
be made to developing an applied psychology workforce within public
health so as to close the gap that we consider emergent in the
proposals.
7. Although strong secondary prevention
and rehabilitation services exist within the current NHS configuration,
these are variable in portfolio across the UK. Given the significant
impact (across domain) of long-term conditions, we are uncertain
about the role that NHS Trusts will have in developing the public
health objectives (although we acknowledge that the White Paper
will address this issue in the delivery plan). However, we would
suggest that further consideration be made to developing and extending,
at a national level, the role of multi-disciplinary chronic disease
management programmes that incorporate a psychological care dimension
and contain a significant therapeutic focus on secondary prevention
parameters (as envisioned in the various National Service Frameworks).
We also consider that these structures should develop strategic
linkage to the Expert Patients Programme.
8. The British Psychological Society would
welcome the opportunity to develop further partnerships, as a
professional organisation, to support the implementation of the
core objectives of the White Paper.
Are the proposals appropriate, will they be effective
and will they represent value for money?
9. The British Psychological Society considers
the proposals to be wide-ranging and complex in organisation form,
but highly appropriate to the health of the nation. If the objectives
can be fully implemented, then there will be a significant enhancement
of health parameters across the nation. However, the proposals
are focussed on those people who are ready to make the necessary
positive health changes. We consider it important that the evidence-base
for psychological interventions designed to modify people's motivational
status to behaviour change (for example, from a contemplative
position to being ready to make choices) be further considered.
Public health practitioners should have, or should develop, competencies
to implement interventions designed to achieve motivational parameter
changes. We would encourage further psychological change skills
training, delivered by an applied psychologist with the necessary
competencies.
10. The White Paper requires a matrix of
interventions, but which are co-ordinated and integrated across
agencies. In terms of effectiveness, interventions that are individually
tailored result in greater behaviour change. We would, therefore,
support the further development of the public health workforce
in psychological change work. However, to provide psychological
interventions, at the levels specified, would appear to require
significant training within applied psychology (practitioners
within applied psychology require doctoral level or equivalent
qualifications). Psychological interventions can be time consuming
to implement because of the complex nature of the cognitive computational
tasks required to be undertaken, both to create psychological
change and then to maintain these same changes. We therefore recommend
that consideration be made to these factors when mapping training
competencies.
11. The White Paper requires complex organisational
collaboration and will require the mobilisation of various workforces,
towards the shared vision. This, in turn, will require strong
leadership to implement across the national frame. It will also
necessitate additional resources to develop the public health
team beyond the current configuration.
12. In terms of primary prevention, we support
the developments of health trainers as supporters of people who
wish to make health choices. We also support the role for community
matrons in leading the deployment of the new public health objectives.
We support the development of further psychological knowledge
and skills in the current public health practitioner workforce.
However, the British Psychological Society would consider there
to be a gap in the White Paper, in terms of its capacity to deliver
core psychological services to support the strategic objectives
(both direct and indirect services). We would therefore recommend
that consideration be made to the development of an applied psychology
workforce with the necessary competencies, to be integrated into
each public health team configuration.
13. In secondary prevention/rehabilitation,
service delivery has begun to enable people with long-term conditions
to consider health choices. Although these services are delivered
through multi-professional teams, the evidence-base highlights
a central role for an integrated psychological care dimension.
Applied psychologists are currently active within this service
domain, but deployment is variable across the UK. We are of the
view that it is of fundamental importance to the success of the
White Paper that further consideration be made to developing these
teams. This would require both re-deployment and workforce development.
We would also consider the benefits of structural linkage between
secondary prevention services and to other policy drivers such
as the Expert Patients Programme.
14. By implementing our applied psychology
workforce planning recommendations, both the public health teams
and the services providing secondary prevention would have on-line
direct access to psychological resources. This position has been
well understood in terms of current guidance (in terms of National
Service Frameworks and National Institute of Clinical Excellence
guidelines) and we would therefore strongly urge consideration
of the added benefits that incorporation of an applied psychology
dimension would have to the delivery of this strategy.
15. The British Psychological Society strongly
supports the policy shift, as described in the White Paper, for
improving the health of the nation. Significant benefits will
accrue at individual, vocational and community levels, should
the objectives be achieved. Given the proportion of resource that
will be made available to this strategy against the entire NHS
budget and the potential benefits that will emerge, then these
proposals do indeed represent value. We are of the view that the
additional applied psychology workforce developments described
above would add further value to the proposals (and this position
is supported from the evidence-base for psychological skills development
within other healthcare professionals from an integrated psychological
care stream, as reflected in the national clinical guidelines).
Will the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
16. The British Psychological Society would
consider that the infrastructure will require additional development
from that specified, if the objectives laid out in the White Paper
are to be achieved. We have suggested that the further development
of public health teams and secondary prevention services would
be required. We have described the benefits that these services
would gain from primary investment into an integrated applied
psychology workforce, both in primary and secondary prevention
services, to develop overall, the matrix of psychological skills
that will be required within the entire organisational frame to
ensure implementation.
17. We are concerned that the new public
health workforce configurations, as detailed in the White Paper,
will not have sufficient access to services offered by applied
psychologists with the appropriate competencies, for onward referral
or assistance with psychological issues. This may well lead to
potential difficulties in service quality and reaching the necessary
performance standards. We therefore recommend that further consideration
be made to developing the applied psychology workforce within
the structures identified to achieve full implementation of the
proposals.
18. We highlight the benefits that would
accrue from developing the roles that NHS Trusts could have in
delivering the service structures required for successful implementation
of the White Paper (although we acknowledge that the White Paper
will address this issue in the delivery plan).
19. The British Psychological Society strongly
supports the leadership and governance (including regulation)
structures that will be configured within the delivery plan. We
also support the central role that will be undertaken by the "change"
agencies. We would welcome the opportunity to work within these
frameworks to support workforce skills development and improving
performance, but also in consideration of our earlier recommendations
for the additional applied psychology deployment required.
20. The British Psychological Society supports
the objectives considered for enhancing public health research
and also in the development of the National Institute for Health
and Clinical Excellence. We would welcome further opportunities
to enhance our partnership with NICE to support the objectives
as specified in the White Paper.
RECOMMENDATIONS
21. To summarise our recommendations:
— The British Psychological Society
strongly supports this shift in public health policy. We would
welcome the opportunity to develop further partnerships, as a
professional organisation to support the implementation of the
core objectives of the White Paper.
— The British Psychological Society
recommends that added value would emerge through developing an
applied psychology workforce, with the necessary competencies,
to be integrated into each public health team configuration and
through deployment into secondary prevention teams. By implementing
our applied psychology workforce planning recommendations, both
the public health teams and the services providing secondary prevention
would have on-line direct access to psychological resources.
— We recommend that public health practitioners
should have or should develop further competencies in implementing
psychological change interventions.
— We suggest that significant benefits
would emerge from strategic linkage of various strands of self-management
healthcare policy (Expert Patients Programme).
— The British Psychological Society
would highlight the need to consider "hard-to-reach"
groups within the population and suggest development of public
health interventions to reach these groups.
— The British Psychological Society
would welcome further opportunities to enhance our partnership
with NICE to support the research and effectiveness objectives
as specified in the White Paper.
January 2005
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