Increasing impact and developing psychology

services

Alex Clarke

Clinical psychology: making a difference

UCL, 27.06.14

Aims• Identify the challenges to building and sustaining clinical psychology in health care

• Illustrate the way we have continued to build new services at the Royal Free Hospital

• Convince you that this is one of the best times to be a psychologist in the NHS!

Challenge 1.Non psychologists don’t understand what psychologists do

• don’t refer appropriately (or at all)

• can’t explain psychological processes to patients

• perceive psychology as the “icing on the cake”

• prioritise other professions within the service

Challenge 2: Psychologists…..

• are not good at explaining what we do

• tend to focus on patient need rather than on the benefits of intervention

• are reluctant to invite observation or engage with the media

• assume knowledge that others don’t have (e.g: relationship between anxiety and pain)

• Complicate referral processes

Meeting the challenges• Observing other professional practice

• Inviting observation• Contributing to MDMs• Teaching and case presentations

• Joint research projects

• Publications• Annual report• Engaging with media

Engaging with managers• Bilateral breast reduction pathway

• Improved patient outcomes +

• Improved service outcomes

• = QUALITY

Canadian Psychological Association 2002

• Clearest effects for cost offset in inpatient service costs (surgery, oncology etc)

• Clearest effects for structured interventions specific to condition rather than generic psychotherapy (MDT approach)

• For every $1 spent on psychology, $5 saved within the health system

Return to work

Tax revenue &benefits @ £8464 per person pa) Reduced GP appointments @ £25 – 63 each Healthy behaviours & medication use (smoking cessation £24,000 average savings total life health costs) Effective use of appointments & discharge/

health professional time/ procedures Reduction in A&E attendance @ £59 - 117 Reduced Length of stay @ £225 per day Effective use and reduction of medication (up to

£10,000 pa per patient annual cost of biologics in dermatology)

Improved staff patient experience/ reduction in complaints

Improved activities of daily living

Social engagement and social support Family activities – child care, Intimacy and positive relationships

Relapse prevention, symptom control, reduced frequency of flare up & and infection, lower recurrence of cardiac events , reduced BP, stable blood sugar, reduced medication, impact of managing anxiety, stress, depression on physical condition, reduced disability

Affect Behaviour Cognitions Reduced: Improved : Improved: Anxiety, shame, sleep, fatigue

understanding of condition, control loss, disgust, activity, weight, self efficacy, motivation depression (30% cost pain, breathlessness saving cp with medication) coping skills & self management

Society

Primary care

RFL Trust

Family

Disease factors

Evidence based health & cost benefits associated with psychological intervention in specialist health settings .(Alex Clarke 2012)

Over 90% of psychology services are cost saving or cost neutralOnly 7% fail to cover costs

Patient impact

Psychological Services: Key questions

• What do you do?• Who do you do it to?• Is what you are doing effective?

• How much does it cost?• Could anyone else be doing it? • How does it benefit this organisation/sector?

Why are we feeling pessimistic?

• NHS set up in 1948 when UK bankrupt

• Change is harder without cost incentives

• The big challenges now are for behaviour change

• Psychologists are expert problem solvers

Engage with the problems

• Make clinical psychology visible

• Explain the benefits of what we do

• Engage positively with stakeholders

• Understand the drivers and costs

• Reframe outcomes• Now is a very good time to be a psychologist!