Evolution of NHS-based health psychology training in Scotland and England
Ellen Jardine, Dr Hannah Dale and Dr Elizabeth Jenkinson report.
04 June 2024
Way back in 2006, a British Psychological Society briefing paper stated:
'Given the current demands on the NHS for the expertise that Health Psychologists can offer, there is a clear need for a consolidated career pathway and designated funding for the training of Health Psychologists to Chartered status.'
The following year, the Stage 2 Health Psychology Programme in Scotland was born. At the time, it was a creative and novel way in which Scottish Health Boards could be supported by NHS Education for Scotland (NES) who together jointly fund band 6 trainees with Health Boards to incorporate health psychology knowledge and skills into local teams to help meet ever-increasing demands.
With a broad brush stroke these demands can be described in terms of prevention:
- Primary prevention – preventing illness and poor health from occurring through population and community level interventions over the lifespan, focusing on behaviour change that addresses behaviours such as movement, nutrition, self-care, screen time, smoking and sun-cream use,
- Secondary prevention – intervening early to reduce the likelihood of illness and poor health developing through population, community, group and individual interventions, focusing on behaviour change that addresses health screening, self-management and associated behaviour
- Tertiary prevention – intervening once a condition has been diagnosed to support self-management and to slow down or stop deterioration. Group and individual interventions focus on behaviour change that addresses behaviours relating to psychological adjustment and self-management.
The common thread that runs through helps to explain how a Health Psychologist/Trainee Health Psychologist, a healthcare professional who is trained to doctoral-level in behaviour change and long-term condition management, can be directly positioned to help meet demands relating to the three tiers of prevention. It was through this lens that Scottish Health Boards developed proposals for placements that were grounded in the application of scientific and theoretical health psychology knowledge and skills to address complex and behaviorally-driven challenges across a range of different health areas.
As the NES programme became more established, the look and feel of the accompanying training developed and adapted to meet the needs of trainees in relation to the work. This has resulted in a core training programme that supports development of the five BPS Stage 2 competences (generic professional, psychological interventions, research, teaching and training and consultancy) in combination with applied psychological skills and integrated intervention modalities.
Examples of work of trainee health psychologists in Scotland
The years that followed saw Trainee Health Psychologists undertake pieces of work in a variety of areas. The table below highlights some of these by core competencies required for the qualification.
| Psychological interventions | Research | Consultancy | Teaching and training | |
| Generic professional competence | ||||
| Primary prevention | Reducing the risk of hepatitis C through an intervention to reduce injecting risk taking behaviour in people who inject drugs (NHS Tayside) | Evaluating programmes for falls prevention in older people (NHS Tayside) | Understanding health anxiety in a sexual health setting and opportunities for intervention (NHS Grampian) | Psychosocial barriers training to health and social care staff working with older people |
| Secondary prevention | Smoking cessation in a mental health in-patient population (NHS Greater Glasgow & Clyde) | Exploring the factors influencing engagement in weight-loss interventions for young adults (18-39) with overweight or obesity (NHS Tayside) | Increasing staff promotion of physical activity in an in-patient mental health setting using a co-design approach (NHS Highland) | Developing behaviour change skills training for podiatrists (NHS Grampian) |
| Tertiary prevention | Psychological intervention to manage COPD symptoms and reduce hospital admissions (NHS Grampian) | Assessing the psychosocial and behaviour change needs of men with cancer (NHS Fife) | Developing a tier 1 long covid intervention accessible across a health board (NHS Orkney) | Developing a train-the-trainer communication skills package for radiotherapists (NHS Lothian) |
Over time, the impact of placements has become clearer. Each two-year placement, a trainee is producing a high number of quality outputs, delivering a significant number of individual and group interventions and contributing to a growing body of applied behavioural scientific knowledge. Above all, the legacy of work is setting a standard for what health psychology in healthcare is about and demonstrates the discipline's passion to leave services in a much stronger position to face behaviourally-driven challenges, evidenced in some of the exemplary pieces of work below:
- A health psychology liaison service developed in partnership between the local authority and NHS in North Lanarkshire improved the health and wellbeing of older adults - reducing or delaying care home admission, preventing unnecessary hospital admissions, and reducing use of community alarms, out of hours and emergency services. Contact: Heather Connolly: [email protected] and Susan Ross [email protected]
- Health psychology trainees have been involved in delivering 13 MAP behaviour change training courses across 8 health boards since 2020. These courses have supported around 120 healthcare professionals to learn and apply health behaviour change skills to their practice and support patients more effectively to improve health outcomes. Contact: Michelle Clark: [email protected] and Heather Connolly: [email protected]
Celebrating 15 years of the NES Stage 2 Health Psychology Programme
On 15 November 2023, NES were delighted to invite many people along to celebrate 15 years of the Stage 2 Health Psychology Training Programme in Scotland and learn about the breadth of health psychology work going on across the UK and internationally. [Past and present trainees are pictured above, on the day.]
The day was split broadly into three parts:
- We learnt about the diverse health psychology approaches and intervention skills that trainees are using and saw these brought to life in a range of different applied NHS examples, such as providing behaviour change support in prevention and management of diabetes, pain and workplace stress as well as supporting individuals in substance use and specialist weight management.
- We heard about the contributions qualified NHS Scotland Health Psychologists are making, providing unique skills and expertise in multi-disciplinary settings in substance use, diabetes, dentistry, a high secure hospital and pain management.
- And we heard from experts in the field who discussed, applications of the MAP of behaviour change training programme, the transition of behaviour change interventions to the digital world and the use of a very specific technique to support maintenance of health behaviour change from our keynote Dr Stephan Dombrowski.
Initiation of the NHS England THP prog
A pilot programme which draws inspiration from the NES programme has now been established in England, funded by NHS England Workforce Training and Education led by Dr Liz Jenkinson as National Training Director, and Lucy Renwick at NHS England, supported by a Steering Group including Prof. Angel Chater, Prof. Jo Hart, Prof. Lucie Byrne-Davies and Dr Adrian Whittington, National Lead for Psychological Professions, NHS England. This programme has a slightly different focus - on 'workforce transformation and redesign' within the NHS, with projects and practice aimed to support the development of a workforce that is responsive to changes in healthcare by improving the way the NHS recruits, retains, deploys, develops, and supports the healthcare workforce. Seven trainees are currently in post in newly developed Band 6 Trainee health psychologist roles – one in each of the seven NHS regions in England. Each trainee is leading projects and practice of strategic importance within their trust and/or region including the upskilling of health care professionals in behaviour science and psychologically informed approaches, delivering one to one and group psychological interventions to improve staff wellbeing, contributing to the delivery of new services (e.g. Long Covid, Waiting list online support in mental health care) and delivering research in understanding how to address workforce challenges. Trainees will complete the current programme in May 2025, with the impact of the programme is being independently evaluated.
Dr Adrian Whittington says:
"This is a great opportunity for systems to benefit from a health psychology approach to making changes in how they work. It is also a great career opportunity for aspiring health psychologists to undertake a paid NHS training path, as part of the wider expansion of the psychological professions set out in the Psychological Professions Workforce Plan."
The future for trainee health psychology programmes and health psychology in the NHS
Health psychology is a growing and much needed field. Prevention of and management of conditions is needed at all levels and health psychologists can apply their expertise to develop and evaluate interventions, work within multi-disciplinary teams, and train health, social and third sector staff in health psychology/behavioural science principles. With further support and opening up of jobs in line with BPS guidance (BPS, 2021), health psychology can be a valued part of the psychology and wider skill mix to support better and health and wellbeing.
For further information about health psychology, please a leaflet developed by the Division of Health Psychology-Scotland
Explore more Health Psychology in our archive.
Information about Health Psychology training routes, and career pathways for health psychologists is available via:
Division of Health Psychology | BPS
Qualification in Health Psychology (Stage 2) | BPS
Follow us on X @NES_Psychology #healthpsychologyscotland
Authors
Ellen Jardine, Health Psychologist/Health Psychology Tutor NHS Education for Scotland, [email protected]
Dr Hannah Dale, Health Psychologist/Head of Programme for Health Improvement NHS Education for Scotland, [email protected]
Dr Elizabeth Jenkinson, Associate Professor in Health Psychology, UWE, Bristol and National Training Director for Health Psychology in Workforce Redesign, NHS England
