‘We’ve never been in a more fertile environment for psychological approaches to expand and take root further’

You were formally appointed to your role last year, having been in an interim role as national lead for about three years prior. During that time, what's changed?

I think we have really come a long way in three years. We're in a much less fragmented place in terms of the psychological professions' identity now. We set out to create a more united sense of direction for psychologists, psychological therapists and psychological practitioners. There are many different voices speaking on behalf of these different groups, and it was quite difficult for policymakers to hear a coherent response. We're trying to create a more unified sense of who the psychological professions are, and the direction of travel that we're all able to commit to, whilst recognising our unique contributions as individual professions within that.

What are those individual professions? 

We're talking about 20 different occupations. In the psychologists category, big contributors in NHS commissioned services are clinical psychologists, counselling psychologists, forensic psychologists and health psychologists. Clinical associates in psychology are also making a growing contribution.

Within the psychological therapists grouping, we've got CBT therapists, family and systemic psychotherapists, counsellors, adult psychotherapists, child and adolescent psychotherapists, and others. And within the psychological practitioner group, these are some of roles that have developed more recently, including psychological wellbeing practitioners, children's wellbeing practitioners, education mental health practitioners and mental health and wellbeing practitioners. 

Are you constantly going to be welcoming different occupations into the psychological professions network, so that it continues to grow?

Two different things need to happen here. Yes, let's create this broad coalition of support around psychological approaches in health care: that means everyone is welcome, and everyone gets on board. And then there's a second strand to this work, which is about providing the professional leadership and home for specific occupational groups that don't otherwise have one in national NHS structures. 

We're trying to do both of those things, and that second aspect is a more restricted group, because others who make a contribution to psychological healthcare clearly have another professional home. So for example, mental health nurses would be represented through the nursing professional leadership, occupational therapists through the allied health professions professional leadership. But when I first started out on this work, there wasn't a professional leadership for many of our groups. That's what we set out to achieve.

And is that in collaboration with the British Psychological Society in terms of providing that professional home?

My work is focused on NHS commissioned health care. The purpose of my role is to maximise the impact of the psychological professions for the public, within NHS commissioned health care. We actually work with 15 different professional organisations who represent different components of this workforce, including the BPS. The work I'm doing is very distinct from the focus of a professional body. 

It's about how we create the conditions in which all of these different occupations can make the biggest impact for the public and in line with policy, whereas a professional organisation is also trying to represent the needs of its members… to push forward certain agendas and to create a voice for the value of these occupations within a political arena.

I've seen your role described as making the NHS more psychological. What does that look like to you? 

Whatever part of health and care you're coming into contact with, as members of the public, what you're offered should be appropriately informed by psychological approaches and the discipline of psychology and psychological therapy. Whether you're receiving cancer treatment, or you have complex mental health needs, psychological approaches can bring a huge benefit. 

But they're also not currently provided to that maximum level of benefit. A more psychological NHS means more psychological practice delivered by the whole multidisciplinary team, but it also means more specialist psychological professionals in the system. We need to grow the psychological workforce by 60 per cent between 2019 and 2024, and we're now planning for further significant growth in the period after that. 

If we're able to achieve those growth ambitions, we'll be in a significantly different place. And to give an example, over the last three years we've nearly doubled the number of commissioned training places for clinical psychology training. We've also significantly expanded psychological therapies training as a route in for people working in health and care, and we've developed a number of new roles that are also great destinations for people to start their career or change their career within the NHS. So a big focus on expansion, but also on the role of the psychological professions in influencing across the whole system. 

Over the years, the concerns that I've seen from some psychologists over workforce expansion – although this is not, I would note, from the very best psychologists I meet – are around the devaluing of their own specialist skills and training, and the potential for the manualisation of psychological therapy. How do you see that opportunity versus threat for the profession of psychology?

I think the greatest opportunity for practitioner psychologists is to demonstrate how they can play a part in being the architects of this much wider access to psychological health care. That does mean using their unique skills as specialists, but it also means ensuring join-up with these other forms of psychological delivery, including psychological therapies and the work of the psychological practitioners. 

You know, I don't think following a manual is a dirty word either. The trials that have demonstrated a lot of the effectiveness of particular psychological therapies have been based on the therapists following a manualised approach, but they've done that in a way that is appropriately flexible and adapted to the needs of individuals. And that's exactly what we need our practitioners to be doing.

In terms of that evidence of effectiveness – and, presumably increasingly, cost effectiveness – do you feel you've got enough on what works and whether in the next 5-10 years it's going to be feasible to deliver?

We definitely need to collect more robust evidence across the range of different approaches that have been used by our workforces. We currently only have one pathway in health care where psychological professions are deeply involved that openly publishes its data, and that is the NHS Talking Therapies for anxiety and depression service.

We can be very clear exactly what that's delivering, in terms of outcomes for patients; we can't be that transparent about what other parts of the services are delivering and what some of our practitioners are able to achieve. So having transparently reportable outcomes against all of our work is going to be increasingly important. It's very important in winning arguments about funding that you can demonstrate impact. We need to be able to do that. 

We also need all of the different components of the system. There's much more to psychological health care than psychological therapy. There's also working across teams, working to influence systems, leadership, developing systems of care. All of that is very important, too. I tend to take a 'both/and' approach: we need to push all of these agendas forward at the same time, and we're stronger together. 

In terms of a more psychological NHS in how it runs, I've always found Michael West's work interesting, on a more compassionate NHS. Psychologists clearly have a lot to contribute not just in terms of delivery, but in terms of the NHS as a working environment.

Absolutely… that broad spectrum of knowledge, working across a whole system. By joining forces across these different strands, we can make the most of everybody's contribution. We shouldn't be seeing contributions from different specific occupational groups within this big family as being in competition with one another. For the benefit of the public, we need to work together in a way that's coherent and as seamless as possible.

Talk to me about the values you bring to the role: it sounds like family values are an important thing there.

Some people don't like the word 'family', because not everyone has a positive experience of family. But to me, it is about working together, it's about everything being about impact for people who use services and their families and carers. And for us to be driven by that, rather than by our own specific professional concerns. So, yes, collaboration for the benefit of people who use the service.

That sounds like a challenging part of the role. Psychologists can be very good at collaborating, but I think we're also often focused on our own little battles and how different parts of the system impact on us. You mentioned fragmentation earlier… where do you think we are in terms of that risk, with the different types of psychologist you mentioned?

What we're trying to do is bring people together. The place to start from is understanding the unique contributions of each of these disciplines, but also the way in which we can collaborate and contribute to a shared direction. We've been trying to do that through our national work: we have a stakeholder group and we'll run a session each time we meet where we hear about specific issues for a particular discipline, but also the ways in which that discipline is contributing to a shared vision.

We have a National Vision for Psychological Professions, which has been widely consulted on with the public, with professionals, with wider groups of NHS staff, etc. It sets out five commitment areas that all of our disciplines have been happy to sign up to: put people first, help our communities thrive, make all health and care psychological, unite and increase diversity in the psychological professions, and transform and innovate. We trying to hear from each discipline about their unique contribution to this shared direction, so that we can understand more about that. Of course, some of the roles will overlap significantly. But let's not be in competition: let's find a way that we can all bring a contribution to the table.

That overlap… two years ago the BPS published guidance on best practice in recruiting psychologists, and I understand the potential of different types of psychologist to do the same role, and the desire to talk about jobs in terms of competencies rather than specialisms. But that's going to be a gradual cultural shift, and it would be surprising to me if we were looking to get to the position where every role was advertised as 'Applied Psychologist'… so much of our profession is set up around specialist training leading to specialist roles.

The important starting point is what are the competencies required for a role. We shouldn't assume that the competencies for a particular role require a particular occupational group to fulfil it, based only on historical precedent. We can do a bit of loosening up from where we are moment to ensure, particularly for our most senior roles, that there's an assumption that if people can demonstrate the right competencies within a set of psychological occupations, they might still fit that role. But we also need to recognise that there will be specific roles that do require a particular qualification and particular specialism to undertake them. 

I can understand why this has become a debate, because both of these drivers are true: we need a more flexible and competence-driven system, but we also need to recognise that there are specific competencies that matter sometimes. We need to move towards a way of working that recognises both of those positions. We're going to be doing a piece of work on this within NHS England to provide a bit of a clearer steer.

That sounds good, let me know how that pans out. Your role is NHS England: do you find that there are different issues and/or learning opportunities from what happens elsewhere around the UK?

Definitely. So I'm working with colleagues across other administrations to ensure that we're joined up where that's beneficial. There are differences: which roles are being commissioned, what the names are of different roles, specific needs across nations. But yes, we really want to collaborate and learn from one another.

How do you see yourself as a psychologist now – still very much as a clinical psychologist?

Absolutely, every day I'm drawing on a psychological frame to help with the work. I've had a particular focus on working with systems at various points in my career. I started out working with adults with learning disabilities, and we ran a systemic consultation service where we were explicitly working with all of the system around a person to ensure that person gets the right support for their needs.

My interest in developing that way of working continued in a variety of roles in higher education, then an NHS Trust, then at a regional level, and now national. It feels like applying some of the same principles and learnings but in different territory. In the end, a lot of what we do is about people and collaboration and how we move forward together to make good stuff happen, for the people that need to benefit from it.

What does that 'good stuff' look like in terms of the next three years?

We need to grow the psychological professions workforce, at a continued pace. We need a coherent and attractive career framework that is more connected. We need to do more work on equality, diversity and inclusion, to ensure that our workforces are appropriately representative of the communities they serve, but also that they are workforces and workplaces that welcome people of all backgrounds and talent.

We want a focus in this next period around getting the right psychological professionals into the new integrated care boards and integrated care partnerships. And there's work we need to do still on supporting transformation: more routine use of outcome reporting and impact reporting, we can lead the way on this and support the wider system to change.

Are you able to get a clear picture at this stage of whether the direction of travel is a positive one, given that we've had Covid, and we've got the political and economic climate as it is? People might read this and think, 'Well, my experience of the NHS in terms of waiting lists for psychological therapy, for example, is that things are getting worse'.

Let's be clear, it's a really difficult time for the NHS – both for those using it and those working within it. How do we move forward and recover from where we are now? That is going to take some time. However, a psychological approach can be part of that solution. It can provide a holistic approach to health care, that means people may be able to move forward without the need for unnecessary consultations they might be having, so a more psychological approach might reduce cost and increase efficiency. But also, that psychological approach can be really important in supporting the whole service, teams and staff as they move forward after what's been a critically difficult time. Psychological professionals need to look after themselves too, and one another. On both of those fronts, psychological ways of working can be part of the solution.

When you make that argument at the top table, is it is it readily accepted? It seems a hard thing to argue against – that the psychological is important in health and in how health services run.

We've never been in a more fertile environment for psychological approaches to expand and take root further. Within mental health, this really is quite embedded in policy as well. Within the broader services – physical health care, primary care, etc – we do have further to go for psychological practice. There isn't yet the same embedding of the recognition for the role of psychological practice into policy. So we're now looking at how we help to develop that, so that we can be really clear what the contribution is of psychological practice in physical health.