ACP
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The Association of Child Psychotherapists (ACP)
Response to the House of Lords Select Committee
Long term Sustainability of the NHS: How can we ensure a sustainable future for the NHS?
About the ACP
The Association of Child Psychotherapists is the main professional body for psychoanalytic child and adolescent psychotherapists in the UK. It is responsible for regulating the training and practice standards of child and adolescent psychotherapy, provides information to the public about child psychotherapy and is working to increase its availability to children and young people within the public sector, including the NHS, schools and social services.
Members of the ACP work with children and young people, as well as their parents, families and wider networks. They work with some of the most vulnerable children and young people in society such as those who are looked after and adopted, which means they have the knowledge and experience as well as insight, to enable them to make informed decisions about effective treatment and support. They also play an important role supporting other professionals who work with children and young people, including teachers, social workers, youth workers and other mental health professionals. They do this through training, supervision and consultation.
Established in 1949, the ACP has over 900 members working in the UK and abroad. Child and adolescent psychotherapists who have qualified at one of our five recognised training schools are eligible for full membership of the ACP, which enables them to work with children in a range of settings and give expert advice and responses regarding child and family mental health related issues.
Publication and Queries
We are content for our response, as well as our name and address, to be made public. We are also content for the House of Lords Select Committee to contact us in the future in relation to this inquiry.
Please direct all queries to:-
Alison Roy - editor@.uk
07801 803579 or 020 7281 8479
About this Response
The response was jointly led on behalf of the ACP by:
Heather Stewart
ACP Chair
Isobel Pick
Chair of the Training Council
Alison Roy
Media, Policy and Communications Lead
We hope you find our comments useful.
The Association of Child Psychotherapists response to the House of Lords Select Committee
Long term Sustainability of the NHS: How can we ensure a sustainable future for the NHS?
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| |The future healthcare system |
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| |Taking into account medical innovation, demographic changes, and changes in the frequency of long-term conditions, how must the |
| |health and care systems change to cope by 2030? |
|1. | |
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| |Resource issues, including funding, productivity, demand management and resource use |
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| |To what extent is the current funding envelope for the NHS realistic? |
| |Does the wider societal value of the healthcare system exceed its monetary cost? |
| |What funding model(s) would best ensure financial stability and sustainability without compromising the quality of care? What |
| |financial system would help determine where money might be best spent? |
| |What is the scope for changes to current funding streams such as a hypothecated health tax, sin taxes, inheritance and property |
| |taxes, new voluntary local taxes, and expansion on co-payments (with agreed exceptions)? |
| |Should the scope of what is free at the point of use be more tightly drawn? For instance, could certain procedures be removed |
| |from the NHS or made available on a means-tested basis, or could continuing care be made means-tested with a Dilnot-style cap? |
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|2. |We would like to comment on mental health in particular but with a link to health care in general within the NHS. |
| |a)In short – Yes. |
| |The economic and societal costs of individuals being unable to access effective, timely treatment are huge. This is especially |
| |the case for mental health, which currently receives a fraction of health funding overall. It is hard to put an exact figure on|
| |what resources will be required going forward, but we would emphasise the need to invest in building services so that there is a|
| |provision for the right treatment to be available at the right time, this means having specialists as well as generic workers |
| |available to provide a choice of quality and evidenced treatments (as highlighted in the MH taskforce report, Future in Mind). |
| |This will save significant costs in the long run. |
| |The cost of mental health to the economy is estimated at £105 billion a year – roughly the cost of the entire NHS.1 |
| |Mental illness results in 70 million sick days per year, making it the leading cause of sickness absence in the United Kingdom.2|
| |44% of Employment and Support Allowance benefit claimants report a mental health and/or behavioural problem as their primary |
| |diagnosis.3 |
| |b) We are concerned that mental health provision, despite recent promises of funding for CAMHS, does not seem to have had the |
| |positive and desired effect of increasing access to services and treatment for some of the most complex and enduring |
| |difficulties. Our members who are well trained and many of whom, occupy senior clinical posts, report that they are spending |
| |more than twice as much time as they were five years ago, completing administrative tasks and inputting data such as lengthy |
| |tick box risk assessments. Meeting the demands of “time hungry” IT systems is not a good use of a specialist staffing resources|
| |- already in scarce supply. |
| |We would also recommend a fairer system of funding across health and mental health. In terms parity of esteem, access to good |
| |and recommended treatments for mental health is key to recovery as with physical health. We would argue that mind and body could|
| |be better treated using a more integrated model of care and allocation of funds. |
| |c) The ACP has no comment to make here. |
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| |d) We would recommend that services for those who need them are accessible and of the highest quality. We cannot comment on |
| |medical procedures but our members work in a range of settings such as community CAMHS, hospitals, cancer units, perinatal |
| |services, local authority projects and voluntary of private enterprises and we would advocate the provision of services to meet |
| |needs rather than the best service only being available to those with the ability to pay. |
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| |Workforce |
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| |What are the requirements of the future workforce going to be, and how can the supply of key groups of healthcare workers such |
| |as doctors, nurses, and other healthcare professionals and staff, be optimised for the long term needs of the NHS? |
| |What are the options for increasing supply, for instance through changing entry systems, overseas recruitment, internal |
| |development and progression? |
| |What effect will the UK leaving the European Union have on the continued supply of healthcare workers from overseas? |
| |What are the retention issues for key groups of healthcare workers and how should these be addressed? |
|3. |The ACP would like to comment on mental health in children and young people more specifically but provision for this group |
| |affects future and more general healthcare costs. |
| |a) Not providing an adequate workforce now and going forward into the future, would have significant cost implications. In order|
| |save money in the long run, the workforce needs to have a good skill and experience base. Keeping current specialists in place, |
| |to provide training and supervision for more junior and less qualified practitioners. Career progression and learning from |
| |senior and experienced staff, is vital in order to maintain quality of care. |
| |Think Tank the Education Policy Institute (formerly Centre Forum) published its second report into children and young people’s |
| |mental health which looks into the progress made since the publication of Future in Mind and identified key barriers to the |
| |delivery of the transformation programme which relates to staff retention and how these should be addressed. 4 |
| |Key findings include: |
| |83% of trusts who responded said they had experienced recruitment difficulties. 80% of trusts had had to advertise posts on |
| |multiple occasions to fill roles, with mental health nurses being the most difficult profession to recruit, followed by |
| |consultant psychiatrists. |
| |Recruitment challenges had led to an 82% increase in expenditure on temporary staffing in the last two years. In 15/16 nearly |
| |£50m was spent on agency staff by 32 trusts, an expensive solution which undermines continuity of care. However, there were |
| |significant regional variations in recruitment difficulties, with six areas (15 per cent) not experiencing any problems, in |
| |particular trusts in the Midlands and some Northern trusts. |
| |Of the 122 published Local Transformation Plans, only 18 areas (15%) have ‘good’ plans. 85% required improvement. 58 (48%) plans|
| |‘require improvement’ and 45 (37%) ‘require substantial improvement’. The report judged published plans on transparency; |
| |involvement of children and young people; level of ambition; early intervention, including links with schools and GPs, and |
| |governance. |
| |For 2016/17 £119m has been allocated to local areas, but this has not been ring-fenced, instead, it has been included in their |
| |total baseline allocation– specialist services also sit within a wider network of support from youth services to local authority|
| |funded charities and social care, meaning there is a risk that the overall budget for children and young people’s mental health |
| |may not increase or may even be reduced due to wider austerity measures. |
| |b) The ACP cannot comment on this. |
| |c) Retention issues for ACP members are affected by the demands on practitioners within the NHS as opposed to working in private|
| |practice or independently. We are aware that more members are reporting more difficult working conditions, with less opportunity|
| |for development and career progression. These could be addressed through better working conditions, more multi-disciplinary team|
| |support and approach to cases, with shared decision making and greater access to good supervision. |
| |On recruitment difficulties, the following passage from the report mentioned above states: |
| |“There are signs that recruitment difficulties will continue for the foreseeable future. Statistics from Health Education |
| |England show that in the August 2015 intake over half (51%) of ST4 (specialist training post) trainee Child and Adolescent |
| |psychiatry posts were unfilled. This means that there will continue to be significant shortages of consultant psychiatrists in |
| |future. According to Health Education England, providers’ plans for the mental health workforce “do not appear to represent the |
| |additional focus and resources we might anticipate in light of the policy around parity of esteem”. This may reflect concerns |
| |over commissioning plans over the period. |
| |“Planned changes to the training of health professionals could impact on the numbers coming into the workforce and therefore |
| |make matters worse.” |
| |After outlining the proposed reforms to funding for training and their stated purpose, the report notes: |
| |“The risk, however, is that the change from a grant to a loan will lead to a reduction in applications for these posts, further |
| |undermining the ability of providers to recruit for mental health nursing and allied health professional posts.” |
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| |How can the UK ensure its health and social care workforce is sufficiently and appropriately trained? |
| |What changes, such as the use of new technologies, can be made to increase the agility of the health and social care workforce? |
| |What are the cost implications of moving towards a workforce that is equipped with a more adaptable skill mix being deployed in |
| |the right place at the right time to better meet the needs of patients? |
| |What investment model would most speedily enhance and stabilise the workforce? |
|4. |Our overall statement in response to wider question is: |
| |The health and social care workforce appear to have ever demanding caseloads, thus making the training of specialists more |
| |important, in order to hold and manage high levels of risk and anxiety. This is especially the case within NHS CAMHS teams, |
| |where the are reported higher levels of stress and post retention difficulties. Specialists are needed in order that they can |
| |continue to train, support and supervise others both in health and social care. Many of our members provide support and |
| |consultation to social work staff in children’s homes, specialist LAC and adoption services and help social care staff manage |
| |the high level of complexity and vicarious trauma. |
| |We would therefore recommend greater clarity around protecting specialist NHS postgraduate trainings in order to maintain the |
| |quality of treatment on offer in health and mental health services. This would have a cost implication negatively if this |
| |training was removed. In the long run, this would create greater risk to staff and patients, and generate more complexities and |
| |costs around managing privately contracted specialists or consortiums who in our experience, can have a limited understanding of|
| |the specifics of the national legal framework and the local priorities. |
| |Helping social care practitioners understand their role in safeguarding through establishing relationships with families in |
| |need, rather than only with regards to reporting, is important. This also links to implementing the legal framework with |
| |regards to Section 47 and Section 17, helping social care workers understand their role in protecting children, not only the |
| |legal requirements but how to build a broader range of safeguarding skills, is key going forward. |
| |Our members report that fewer social workers appear to focus on core relationships with families and carers and work less in |
| |partnership with mental health professionals. Social work therefore appears to have become more focused on reporting risk and |
| |signposting, rather than building information through observation skills and completing good needs assessments. Many appear to |
| |not have the time or resources to understand the complexities of the families they work with. |
| |a) With regards to new technologies - these need to take on board the challenge of current technologies – our members report |
| |that many social workers use email as a therapeutic and social care tool, to inform others of risk, to update professionals and |
| |families but this creates its own demands and risks, but on time, but also means that detail can be lost. More safe, online |
| |supervision portals, questions and answer forums and access to senior staff on-line would be helpful for social care |
| |practitioners out in the community and support lone workers. |
| |b) With regard to cost implications and skill mix within the workforce, we are of the opinion that having the expertise of |
| |experienced or mental health specialists such as child psychotherapists, to support junior social care staff members, is needed,|
| |in order to decrease risk to children in the long run through a greater understanding of the underlying issues and prove to be |
| |more cost effective overall. This would also enable workers to adapt and respond to areas of difficulty which may be out of |
| |their area of knowledge and expertise, with access to specialist consultation when needed. |
| |We would also recommend more multi-professional training about the interpretation and implementation of legal frameworks to fit |
| |local areas and priorities, whilst learning from the approach and experience of others. |
| |In our opinion, inductions need to be better, with more information about local demographics and particular areas of need, to |
| |ensure that workers understand these and services operating in the area. Social workers are often expected to ‘hit the ground |
| |running’. The cost implications would mean more resources would need to be available to set systems up and provide the support |
| |infrastructure, but once these were in place, the cost would reduce and the cost saving effect of professionals working more |
| |closely together and training together, could be significant. Our members have reported some confusion though about the closure |
| |of family centres and the limited opportunities for early intervention, available in the community which once supported the role|
| |of social care staff and ultimately helped to free up more resources for higher risk and complex cases. |
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| |d)The ACP advocates for investing in relationships as early as possible with families, making relationship focused practice a |
| |priority, integrating this approach into the training of staff, in order to build stronger and more meaningful connections with |
| |those in the greatest need. This would enable staff to gain a more in-depth understanding of the needs but also risk and what |
| |would be the best support/treatment package to implement. |
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| |Models of service delivery and integration |
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| |What are the practical changes required to provide the population with an integrated National Health and Care Service? |
| |How could truly integrated budgets for the NHS and social care work and what changes would be required at national and local |
| |levels to make this work smoothly? |
| |How can local organisations be incentivised to work together? |
| |How can the balance between (a) hospital and community services and (b) mental and physical health and care services be |
| |improved? |
|5. |a) The ACP is aware of members who have developed partnership working projects with social care, where they not only deliver |
| |therapy services in partnership with the Local Authority, but they share responsibility in terms of finances and budget |
| |planning. Our members work with networks and organisations to encourage shared decision making and reflective practice. This |
| |requires managers and commissioners to work together and agree shared goals and allocate resources together. This would be a |
| |recommendation going forward in delivering more cost effective but better integrated services where a deeper understanding of |
| |care and support can be achieved. We would be happy to provide details of these innovative projects if requested. |
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| |b) National commitment and funding for good partnership models between health and social care would be an added incentive to |
| |encourage services to work together. |
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| |c) As above. |
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| |Prevention and public engagement |
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| |What are the practical changes required to enable the NHS to shift to a more preventative rather than acute treatment service? |
| |What are the key elements of a public health policy that would enhance a population’s health and wellbeing and increase years of|
| |good health? |
| |What should be the role of the State, the individual and local and regional bodies in an enhanced prevention and public health |
| |strategy; and what are the key changes required to the present arrangements to support this? |
| |Is there a mismatch between the funding and delivery of public health and prevention, compared with the amount of money spent on|
| |treatment? How can public health funding be brought more in line with the anticipated need, for instance a period of protection |
| |or ring-fencing? |
| |Should the UK Government legislate for greater industry responsibility to safeguard national health, for example the sugar tax? |
| |If so how? |
| |By what means can providers be incentivised to keep people healthier for longer therefore requiring a lower level of overall |
| |care? |
| |What are the barriers to taking on received knowledge about healthy places to live and work? |
| |How could technology play a greater role in enhancing prevention and public health? |
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|6. |a –f) The ACP has no specific comment to make here, other than to highlight the importance of early intervention and the |
| |usefulness of combined assessments. Connected to this, is the importance involving children and young people (and their parents,|
| |where possible) to create environments where they can learn together and along-side each other, about health and mental health, |
| |with the support of specialists. |
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| |g) Young people know how to use and make the most of technology but also find it hard to control and regulate their use of it. |
| |We would therefore recommend a combined technology and face to face approach. Our members have reported that on-line treatments |
| |without additional input from a clinician, appear to have little impact. |
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| |What are the best ways to engage the public in talking about what they want from a health service? |
|7. | |
| |In our experience, the best way to engage with the public is to ensure that people are listened to and have the opportunity to |
| |explain in their own way, what they think they need and what the main difficulties are – this requires time but can also save |
| |time in the long run. Providing good and detailed information about possible treatments will also enhance informed decision |
| |making, make waiting for treatments more bearable and empower those who currently feel let down and ignored by services. |
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| |Digitisation of services, Big Data and informatics |
| |How can new technologies be used to ensure the sustainability of the NHS? |
| |What is the role of technology such as telecare and telehealth, wearable technologies and genetic and genome medicine in |
| |reducing costs and managing demand? |
| |What is the role of ‘Big Data’ in reducing costs and managing demand? |
| |What are the barriers to industrial roll out of new technologies and the use of ‘Big Data’? |
| |How can healthcare providers be incentivised to take up new technologies? |
| |Where is investment in technology and informatics most needed? |
|8. | |
| |The ACP has no comment to make here, but we do have members who are doing more research in this area and may be able to provide |
| |evidence at a later date. |
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| |References |
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| |Green H, McGinnity A, Meltzer H et al. 2005 Mental Health of Children and Young People in Great Britain, 2004. Basingstoke: |
| |Palgrave Macmillan.) |
| |The Mental Health Policy Group – General Election 2015, A Manifesto for better mental health, August 2014. Available at: |
| |) |
| |Murphy M and Fonagy P (2012). Mental health problems in children and young people. In: Annual Report of the Chief Medical |
| |Officer 2012. London: Department of Health. |
| |4. The Think Tank report: |
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