Mapping the Renal Psychosocial Workforce Dr Emma Coyne Consultant Clinical Psychologist

Previous Surveys of Renal Psychosocial Provision Renal social workers and psychologists in 2001 (UK) Psychology: 7 renal clinical psychology posts (2.5 wte) This equated to 1 wte post: 15000 RRT patients. Social Work: 54.9 wte renal social workers This equated to 1 wte Post: 348 dialysis patients 14% of units had no renal social work input Renal Psychologists and Counsellors (2010) (Adult units - UK) Psychology/Counselling: 26 posts identified (14 full time and 12 part time posts)

Combined Data Sources BRS Workforce planning survey (Unit Directors) Freedom of information requests (Renal social work research project) (Hospital Trusts) Renal psychosocial questionnaire (2016)(Individual psychosocial practitoners)

Data Triangulation Units not replying Units not knowing who is employed (or what their role is e.g. psychologists, counsellors, social workers used interchangeably). Partial data Triangulation of data raised multiple queries Renal psychosocial questionnaire more reliable data as used individual responses. A snapshot

Response rate 77 out of 84 hospitals (91.7 percent) have responded to at least one of the surveys with some information The hospitals that have not replied to any of the surveys are: Doncaster Royal Infirmary, - Belfast City Hospital, Southampton Children’s hospital - Airdrie-Monklands Hospital Kirkcaldy - Inverness-Raigmore Hospital, Dundee-Ninewells 4 hospitals have stated they have no psychosocial provision: “Although we’d love to have people with these skills, we unfortunately don’t have any of these very important staff here….” Colchester General Hospital - University Hospital of North Staffordshire, Sunderland Royal Hospital - Aberdeen Royal Infirmary The results of the different surveys suggest that the total number of psychosocial staff available to kidney patients in the UK is at least 165, of which 104 (63%) have completed the renal psychosocial survey. 86.9% of UK Renal Units have some psychosocial provision in place

Numbers of Renal Psychosocial Staff Profession Total Completed the psychosocial survey Percentage Psychologists 65 49 75% Social Workers 55 29 52% Youth/Young Adult Workers 13 7 54% Counsellors/psychotherapists 24 15 62.5% Welfare officers 6 3 50% Play Therapist 1 0% Mental Health Nurse Music Therapist 100% Other 2

How many sessions do they work? Profession Mean number of sessions per week in renal Psychologist 4.9 Social Worker 7.7 Youth/Young Adult Worker 7.3 Counsellors/psychotherapist 6.1 Welfare officer 6 Play Therapist Mental Health Nurse Unknown Music Therapist 2 Other 9

FTE Renal Psychosocial Staff (Estimated) Profession Total WTE Psychologists 65 31.85 Social Workers 55 42.35 Youth/Young Adult Workers 13 9.4 Counsellors/psychotherapists 24 14.64 Welfare officers 6 3.6 Play Therapist 1 0.6 Mental Health Nurse ? Music Therapist 0.2 Other 2 1.8

How many staff do units have?

Number & Percentage of UK Renal Units with Psychosocial Staff Profession Total Renal Units N % Adult Renal Units N % Paediatric Renal Units N % Psychologist 44 52.4 35 50.0 9 64.3 Social Worker 38 45.2 33 47.1 5 35.7 Counsellor/Psychotherapist 14 16.7 13 18.6 1 7.1 Youth Worker/Young Adult Worker 15.5 10 14.3 3 21.4 Welfare Officer 4 4.8 5.7 0.0 Play Therapist 1.2 Music therapist Mental Health Nurse 1.4 Other 2 2.4 2.9

Who employs the staff? Profession Employer Frequency Percentage Psychologist Acute hospital Trust 46 88.5 Mental-Health trust 6 11.5 Social Worker 18 52.9 Local Authority 15 44.1 1 2.9 Counsellor/ psychotherapist 83.3 Self-employed 2 11.1 Welfare Officer 33.3 66.6 Youth/young adult worker 8 100.0 Play therapist Music therapist Other

Who funds the Psychosocial Staff? Profession Funding body Frequency Percentage Psychologist Acute hospital budget 19 35.8 Renal budget 22 41.5 Externally funded by CCG 3 5.7 Mental health services 2 Charity 3.8 Other 4 7.5 Social Worker 9 25.0 16 44.4 Local Authority 11.1 Joint funding: renal budget + local authority 8.3 5.6 Counsellor/ Psychotherapist 25 10 62.5 12.5 Youth/ Young Adult Worker 37.5 1 Welfare Officer 66.6 33.3 Acute Hospital Trusts & Renal Budgets Fund 77.3 % CCG/Mental Health Fund 11.4 % Acute Hospital Trusts & Renal Budgets Fund 69 % Hospital jointly funded with LA 8.3 % LA fund 11.1 % Acute Hospital Trusts & Renal Budgets Fund 87.5 % Acute Hospital Trusts & Renal Budgets Fund 50 % Acute Hospital Trusts & Renal Budgets Fund 100 %

What are the pay bands? Profession Band Range Median Psychologist Social Worker 6 - 8c 7 Counsellor/psychotherapist 6 - 8b Youth / Young Adult Worker 5 - 7 6 Welfare officer 4 - 5 5 Play therapist Music therapist Other 6 - 7

So what do renal psycho-social staff do?

What do Renal Psychosocial staff do?

How many patients do they see? Profession Mean number of annual individual referrals (range) Mean number of sessions (range) Psychologists 78 ( 20-170) 5 (1 – 10) Social Worker 170 (34 – 280) 7 (4 –10) Youth/young adult Worker 38 (15- 70) 7.3 (1 –10) Counsellor/psychotherapist 100 (55 –142) 5.3 (1 – 8) Welfare officer 185 (70 – 300) 6 (2 – 10) Music Therapist 25 2 Social Care practitioner 200 10 The average number of annual referrals for the teams was 235, with a range of 10 - 714

% waiting list per profession

Distribution of staff across patient groups

Which therapies?

What therapies are being used? Therapy Psychologist Social Worker Counsellor/ Psychotherapist Person Centred Counselling 30.6 37.9 46.7 Cognitive Behavioural therapy 87.8 60 Behaviour Therapy 26.5 13.3 Psychodynamic Therapy 10.2 53.3 Acceptance and Commitment Therapy 77.6 6.9 20 Mindfulness 65.3 Compassion Focussed Therapy 57.1 3.4 Integrative counselling/psychotherapy 24.5 Solution Focussed therapy 10.3 Motivational Interviewing 59.2 13.8 Couples therapy 18.4 3.6 Psychosexual therapy 2 Family/systemic therapy 32.7 7.1 26.7 Other 33.3

Concerns?

Concerns about their post or service No concerns 44.7% Staffing levels are too low 33.3% Temporary post 9.7% Future funding of post or service 26.2% Long waiting lists 12.6 % Risk of their service being decommissioned 9.7% Potential loss of charitable funding 6.8%

Concerns about Psychosocial Support When asked if they had any other concerns about psychosocial support for renal patients, 63.1% of the respondents commented. ‘Not enough provision, especially as all future predictions are for increased dialysis and transplant numbers. Not enough psychological support available for the renal staff. They are suffering from low staffing levels and self-esteem/confidence erosion by challenging patients that they are not trained to work with.’ ‘There is limited psychosocial support for patients and families once they leave paediatric services and move into adult services. The lack of parity across renal centres is unfair and unacceptable.’ ‘I worry that I cannot provide as much support as my patients need, and there is always the risk that the funding for my post may not be continued.”

Outcome Measures and Data Collection

% of Psychologists Using Outcome Measures

% of Counsellors/Psychotherapists Using Outcome Measures

Who wants to be involved in research on outcome measures? 91.7% of the psychologists 51.9 % of the social workers 80 % of the counsellors/psychotherapists 57.1 % of the youth workers Future work Discussing national outcome measures Feasibility of collecting outcome measures Developing acuity measures to support realistic job planning

Summary Overall renal psychosocial provision has increased Psychology /counselling / psychotherapy have increased Development of new roles (youth work and welfare advisers) BUT Renal Social work appears to be decreasing 2001: 86% of Units had SW Input 2017: 45.2% of Units have SW Input There is significant variability between Units The majority of renal psychosocial provision is funded from central acute hospital budgets or renal units Renal units do not have a tariff for this work and are top-slicing current funding to fund renal psychosocial provision This leads to inequality across units which must be addressed

Thanks and please help us! Thankyou to everyone who contributed to design and analysis of the data and particularly: Amanda Bevin Alison Danberry-Lee Paula Ormandy Maaike Seekles If you want to check your units data or tell us that your unit has psychosocial provision please email: M.L.Seekles@salford.ac.uk