1. Mapping the Renal Psychosocial Workforce
Dr Emma Coyne
Consultant Clinical Psychologist

2. 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: 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)

3. 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)

5. 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

6. 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

7. 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

8. 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

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

10. How many staff do units have?

11. 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

12. 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

13. 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 %

14. 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

15. So what do renal psycho-social staff do?

16. What do Renal Psychosocial staff do?

17. How many patients do they see?
Profession
Mean number of annual individual referrals (range)
Mean number of sessions (range)
Psychologists
78 ( )
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

18. % waiting list per profession

19. Distribution of staff across patient groups

20. Which therapies?

21. 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

22. Concerns?

23. 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%

24. 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.”

25. Outcome Measures and Data Collection

26. % of Psychologists Using Outcome Measures

27. % of Counsellors/Psychotherapists Using Outcome Measures

28. 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

30. 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

31. 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