Psychological therapies and interventions specification: consultation analysis

11 Implementation and measurement

Introduction

The final part of the consultation contained more detailed questions to gather initial views on what support services will need to implement the specification and around how to measure the national specification. This part of the consultation was particularly targeted at people with experience of working in or providing services.

Question 50

Overall, what support do you think services will need to implement the seven outcomes of the National Specification for Psychological Services and Interventions?

Over two-thirds (69%) of all consultation respondents answered Question 50 which asked respondents what support they think services would need to implement the seven outcomes of the National Specification for Psychological Services and Interventions. The main themes are presented below.

Theme 1: A repeat of key themes that emerged from the consultation

Some respondents repeated points they made to earlier consultation questions - see Chapter 2 for more detail. For example, this included that:

• there would be a need to address workforce challenges, including recruitment, retention and wellbeing
• that the specification should be clear, concise, user-friendly and easy to understand

Theme 2: Consistency and collaboration across services

Some respondents felt that there was scope to improve communication, collaboration and coordination between services, including greater consistency in how (and what) information and data is collected, recorded, reported and shared.

Wider feedback included that this could:

• make it easier for people to move between and out of services
• increase the efficiency and effectiveness of services
• require additional investment in digital infrastructure and support

Theme 3: Self-assessment on its own may be too subjective to robustly measure outcomes

While monitoring and reporting outcomes was considered important, a few individuals felt that self-assessment on its own may not be sufficient (for example, it was considered too subjective) to provide a full and robust assessment of whether the outcomes identified within the specification have been achieved.

As noted above, a few respondents reported that additional investment would be needed (for example, shared or standardised IT systems), for services to be able to monitor, measure and report on outcomes. It was suggested that better systems could support more efficient data collection and reporting, and free up clinicians’ time to focus on their specialisms.

Question 51

How far do you agree that the specification should be measured using a validated self-assessment tool?

Table C40 presents the quantitative response to Question 51. This shows that:

• around two-thirds of all consultation respondents who answered Question 51 either agreed or strongly agreed (64%) that the specification should be measured using a validated self-assessment tool
• a relatively large proportion of respondents neither agreed nor disagreed (26%) with this statement
• 10% either disagreed or strongly disagreed

Question 52

How far do you agree that the specification should be measured using a range of indicators?

Table C41 presents the quantitative response to Question 52. This shows that:

• a vast majority of all consultation respondents who answered Question 52 either agreed or strongly agreed (86%) that the specification should be measured using a range of indicators
• 12% neither agreed nor disagreed
• 1% either disagreed or strongly disagreed

Question 53

Do you have any other comments on the possible questions to include in the self-assessment, including any further suggestions?

Almost half (46%) of all consultation respondents answered Question 53 which asked respondents to give their views on the possible questions to include within the self-assessment. The main themes are presented below.

Theme 1: A repeat of key themes that emerged from the consultation

Some respondents repeated points they made to earlier consultation questions - see Section 2.6 for more detail. For example, this included that:

• services would need adequate funding and other support to ensure sufficient capacity and capability to implement the self-assessment tool
• self-assessment may increase the administrative burden placed on services and staff – and reduce time available for clinical work
• wording of the questions would need to be accessible as well as clear and detailed guidance provided to accompany the self-assessment tool

The following quote is reflective of the points raised.

“For this to work, there would need to be an increase in administrative staff and managerial work taken on by clinicians. The Scottish Government would need to decide whether this represented the best way to raise standards, or whether it will impact on time able to do clinical work.” - Medical Psychotherapy Faculty of the Royal College of Psychiatrists in Scotland

Theme 2: Greater clarity required on data and evidence gathering, use and reporting

A few respondents called for more clarity on how the information and data collated through the self-assessment tool would be stored and used. These respondents were unsure whether self-assessment questions would be completed by service users, practitioners or both.

A few respondents also highlighted the importance of drawing on and using information and data from a range of sources to provide a more holistic view of progress (for example, feedback from people with lived experience, practitioners, and performance data).

A wider point noted was that the data to be captured should be finalised in discussion with people with lived experience of accessing these services – this would help to ensure data is meaningful and person-centred and can be used to improve services.

A few respondents also felt that it may be challenging and time-consuming to collate evidence for some of the outcomes (for example, Outcome 1 was mentioned with feedback that this would be time-consuming as it would rely on a review of case notes).

Theme 4: Limited feedback on specific validated assessment questions

In general, a few respondents felt that the assessment questions proposed in the consultation document were appropriate and could be helpful, particularly for people accessing psychological services.

There was, however, limited specific feedback on the self-assessment questions. Where specific comment was provided, this included:

• Outcome 1: it was suggested that data gathering may be challenging to capture and time consuming
• Outcome 2: it was suggested that a question could be asked on whether the service has met the person’s communication needs
• Outcome 3: it was suggested that there should be question which looks at the range of range of psychological therapies and interventions offered by a Health Board, HSCPs and services – it was said that this could help assess whether these services are accessible to particular groups and areas
• Outcome 3: it was suggested that there could also be a focus on how ‘included’ a person felt in making decisions about the type of psychological therapy offered to them
• Outcome 6: the importance of informed consent was emphasised regarding the involvement of a family member or carer

Question 54

Please give us your views on these suggestions for possible indicators to include. Please provide any further suggestions for indicators you may have.

Almost two-fifths (39%) of all consultation respondents answered Question 54 which asked respondents their views on possible indicators to include. The main themes are presented below.

Theme 1: A repeat of key themes that emerged from the consultation

Some respondents repeated points they made to earlier consultation questions - see Chapter 2 for more detail. For example, this included that:

• wording and terms used within indicators should be clear, concise, sufficiently defined, user-friendly and easy to understand
• further resources would be required as data collection and reporting on indicators should not present an administrative burden for service providers

Theme 2: Indicators of feedback from service users and carers

A few respondents welcomed the focus on service users’ and carers’ feedback as indicators to assess the accessibility of services, with a particular focus on how services are meeting the needs of specific groups (such as ethnic minority groups or people with protected characteristics) and reducing inequalities.

These respondents reported potential benefits including that it could:

• allow for feedback and monitoring of service from multiple perspectives
• involve service users and carers with lived experience in the development and improvement of services – this was considered particularly important as they will identify and understand the potential accessibility barriers

For example, it was suggested that there could be an indicator to assess involvement of service users and carers in the proposed Psychological Services Leadership Team.

Theme 3: Person-centred care

A few respondents expressed concerns around defining and measuring person-centred care, in particular, how to divide this into measurable outcomes.

It was said that outcomes may vary depending on the type of person-centred care an individual is receiving, and this should be acknowledged when setting, measuring and reporting on indicators.

The following quote is reflective of the points raised:

“Traditional indicators could be insufficient to measure the outcomes of personalised and person-centred support. There is a need to introduce newer and innovative quantitative or qualitative methods to measure requirement, types and adequacy of personalised support. The specification can also include indicators to measure those receiving a particular person-centred support, awareness of the different types of personalised support and access in various geographical areas.” - Playlist for Life

Question 55

How would you suggest that we support services to reduce inequalities in the outcomes and experiences of people who use services, including in the measurement of the specification?

Almost half (46%) of all consultation respondents answered Question 55 which asked respondents what support they think services would need to reduce inequalities in the outcomes and experiences of people who use services. The main themes are presented below.

Theme 1: A repeat of key themes that emerged from the consultation

Some respondents repeated points they made to earlier consultation questions - see Section 2.6 for more detail. For example, this included that:

• adequate funding, workforce development (and diversity) and other support would be required to ensure that staff and services have the capacity and capability to reduce inequalities in the outcomes and experiences of people who use psychological services
• information must be accessible and available in easy read formats, different languages and adjusted to meet different communication needs (for example, learning difficulties and neurodiversity)

Theme 2: Use of equalities and diversity data

In order to assess whether the specification has reduced inequalities in the outcomes and experiences of people who use services, some organisations felt that appropriate equality and diversity data, such as analysis by Scottish Index of Multiple Deprivation, would need to be routinely collected and reported on.