Psychological therapies and interventions specification: consultation analysis

Appendix D: feedback on specific statements

Some respondents provided feedback on specific statements in the consultation document that could be amended, reworded, reframed, enhanced, and/or further strengthened in some way.

This feedback in part reflects calls from respondents for more detail, specification and/or greater clarity on these statements, including terms used.

Outcome 1: High-quality care and support that is right for me

Statement 1.1: “When receiving care, a psychological formulation will be agreed with me in an outcome focused and transparent way, linked to jointly agreed goals and decision-making.”

Some respondents reported that psychological formulations may not always be appropriate or necessary in all cases. It was suggested that professional judgement could be used and a more flexible approach to decide whether a formulation is required, and in particular for people with complex learning disabilities, people who are acutely psychotic, or who have a head injury.

The following quote is reflective of the points raised.

“Some people [as listed above] may find it difficult to articulate, let alone define an outcome, for several sessions and this should be acknowledged if setting the standards.” - COSLA

Some service providers noted that only staff at “advanced” and “specialist” level can conduct formulations which would require workforce planning and upskilling to ensure an adequate supply of appropriately trained professionals.

For example, a mental health organisation noted that “rural boards sometimes have to borrow a senior clinical psychologist to complete the formulation” (Change Mental Health). Therefore, it must be ensured that we have the staff available in each health board to ensure this outcome can be met.

It was stated there was a risk of “inappropriate, potentially even harmful, care” in the absence of appropriately trained professionals to complete psychological formulations (NHS Greater Glasgow and Clyde).

Some respondents called for a clearer definition of psychological formulation. A few service providers went further and called for it to be replaced with a more accessible term which would be easier for layperson to understand. For example, it was stated that “plan of care” or ”care plan” have been used elsewhere.

Statement 1.2: “When receiving care, I will be able to provide regular feedback about the psychological care offered. With my agreement, my carers will also be able to offer feedback.”

A few service providers asked for further clarity on how regular feedback would be resourced and gathered in accessible formats to ensure confidentiality, avoid power imbalances, inform service development, and not be to the detriment of the individual. A wider point noted was around the implications of gathering feedback from people detained under the Mental Health Act.

Statement 1.3: “Psychological care that is offered to me will be appropriate to my needs and individual circumstances.”

A few respondents felt that some of the statements within Outcome 1 contradicted statement 1.3 that psychological care services are based on people’s needs rather than expectations.

Statement 1.4: “I will be seen when it is my turn, and this will be in a timely way. Where necessary, services will prioritise the referrals for those at risk with urgent care needs, and detail the criteria used to prioritise.”

Some organisations raised concerns around the wording of statement 1.4. For example, the reference to “timely way” was considered to be too “vague” and “subjective” and would need to be clearly defined. Also, “I will be seen when it is my turn” was considered “infantilising” and “entitled”.

A few respondents highlighted that prioritisation is more complex for psychological care – here, it was noted that individuals should not be disadvantaged (where longer or more complex treatment is required as early intervention is key) or discouraged (by perception of needing “severe difficulties” to meet threshold of prioritisation).

There was also a wider point raised that statement 1.4 risks a focus on turnaround times rather the provision of high-quality psychological care.

Statement 1.5: “Regardless of where I live, and where possible, psychological care systems will minimise unnecessary delays and limit unequal waits across Scotland.”

Some respondents, mainly organisations, highlighted that the provision of psychological care varies across Scotland’s urban and more rural and remote areas. It was noted that this statement may be unrealistic to achieve as some Health Boards, HSCPs and services were better resourced than others. For example, it was suggested that (some) urban areas may be better able to minimise unnecessary delays and long wait times, and that there needs to be more funding, resources, and support to help rural and remote areas to ensure the deliverability of this statement across Scotland as a whole.

A few service providers called for further clarity on whether the statement proposes greater coordination across areas and services to limit unequal waits across Scotland – it was noted that this would require further consultation with relevant organisations such as Health Boards, HSCPs and services.

The following quote is reflective of the points raised.

“Point 1.5 As a gold standard it is difficult to disagree with this, but in reality this will be very difficult to deliver. Our services are not equally equipped to deliver all services – some parts of service are not available at all due to capacity available. It depends on what is meant by ‘minimize’ and ‘limit’ in the different circumstances services find themselves in.” - Child Head of Psychology (CHOPS)

Statement 1.6: “Psychological care will guide, support, and enable me to make informed choices about how to access the right services at the right time, based on my needs, the evidence base, and expert advice offered.”

There was limited feedback on statement 1.6. A few respondents suggested that the statement would apply beyond psychological therapies and interventions, and that it is also reliant on other factors (such as waiting times impacting on “right time”).

Statement 1.7: “Leadership should be of a high quality and clear so that I, and others, know that the people helping us are providing safe, efficient and effective care. There will be a system wide Psychological Services Leadership Team with appropriate business management support to ensure equitable access to care is available.”

A few service providers expressed support for the Psychological Services Leadership Team as it could be “helpful in establishing the importance of governance in improving quality and effectiveness” as well as freeing up clinicians’ time away from administrative management and project management tasks. A few respondents called for greater clarity on what is meant by “system wide” as therapies are not a universal service.

Statement 1.8: “The care and support I receive will be centred on my personal circumstances, taking into account cultural and social needs, and regardless of my background. There will be a commitment to reduce inequalities and improve access to psychological care for all.”

A few respondents welcomed the focus of statement 1.8 on addressing the wider determinants of mental health and reducing inequalities. However, it was felt that greater detail could be provided on the criteria of social and cultural needs and that consideration could be given to “economic” needs in context of the cost of living crisis.

Statement 1.9: “Nationally agreed methods of measuring my progress during treatment will be used so I can see how the psychological care offered to me is helping me in a meaningful way. This helps services know they are offering quality care too.”

A few service providers called for further clarity, detail and discussion on statement 1.9. These respondents felt that a national approach to measurement could be complex and challenging given the subjective nature of the outcomes, and that it may be difficult to capture meaningful outcomes that are person-centred.

Statement 1.10: “Methods and systems required to record waiting times are fit for purpose and nationally adopted by all relevant health and social care services and teams. This should provide meaningful information about quality as well as quantity of care provided to others and to me by staff.”

A few organisations reported that digital infrastructure and support would be needed to deliver on this statement. For example, it was reported that development of standardised IT systems is not currently rolled out for across all services.

It was also suggested that statement 1.10 should be aligned with relevant strategies and existing workstreams such as the Health and social care data strategy (jointly published by Scottish Government and COSLA) and the work that is ongoing to develop a single health and social care record which aims to make “information sharing less resource intensive…and reduce the number of times a person needs to repeat their story to professionals”.

Statement 1.11: “Services and systems will work to reduce barriers to accessing psychological care and reduce waiting times so there is timely and appropriate access to the psychological care workforce. This will include consideration of inequalities related to cultural, ethnic, and other protected characteristics.”

The focus on inequalities was welcomed but a few organisations called for further clarity on how statement 1.11 would be achievable and delivered in practice.

Statement 1.12: “Access to peer support can be vital to recovery, and where possible, I will be supported to connect with others with lived experience to aid recovery, if I choose to do so.”

A few service providers considered the inclusion of peer support beneficial as it was considered an area that could be further developed and makes a “valuable contribution to psychological care”.

The following quote is reflective of the points raised.

“We feel that there are many ways that peer support could improve the patient experience within mental health services. For instance if there is a substantial waiting period to access a psychological service then a structured peer support group could enable the patient to prepare for the therapies and still feel ‘connected’ to the service prior to resuming therapies through a peer support group.” - NHS Greater Glasgow and Clyde

Statement 1.13 details the range of choices that will be offered to and discussed with a person when receiving psychological care from an appropriately trained professional.

While having a range of choices was welcomed by respondents, it was noted that, in practice, choice is limited in some services, settings and geographies. Some respondents felt that implementation would require significant funding, resources and support to be able to offer a range of choices to individuals accessing psychological care across Scotland.

A wider point raised by few respondents was that choice may not always be appropriate - for example, options of family to join may not be available or appropriate in certain secure services or group settings and professional judgement would be important in certain circumstances.

While digital provision was considered important (for example, improves access to services people living in rural and remote areas), it was considered important that people should always be given the choice of how their care is delivered, including in-person delivery.

Also, a few respondents noted that wording of “discuss” could be more empowering if it was replaced by, for example, “the right to choose”.

Outcome 2: I am fully involved in decisions about my care

Statement 2.1: “Staff, communities and services must work with my family / carers and me to find out what I want and how professionals can help me.”

Some organisations highlighted the importance of informed consent. For example, some people looking to access these services may have a difficult or abusive relationship with a family member or carer and does not consent to their involvement in the process. It was suggested that “must” should be removed and “my family/carers” should be placed after “me”.

Statement 2.2: “The psychological care offered to me should be tailored to my needs and individual circumstances to help me live the life I choose.”

A few service providers felt that the phrase ”help me live the life I choose” may be problematic if the individual chooses harmful or unhealthy behaviours (for example, substance use) which may also pose a risk of harm to others. Alternative wording was suggested including “to help me improve the quality of my life”.

Statement 2.3: “All staff seeing me should use terms and language to describe what I need in a way that I can understand.”

Some respondents emphasised the importance of the Outcome 2 statements (and specification more generally) being easily accessible and understandable for people looking to access psychological care. This would be consistent with the requirement for services and staff to use inclusive and accessible information and communication in all that they do.

In particular, a few respondents repeated their views to Question 13 that the term “psychological formulations” (also used in statement 2.6) could be more accessible and would require a clear definition or rephrasing.

Statement 2.5: “Where possible, staff seeing me have access to wider clinical expertise from other registered professionals through supervision and joint working so their views can help inform my care.”

As a few respondents felt that supervision of psychological care is essential, there was concern that Statement 2.5 implied that staff supervision and access to clinical expertise would only be available “where possible”.

The following quote is reflective of the points raised.

“This standard should give consideration to whether ‘where possible’ is appropriate in this case. Clinical supervision is a requirement of many registered professions. If this is the case for all professions that would be covered by the standards ‘where possible’ should be removed or practice maybe unsafe.“ - COSLA

Statement 2.6: “If I receive a psychological assessment or treatment, a psychological formulation will be developed and shared with me and the best evidence base will be considered.” The statement also sets out the process for initial and further contact in line with national waiting times standards of assessment within 12 weeks and treatment within 18 weeks of referral.

Some respondents welcomed people having a range of available appointment times to choose from. This was, however, viewed as unrealistic and may be constrained by workforce challenges and other factors (such as reduced staff working hours and availability of clinic space) – and that people living in remote and rural areas may be disproportionately impacted.

A few respondents commented on the timescales of 12 and 18 weeks which were set out in statement 2.6. It was suggested that placing an arbitrary timescale may be unhelpful and may also raise unrealistic expectations which cannot be met without adequate funding, resources and support.

Further, it was reported that services operate to different timescales for assessment and treatment, and that 12 and 18 week standards may not be appropriate in all cases.

A few respondents expressed mixed views on the choice to be copied into letters. While a few individuals noted that this would ensure transparency, a few organisations noted that it would be important for practitioners to use appropriate, compassionate, and accessible wording and terminology.

Statement 2.7 details the communication process if, for any reason, the person has not started treatment within the national waiting times standard of 18 weeks (as per Public Health Scotland Guidance).

A few service providers felt that there may be a need for “regularly” to be more clearly defined. These respondents noted that the statement is “vague in terms of service requirements” and may present a significant administrative burden for “stretched services”.

A wider point raised was that Statement 2.7 may be contradictory to Statement 2.6 which states that “I will have started treatment no longer than 18 weeks from referral”.

Outcome 3: High-quality interventions and treatments that are right for me

Statement 3.1: “The Psychological Therapies Matrix will be used to guide delivery of the right psychological care offered to me. The Matrix is the evidence-based guide for the delivery of psychological therapies. Psychological care may also include wider choices based on the professional guidance and evidence base of the registered professional helping me (e.g., occupational interventions).”

Some respondents felt that it would be important to acknowledge the limitations of the Psychological Therapies Matrix, including:

• some effective therapies may not be included as they do not have the financial resource to evidence efficacy
• greater clarity that not all options in the Matrix will be offered across all Health Boards, HSCPs and services
• the therapies included in the Matrix are evidence-based rather than the Matrix itself

Accessibility was highlighted in terms of its language and having clearer links to the Matrix document within the national specification. NHS Education for Scotland, who publish the Matrix, noted that the first phase of an updated and more accessible version is due to published in Spring 2023.

The following quote is reflective of some of the points raised above.

“The psychological Matrix has been reviewed recently, but has failed to look at the evidence base for other psychological therapies such as art psychotherapy and music therapy. This is disappointing as there is evidence for these therapies, but they are hardly supported in the matrix. This means that some NHS boards are reluctant to provide this care, while some boards do. There needs to be consistency across Scotland.” - Individual

Statement 3.2: “When receiving care as part of a wider health and social care system, offers of psychological care should be considered and offered to me as appropriate. I may be offered short interventions, guided self-help, or more directed support. This should be based on my individual needs and not just a diagnosis.”

A few respondents welcomed the emphasis on offers of psychological care being based on individual needs rather than a diagnosis. As it was stated that psychological therapies are often based on needs and agreed formulation rather than diagnosis, it was suggested that the wording “not just a diagnosis” could be amended.

Statement 3.3: “Psychological care will be delivered within an integrated care system, with a shared record where possible, so I do not have to keep retelling my story unnecessarily and I get the help I need.”

Some respondents felt that there should be greater detail and emphasis on informed consent and confidentiality in regard to shared records. For example, a Health Board highlighted their approach to sharing information:

“There are aspects of our care we agree with our clients that is recorded in a ‘break glass’ section – this can be highly personal information with clients agreement we keep in a separate section of shared record only named people can access. This has to be done with client agreement and consent/knowledge.” - NHS Dumfries and Galloway

Raised to a lesser extent by organisations, wider points included that that some repetition is likely to be unavoidable and that sometimes retelling the story can be important for clarifying personal circumstances and establishing connection with practitioner.

Statement 3.4: “The number of appointments and support I receive will be determined by the professionals I see, the available evidence, the service guidance, and will take account of my views and protected characteristics (for example, intellectual disabilities). I can also discuss my needs again with a professional if I feel my psychological health deteriorates.”

A few respondents called for greater detail on process for discussing needs again if psychological health deteriorates and how this would be factored and resourced into current processes.

The focus on protected characteristics when determining appropriate support was welcomed with a few respondents stating that evidence shows that cognitive behavioural therapies are often less effective for people with autism.

Statement 3.5: “There may be a few sessions offered if I have (for example, anxiety) but many more appointments would be offered if I have more complex needs (for example, severe trauma). The appointments offered would be shared with me as part of my treatment plan as a guide, so I know what to expect.”

Some respondents raised significant concerns about the inclusion of anxiety as an example. It was felt that the use of two examples positioned anxiety and severe trauma in competition with each other and minimises the severity of anxiety. This was described as “inappropriate”, “extremely triggering” and “too reductive”.

Other common points raised included that it is more important to offer appointments with greater likelihood of impact rather than simply offering more appointments.

Statement 3.6: “If I do not attend an appointment, my case should not be closed due to nonattendance without contacting me, or the person that referred me. This is to make sure I am not at risk and have the care I need.”

Statement 3.6 was widely welcomed as “helpful” as it takes into a range of wider factors which may impact a person’s attendance. In particular, some respondents considered it important to consider the impact on certain groups, such as people with disabilities, or no fixed address to reduce inequalities.

There was a call for greater clarity and definition of “contacting” to avoid “very minimal tokenistic contact” and for services to understand if additional resources are required beyond standard letter process. Here, some respondents mentioned that an extra safeguard could be a useful tool.

The role of psychological workforce was raised by a few service providers as it was felt that Statement 3.6 may go beyond the scope of specification and apply to primary care workforce

Outcome 4: My rights are acknowledged, respected and delivered

Statement 4.1: “Any written information, including about confidentially, will be provided in an easy read format, use plain language and be in a format I can understand. Information should be available in formats, which are culturally sensitive, and trauma-informed.”

Some respondents welcomed Statement 4.1 with some individuals citing their previous negative experiences with poor written information. Here, it was stated that it could be useful to have specific reference and consideration for groups who could be disproportionately impacted, including people who have a learning disability or dyslexia.

A few respondents felt that the emphasis on accessibility in Statement 4.1 was contradicted by the use of jargon such as “trauma-informed” which could be reworded or clearly defined.

Statement 4.2: “I will be enabled to access care and support from other agencies beyond formal services, if I would find this helpful. This will include consideration of third sector or member led organisations, which support people from different social, economic, cultural and ethnic backgrounds.”

A few respondents raised individual points about Statement 4.2 including that:

• “helpful” could be amended to “appropriate”
• this should be additional rather than diverting certain groups, including people of ethnic minority, away from formal services
• greater clarity on “member-led”
• there will be different levels of third sector or member-led organisations provision in different areas therefore there should be a consideration of inequalities to access

Statement 4.3: “Services and teams that provide care to me will reduce the risk of harms to me or others and support my overall wellbeing.”

Some service providers felt that “will reduce” should be amended to “will aim to reduce” as there can be no guarantee of harm risk reduction, especially for people in forensic settings. It was said that the amended wording could also help to reflect that person is not a passive recipient of care.

Statement 4.4: “There will be a clear responsibility framework and complaints process for services and systems so I know how my concerns will be addressed.”

A few respondents felt that reference to “responsibility framework” was not clear and could be reworded or amended. Raised to a lesser extent, it was stated that monitoring, evaluation and feedback into the process would be important and more detail could be provided to make the process as clear as possible for person accessing psychological care.

Statement 4.5: “There will be ongoing, quality improvement at the heart of offers of care. Listening to the combined voices of those accessing, and those delivering psychological therapies and interventions, will make sure that services continue to develop and improve care for all.”

A few respondents welcomed that ongoing quality improvement would be placed at the heart of service development. There were some calls for greater clarity on how feedback from service users will inform the ongoing quality improvement of psychological care. Also, a few respondents felt that wording of Statement 4.5 should also make reference to families/friend and carers for a consistent approach.

Statement 4.6: “Empathy, kindness, and respect will be used as frameworks for all practice and I should expect this. I am expected to show kindness and respect to staff and those supporting me.”

While some respondents agreed with the intention of Statement 4.6 and welcomed the emphasis on expectations from person accessing care, it was felt that empathy, kindness and respect may not always be possible.

For example, it was stated that this may be challenging for a person with significant relational trauma or personality disorder.

A few organisations felt that training of workforce could help a culture shift to remove stigma around psychological care – it was stated that this would need resourced.

A wider point raised included that more detail would be required on how this would be measured.

Outcome 5: I am fully involved in planning and agreeing my transitions

Statement 5.1: “There will be recognition of the importance of a good therapeutic relationship between me and the psychologically trained professional helping me; and consistency of relationship once in therapy will be the same wherever possible.”

Some respondents restated the importance of a good therapeutic relationship and consistency of relationship for smooth transitions of care. It was felt that Statement 5.1 would be important for implementation of person-centred care and its principles of compassion and non-judgemental care. It was highlighted that this is not the current reality in many cases.

Statement 5.2: “There will be effective communication between professionals, if there is any transition of my psychological care. To support continuity of care, a clear plan that has been agreed with me will be in place. Any risks will be clearly identified and documented; and the flexibility of transfer time and handover of care will be considered.”

A few respondents raised some common points in relation to Statement 5.2, including that:

• there could be more detail on what “effective communication” and “risks” would mean in practice
• incorporating feedback from person accessing psychological care would important to ensuring effective communication between professionals – a potential benefit could be removing stigma
• the draft specification sets out additional reliance on third sector organisations therefore there should be a consideration of different governance arrangements in third sector compared to NHS – for example it was stated that this could have implications on effective communication and continuity of care

Statement 5.3: “Services and teams that provide psychological care will use referral systems that are simple, consistent and efficient. Self-referral options can be offered, where appropriate, for those needing less complex types of support.”

Some service providers highlighted that it may be challenging for self-referral options to be “simple” and “consistent” as options will be different and more/less appropriate in different services, particularly forensic services where clinical oversight is essential.

A wider point raised by a few mental health organisations was that there is a key role for “shared decision-making, advocacy, and advance statements in care” as often person faces a power imbalance when self-referring.

Although a few respondents were supportive of self-referral for ”less complex types of support”, it was stated that a definition of “where appropriate” would be helpful.

Statement 5.4: “Clinical and data systems used by services will be used in a way that confidentially supports my care and does not hinder the quality of care provided.”

A few respondents welcomed clinical and data systems which are fit for purpose, minimise duplications, increase consistency across Health Boards, make efficient use of existing data, and are aligned to the joint Scottish Government and COSLA Digital Health and Care Strategy. As above, it was highlighted that investment in digital infrastructure would need to be adequately funded and resourced.

Raised to a lesser extent, it was felt that Statement 5.4 could be reworded for greater clarity.

Outcome 6: We fully involve people, their families and carers

Statement 6.1: “It is recognised that my existing support network – carers, family, or friends – are key in helping me with my support needs and the delivery of my care, should I consent to them being involved.”

Some respondents expressed concerns regarding Statement 6.1 including that:

• the potential of family and carer abusive relationships should be taken into account and reflected in change of wording to “may” rather than imply that their involvement is necessary
• the importance of informed consent should be better reflected
• a person’s existing support network should not be used as a replacement for mental health services

Statement 6.2: “I will be informed that I can have someone with me, if I choose to do so, when seeking psychological support. All interventions and services will take into consideration my preferences and consent about involving my carers, family, or friends in my care.”

Some respondents considered whether a person would need to have someone else present when seeking psychological support, and that this may not always be. appropriate. For example, feedback included that:

• individuals may not feel that they can express themselves fully with a family member, friend or carer present. This could remove the safe space aspect of seeking psychological support and constrain the ability of the person to speak freely and honestly
• some therapies do not allow for additional people to be present, such as neuropsychological assessments, mindfulness and eye movement desensitisation and reprocessing (EMDR)
• informed consent would be essential, and may also look different for certain groups of people (for example, children and young people)

Statement 6.4: “Peer support and / or informal support will be considered and offered as part of future service planning, where appropriate, to my family members and / or carers.”

A few organisations called for further clarity on how and when peer support would be implemented and what governance and safeguarding arrangements would be in place.

A wider point raised was that peer support may be difficult to access for people accessing forensic services.

Outcome 7: I have confidence in the staff who support me

Statement 7.1: “There will be an adequately funded and staffed psychological workforce, taking into account specific clinical services, population need, and local circumstance so that I receive the level of care I need.”

A few respondents felt that statement 7.1 was too vague and called for more detail and clarity on:

• how “adequately funded and staffed psychological workforce” is defined
• which job roles make up the psychological workforce
• the need for increased investment for services, including those that support marginalised groups

Statement 7.2: “There will be enough resources available for professional, clinical and managerial supervision so that the staff and services helping me are safe and led well.”

While some respondents were generally positive about increased provision of further resources, there were calls for greater clarity on:

• how ‘resources’ is defined (for example, funding, clinic space, therapy rooms)
• what is considered ‘enough resources’

A few respondents felt that statement was too ambitious as they were unsure where resources would come from to deliver it.

Statement 7.3: “The roles and qualifications of all staff delivering direct psychological care will be clearly described in an accessible format to me and will be available for me.”

A few respondents asked for further detail and clarity on how the information on staff roles and qualifications would be communicated to service users, and what information would be shared.

Statement 7.5: “Investment in the workforce will be provided so that staff are trained to deliver interventions that help me to improve my health. All staff providing psychological care will have access to relevant learning materials, and will keep their training updated as part of routine continuous personal development.”

A few respondents highlighted the importance of staff being supported to undertake relevant training and continuing professional development in order to better meet the different needs of people looking to access psychological care.

Statement 7.6: “Services will consider how psychologists can best support those with more complex need, and help train and supervise the wider workforce, including those focussing on early intervention and prevention.”

Some respondents considered it important that the statement acknowledged that it is not only psychologists who support people with complex needs.

Statement 7.7: “There will be a Psychological Care Governance Group in my local area that will be led by the Professional Lead for Psychology, or their delegated senior clinician. All staff in Health and Social Care, who deliver psychological therapies and interventions, will be represented so that care offered to me by anyone is safe and based on evidence.”

A few organisations welcomed the establishment of a Psychological Care Governance Group, and wider points raised included a request for more detail on the Group’s role and remit, and composition of the group should involve diverse representation of the workforce.

Statement 7.9: “Central to all leadership and planning, will be people with lived experience. My views will be sought and analysed through regular service review and research to help improve the care offered. I will be positively enabled to provide clear, regular, and meaningful feedback as standard practice.”

A few service providers felt that the involvement of people with lived experience would need to be resourced (for example remuneration for their time).

Statement 7.11: “The appointment duration is considered to meet my need (for example, longer appointments for neuropsychological testing).”

While a few respondents expressed support for the statement, they also felt that there could be in-built flexibility to allow for shorter appointments for neuropsychological testing if that meets the person’s needs.

Statement 7.16: “Staff seeing me will work within their agreed objectives to support their wellbeing and job satisfaction. Time will be protected for staff to allow them to teach and continually develop the workforce.”

A few respondents noted that action to promote and support staff wellbeing was crucial in order to ensure the provision of high-quality care.