The evidence on the translation of the Guidelines to routine practice is conspicuous by its’ absence. Claims to be NICE compliant are used by mental health service providers to secure funding, but without credible evidence of the Guidelines influencing routine practice. But some individual practitioners within providers such as NHS Talking therapies and Anxiety UK may be compliant. As may some independent practitioners.
There is no agreed audit tool, despite spending £2 billion a year on NHS Talking Therapies
NICE guidelines are diagnosis specific, but NHS Talking Therapies’ practitioners do not make diagnoses, making compliance impossible. Instead its’ clinicians assign an ICD-10 diagnostic code, to what they see as the main presenting problem. But there is no evidence that this is a reliable surrogate for a standardised diagnostic interview. The randomised controlled trials on which the Guidelines are based, begin with a reliable diagnosis and a matching treatment protocol. In NHS Talking Therapies there is ‘no key and lock’.
Rather treatments are random, with alleged CBT programmes for disorders such as ‘mixed anxiety and depressive disorder’, that are not in the NICE lexicon. Yet, we are invited to believe that the recovery rate for this, protocol-free disorder, of over 50%, is on a par with the general recovery rate!
In my book Simply Effective Cognitive Behaviour Therapy (2009) London: Routledge, using the idea of a Sat Nav, I identified the treatment targets for each disorder and the matching treatment protocol. Making it possible for clinicians to get to their destination. But in years since the inception of IAPT, out of the 100’s of treatment records I have reviewed, there has been scarce evidence of compliance to any treatment protocol (fidelity) and in the rare instances where it has occurred, there has been no flexibility e.g persistence with a trauma focussed approach, which was clearly not working, leading the client to default. Flexibility within fidelity has not materialised.
Dr Mike Scott
