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NHS Talking Therapies – A Sacred Cow

NHS Talking Therapies is the only NHS service that it is not independently assessed. Costing £2 billion a year for adult and child services, it has escaped the scrutiny of both the National Audit Office and the Care Quality Commission. It is also, it seems, the only NHS service were staff are not in a public pay dispute.  What is going on?

It deftly keeps below the radar, so that ‘value for money’ questions  are not asked. The other string to its’ bow is ‘gas-lighting’, the repeated repetition of a claim, absorbed by its familiarity. Its’ much vaunted ‘50% recovery rate’, has warmed the cockles of the hearts of politicians,  Integrated Care Boards and the media, who have all readily and willingly accepted the lie [see Scott (2018)] in the name of political correctness – to be seen to be on the side of mental health.  In Mental Awareness Week the powerholders need educating that functioning does not equal working. The Annual reports of IAPT (NHS Talking Therapies previous embodiment) portrays its functioning: numbers seen, waiting times and self-determined targets met. But with no evidence that it is working – no independent assessment of the proportion of clients who are back to their old self and remain so post treatment. There is no credible listening to the client by a Red Cross-like body.

The Citizens Advice Bureaux are a nationally recognised and valued body. Many of their clientele have mental health problems, but there is no evidence that they are any the less served than if they had attended NHS Talking Therapies.  The added value of this NHS service has not been demonstrated. Perhaps NHS Talking Therapies staff dare not consider strike action because they are afraid nobody would miss them. GPs may miss the brief respite that may come with off-loading to NHS Talking Therapies, some perhaps even believing or at least wanting to believe NHS Talking Therapies fairy tale. They may be complicit in marketing the tale to patients.

Dr Mike Scott

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National Audit Office Offers No Evidence That The £0.5 Billion, Per Year, Spent on Talking Therapies Is Value For Money

The £4 billion plus spent on the Improving Access to Psychological Therapies (IAPT) programme over the last decade could have been better spent improving the lot of Nurses. On March 6th 2021, I received a reply from the National Audit Office (NAO), ironically from the Director of the Health value for money Team, saying that it had no intention of mounting an investigation into UK Government’s, Improving Access to Psychological Therapies (IAPT) programme. The Director adds ‘but you raise important issues – around data quality, levels of performance, outcome measurement, and what has been achieved for the spend – that would be important to cover in any report we consider on mental health services’.  

The Director informed me they have been preoccupied with the effects of Covid!  In 2017 the NAO  initiated an investigation into IAPT  but a year later it was discontinued because of ‘Brexit, the collapse of Carillion and concerns about spending on generic medicines’. The NAO never published their findings.  It seems that the NAO will always have an excuse to kick a focus on IAPT into the long grass. But in 2016 it had asked the Department of Health  to investigate why  IAPT was exempt from Care Quality Commission scrutiny.  The DOH made no response – friends in high places?

There appears to be an implicit assumption that just throwing money at mental health must be good. The NAO has signally failed to manage the public purse. At a time when this purse is near empty, and there are clearly pressing needs amongst Care and Nursing staff, this is appalling. 

Dr Mike Scott

 

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The Department of Health Has Failed To Regulate Routine Mental Health Services

Improving Access to Psychological Therapies (IAPT) services are out of bounds to Care Quality Commission inspection.  In 2016 the National Audit Office (NAO) asked the Department of Health to address this issue and it has done nothing.  The Department sets the agenda and budget for NHS England, who in turn do the same with Clinical Commissioning Groups to determine local provision of services. But NHS England staff are lead players amongst service providers, these conflicts of interest exacerbate the parlous governance of IAPT. There is a need for Parliament to step in and take the Department of Health to task.  

 

Whilst no one doubts the importance of improving access to psychological therapies, it was remiss of the NAO in 2016 to take at face value IAPT’s claim that it had the appropriate monitoring measures in place.  Incredulously the NAO accepted at face value IAPT’s claim that it was achieving a 45% recovery. It is always tempting to look only as far as evidence that confirms your belief. But it is equally important to consider what type of evidence would disconfirm your belief. The NAO has failed to explain why it has not insisted on independent scrutiny of IAPT’s claims. 

The The Improving Access to Psychological Therapies (IAPT) programme has exercised a confirmatory bias in its’ audit by focussing only on self-report responses on  psychometric tests (the PHQ9 and GAD7). The service has never looked at a categorical end point, such as whether a person lost their diagnostic status as assessed by an independent evaluator using a standardised diagnostic interview.

Organisations, are inherently likely to be self-promoting and will have a particular penchant for operating, not necessarily wholly consciously, with a confirmatory bias. It is for other stakeholders, NHS England, Clinical Commissioning groups, MPs, the media, Charities and professional bodies (BABCP  and BPS) to hold IAPT to account. For the past decade they have all conspicuosly failed to do so. How have IAPT evaded critical scrutiny, despite the taxpayer having paid £4billion for its’ services? Friends in high places is the most likely answer. I have called for an independent public inquiry for years and will continue to do so  but there is likely to be an echo of a deafening silence as the only beneficiary would be the client with mental health problems.  

Dr Mike Scott