The National Audit Office Fails To Ensure IAPT Does What It Says On The Tin

On February 9th 2023, the NAO gave its’ seal of approval to NHS Talking Therapies (formerly the Improving access to Psychological Therapies, Service), legitimising the £752 million spent on it in 2021-2022. But the small print reveals that less than 50% of clients completed treatment (attended 2 or more sessions). Further the NAO, took at face value, the Service’s claim of a 50% recovery for completers. These are not the hallmarks of a legitimately funded public body. The NAO is strangely silent on the fact that there has been no publicly funded independent assessment of the effectiveness of NHS Talking Therapies. Nevertheless they recommend the Services method of self-audit, (repeated completion of 2 psychometric tests) for adoption by the rest of the mental health services! 

The NAO took no account of my critique of the Service published in the British Journal of Clinical Psychology (2021):

  • diagnosis is not part of the repertoire of NHS Talking Therapies
  • to most people recovery means no longer suffering from the disorder/s that you presented with
  • psychometric tests measure the severity of a disorder, they are not diagnostic and cannot be the primary metric of recovery.
  • the duration of recovery is critical, and if not established talk of recovery is meaningless
  • the best independent evidence of recovery to date is that in fact the tip of the iceberg recover [Scott (2018) ]. The improvement identified by NHS Talking Therapies is most likely the effects of attention and regression to the mean. The burden of proof is on the Service to demonstrate that its’ clients fare any better than a matched group of clients attending say the Citizen Advice Bureaux. 

If the NAO report were presented in a Civil Court, their findings would be dismissed because their conclusions are outside their area of expertise. NHS Talking Therapies is responsible to politicians and Integrated Care Boards, but to date the latter have failed to hold them accountable, `alongside the NAO. It is sadly reminiscent of Hospital Trusts not holding Senior Managers accountable.

Dr Mike Scott