Categories
BABCP Response - NICE Consultation January 2022

Diagnostic Stewardship’s Abscence from NHS Talking Therapies

Diagnostic error occurs when a diagnosis is missed, inaccurate, imprecise, or incomplete.1 Diagnostic stewardship reduces diagnostic error primarily by reducing misdiagnosis. NHS Talking Therapies use problem descriptors, as a surrogate for diagnosis, and on this basis choose an ICD-10 code, but nowhere else in the NHS operates like this. Neither the validity or reliability of ICD-10 codes, established by these means, has been established. It is no more reliable than establishing a code based on the way the wind is blowing. The purpose of such a charade is to give NHS Talking Therapies a spurious scientific legitimacy. It is akin to a candidate for a post over-selling themselves at interview. It is tempting in such circumstance to blame the ‘candidate’, but the real problem is the interviewing panel ( Integrated Care Boards, politicians) all with their own agendas. These include being seen to do something that is immediately credible to the public, such as increase access, shorten waiting times. Achieving these goals maintains their position.

NHS Talking Therapies engages in further posing when it claims its’ therapists intervention are NICE compliant. Given that the services clinicians do not make diagnosis and that the treatments recommended by NICE are largely diagnosis specific, this is logically impossible. But by clever marketing and a strenuous avoidance of independent evaluation, NHS Talking Therapies perpetuates the myth. This is coupled with a phobic avoidance of discussion in the public domain. Preference is given to internal networking meetings of ‘best practice’ in which the agenda is set by the power holders in NHS Talking Therapies. Lessons in this are on offer from all totalitarian states, the only ones that pay are the subjects/clients.

The totalitarians are unwittingly helped by those who totally eskew diagnosis. The latter ‘free spirits’ have no metric with which to invalidate the claims of the totalitarians. It becomes a free for all of assertion and counter assertion, with no methodology that might lead to agreement. The primacy given to an individual therapists subjective formulation of a client’s difficulties can be easily dismissed on the grounds that it is idiosyncratic. In such circumstances the therapist’s bottom line amounts to ‘I want my autonomy at all costs, any infringement is coercion, deserving of my righteous wrath’ and an ignoring of the bigger picture.

Dr Mike Scott

Dr Mike Scott

Dr Mike Scott

1. Balogh  E, Miller  BT, Ball  J; Institute of Medicine.  Improving Diagnosis in Health Care. National Academies Press; 2015.