Tag: Talk Liverpool

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Improving Access to Psychological Therapists (IAPT) or Care Assistants?

The staffing costs of the Improving Access to Psychological Therapies (IAPT) Programme is set to rise to £0.5 billion per year, but the National Audit Office (NAO) has failed to determine whether it is value for money. The average Clinical Commissioning Group (CCG) will need to increase IAPT staffing by 60-75% to meet the 2024 NHS Access Target ,according to the updated IAPT Manual (August 2021). Currently the service employs 8000 staff, another 3,800-6,000 are ‘needed’, taking the total to between 11,800 and 14,000 in the next 3 years.  Assuming a staffing cost of £35K per employee per year and the employment of 13,000 IAPT therapists, annual staff costs will be £455 million a year i.e approximately £0.5 billion per year.  But the true cost will be even greater when overheads  such as rent, phone lines are included. Extrapolating backwards, over £5billion will have been spent on IAPT staff since its inception without independent audit and no intention of NAO audit.

But the pandemic has highlighted the shortage and poor pay of Care Assistants. Drew et al (2021) sampled IAPT therapist-client interactions https://doi.org/10.1016/j.socscimed.2021.113818 and noted a steadfast refusal to let clients tell the story behind their distress. A member of the public listening to these exchanges might contrast them with those of a Care Assistant making visits to a terminally ill patient so they can die at home with their family. The public would I think see the Care Assistant’s work as being more valuable and puzzled that the IAPT worker is paid twice as much.

There is a move to have health and social care under one umbrella, perhaps the NAO might explain why there should not be better pay for the Care Assistants and an increase in numbers at the expense of expansion of IAPT services. I came across this advert for Care Assistants in my area:

a much better investment than Talk Liverpool with a 10% recovery rate, Scott (2018) ‘IAPT- The Need for Radical Reform’ https://connection.sagepub.com/blog/psychology/2018/02/07/.

Dr Mike Scott

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Unregulated Mental Health Service Has Run Away With £4 billion

Following a Freedom of Information request NHS Improvement confirmed to me yesterday that the the total cost of the Governments Improving Access to Psychological Therapies (IAPT) Service in 2017/18 was £394 million.  I had asked them for the annual cost of IAPT since its’ inception, but they said that they were unable to furnish such figures! The service is twelve years old, thus conservatively it has likely cost the taxpayer £4 billion. 

For Rail and Road we have a regulatory body the  Office of Rail and Road, that monitors the performance of Network Rail and the varying train operators, but for mental health there is no such independent regulatory body. IAPT polices itself, and makes unexamined claims of recovery rates to secure funding from Clinical Commissioning Groups, who have never performed an independent audit. In my own area, Talk Liverpool last October publicly claimed an 87% recovery rate  for those who completed treatment, unsurprisingly therefore the Liverpool CCG has increased its funding by 25% to 10 million in the coming financial year. My own research published in 2018 suggests an actual 10% recovery rate.

It is time that the Government and Dominic Cummings got to grips with this.

The dropbox link to the FOI  response is below:

https://www.dropbox.com/s/x5kza6e6bpft2b3/Scott%20Internal%20Review%20Decision%20Letter%2020.01.2020.pdf?dl=0

My own findings are in the dropbox link below;

https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0

more about these matters anon

Dr Mike Scott

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Rely Solely On A Self-Report Measure To Hike Up Funding and Fudge Outcomes

the routine audit of mental health services such as IAPT, is based on client self-report measures such as the PHQ9.  This carries the implicit assumption that the cut offs by themselves meaningfully distinguish cases from non-cases.   Correspondence in this months British Journal of Psychiatry highlights how misleading reliance on a single self-report measure can be. One study using this methodology claimed two fifths of 11-15 year olds had mental health problems  but when in another study assessment was conducted using standardised diagnostic interviews and diagnostic criteria the figure was just 13.6%!. doi:10.1192/bjp.2019.225

Whilst claims of high prevalence rates might be good for funding purposes and placing mental health on the public agenda there is no real world change for clients, the powerholders are the only beneficiaries.

In October 2019 my local IAPT claimed 87% (Talk Liverpool Performance Data) of those who completed treatment recovered in the previous 12 months, making Talk Liverpool outperform all other IAPT services (a national claim of a 50% recovery)! I can only think that Talk Liverpool have looked with envy at how Liverpool FC outperforms  all other teams and has gone into delusional mode! My own    study of 90 IAPT clients that I assessed independently using a standardised diagnostic interview showed that only the tip of the iceberg recover, see link below:

https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0

Rogers and Bender have written about ‘the myth of the laser accuracy of cut offs’ in their seminal work ‘The Clinical Assessment of Malingering and Deception’ (2018) Guilford Press.  Clinical Commissioning Groups could do with lessons in all these issues when interacting with IAPT and stop displaying such breathtaking naivety. 

Dr Mike Scott

 

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IAPT Defrauding A Local Clinical Commissioning Group?

on November 20th I wrote to the Chief Officer, (see link below), of  the Liverpool Clinical Commissioning Group, about Talk Liverpool’s claim that it has had an 87% recovery rate in the last 12 months [see Talk Liverpool’s Performance Data]. A Freedom of Information Response that I received on November 19th from the Liverpool CCG revealed that this financial year it expected to increase its’ funding by £2.5 million to £10.6 million. IAPT’s local claims are eye-brow raising as nationally IAPT claim one in two recover [see IAPT Manual (2018)]  – Talk Liverpool have clearly discovered some therapeutic secret that is being kept very secret!   Liverpool CCG has spent £60.6 million on IAPT since 2013-2014 all without any independent assessment. The CCG has simply taken Talk Liverpool’s word and focussed entirely on operational matters such as numbers seen and waiting times. 

https://www.dropbox.com/s/7ch5uka6yq8pukd/CCG%20letter.docx?dl=0

But the issue is not confined to Liverpool, Mental Health Commissioners nationally need to be critical of IAPT. Unfortunately the focus of Mental Health   Commissioners Network Forum is simply on building liason between Commissioners and Providers. The IAPT National Networking Forum  meeting on January 21st  is to be addressed by the Forum’s Deputy Chair. The day is titled ‘Building and developing your service to meet IAPT LTC expansion’ the advertising blurb  for the meeting reads ‘With access rates going up, is your service trying to do things you don’t have the capacity to do? IAPT staff are invited to bring along a Commissioner free of charge. There is a pressing need for Mental Health Commissioners Network Forum to address the question of the reliability of the evidence that IAPT is value f or money.