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BABCP Response - NICE Consultation January 2022

The Care Quality Commission and NHS Talking Therapies

I have today received the following response from the CQC, after seeking clarification from them of the position between the two. (Thanks to Michael Brazendale for raising the matter with me, in my previous blog).  

Dear Dr Scott,

 

Thank you for your email. I’ve liaised with our policy colleagues and the current position is set out below.

 

  • Psychological therapies are a critical part of mental health services and CQC has a role to ensure that people receive safe, effective, compassionate, high-quality care.
  • The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 schedule 1 defines what ‘regulated activities’ are and ‘Treatment of disease, disorder or injury’ (TDDI) is a regulated activity defined in schedule 1(4)
  • TDDI requires the activity to be provided by or under the supervision of a health care professional or social worker – whether psychological therapies is a regulated activity will depend on the person providing it or supervising it
  • CQC therefore regulates psychological therapies that are provided by or under the direct supervision of a doctor, nurse (‘health care professionals’ defined in the Regulations) or a social worker.

 

Does CQC regulate IAPT services?

  • In the IAPT services model, supervision is most likely led by senior therapists (not medical staff), so this would probably not include a nurse, medical practitioner or social worker therefore, CQC would not be able to regulate psychological therapies in IAPT services as they are usually led and supervised by therapists and not a nurse, medical practitioner or social worker.

 

What does future regulation of psychological therapies look like?

  • We are working with DHSC, trade associations and other key stakeholders to identify and understand how we may inspect and rate psychological therapies going forward and to make sure our legislative powers cover all which needs to be covered, which may include IAPT services.

 

I hope this response is helpful.

 

Many thanks

 

Mat

 

Matthew Hughes

Senior Parliamentary and Stakeholder Engagement Adviser

07384 525677

 

For information about CQC, including contact details, information about how we use and protect personal data, and how to request information from us, go to https://www.cqc.org.uk/contact-us

He responded very quickly to my e-mail and in depth, for which I  have thanked him. I would be very interested in any comments on this missive which I could take forward.

Regards

 

Dr Mike Scott

I responded today March 22nd as follows;

Hi Mat

Following on from your email of yesterday I note that the CQC believes that:

‘Psychological therapies are a critical part of mental health services and CQC has a role to ensure that people receive safe, effective, compassionate, high-quality care’.

I gather from your e-mail that the CQC role is restricted to coverage of agencies, in which a Doctor, Nurse or Social Worker heads the Service Providing agency. How many Service Providers of Psychological Therapies has the CQC inspected? Are there publicly available reports on the inspections? What proportion of NHS Talking Therapies Providers fall under the orbit of the CQC?

It appears that the scope of the CQC has been limited by the ’The Health and Social Care Act 2008 (Regulated Activities)and there is no mention of psychologists. This may be because NHS Talking Therapies in the shape of IAPT did not come into being until 2008 and the Service has slipped under the radar of the CQC. In my experience it is usually a psychologist who is at the head of a local NHS Talking Therapies Service.

If the CQC is to discharge its’ role, it is difficult to see how this can be done without broadening its terms of reference. In terms of the protection of Service Users there can be no justification for the de facto exemption of the great majority of NHS Talking Therapy sites, from CQC inspection. I appreciate that at present the inspection framework has yet to be decided  but this is a separate matter from establishing the legitimacy of CQC inspection across all psychological therapies Service providers.

I would be grateful for your response to these matters.

Dr Mike Scott

 

 

 

 

4 replies on “The Care Quality Commission and NHS Talking Therapies”

Thanks for this, Mike. The exchange has clarified what has been clear on the ground, that NHS TT is not scrutinised by CQC or by any other independent audit of its services.

How incongruous to declare that, on the one hand, “psychological therapies are a critical part of mental health services and CQC has a role to ensure that people receive safe, effective, compassionate, high-quality care” while on the other, “CQC would not be able to regulate psychological therapies in IAPT services as they are usually led and supervised by therapists and not a nurse, medical practitioner or social worker”.

The criterion for qualifying for CQC scrutiny is the status of the staff. The implication is that NHS TT then is not actually recognised as an NHS healthcare service. It’s something else. But what?

Again in practice, it is clear that IAPT/NHSTT has been a world and law unto itself, financed and certified by the NHS as a primary care service but without any of the financial and political scrutiny the rest of the NHS is constantly subjected to. The language of its criteria of diagnoses, treatment and outcomes is designed to locate it in the medical model of health services, with an evidence base and an avalanche of annual statistical returns – its own fortress of Big Data. But the appropriateness of its NICE guidelines to the country’s actual struggle for mental health, and the determined avoidance of the fact that its very own outcome statistics demonstrate its failure rather its success, seem to illicit little if any criticism or concern for its performance to be audited. Why? (A rhetorical question to which I and others have a number of responses)

I applaud your follow-up questions: “How many Service Providers of Psychological Therapies has the CQC inspected? Are there publicly available reports on the inspections? What proportion of NHS Talking Therapies Providers fall under the orbit of the CQC?” Especially interesting given that a good proportion of NHSTT services are in fact private businesses or charities, and will presumably have little if any working association with what the CQC defines as registered healthcare professionals. NHSTT training, supervision and professional accountability is in the hands of NHSTT in partnership with organisations like the BPS and the BABCP. Who scrutinises the training I wonder?

I have been campaigning for independent audit of NHSTT for years. See my most recent challenge via NE London local authority scrutiny committees here – https://uaccess2ct.co.uk/2023/05/01/alternatives-to-nhs-talking-therapy-in-north-east-london/ But the request for criticism to be heard and discussed goes nowhere with the IAPT institution.

Paul Atkinson

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