The flagship programme to widen access to psychological therapies in the NHS is only helping one in ten patients referred by GPs and each session could be costing over three times as much as official estimates, claims a new analysis.
The analysis found that success rates significantly lower if all the patients referred to the Improving Access to Psychological Therapies (IAPT) programme were included, with a recovery rate of 12%.
This compares with official NHS England figures that show a 40% recovery rate, although this is only based on those patients who were ‘at caseness’ to begin with and were considered to have completed treatment.
Researchers from the University of Chester’s Centre for Psychological Therapies in Primary Care (CPTPC) published their analysis in two papers in the Journal of Psychological Therapies in Primary Care this month.
They concluded that their data raised questions over the sustainability of the programme, and urged CCG leaders to ‘look behind’ Government figures to judge whether to invest in IAPT.
But the Department of Health academics who made the economic case for the programme to be set up have rejected the researchers’ claims, which they say are based on ‘flawed analyses’, ‘inappropriate’ calculations and ‘dubious assumptions’.
In the first paper, an analysis of IAPT data from the NHS Information Centre for 2011-2012, the team reported that the official figure for patients moving to recovery was 44%, based on those patients who were ‘at caseness’ to begin with and were considered to have completed treatment.
However, when the researchers considered all patients entering treatment - completeing at least one session - the figure fell to just 22%. If the full quota of patients referred for IAPT was considered, the proportion of patients moving to recovery fell even further, to just 12%.
The authors concluded: ‘The difference between the method favoured by the IAPT programme and the proportion of all referrals is too large to be ignored.’
In their second paper, the team used data obtained from PCTs through a Freedom of Information request to estimate the amount of funding allocated for low- and high-intensity IAPT session completed.
Their estimates suggested the cost for each low-intensity session was £102.38 and for each high-intensity session £173.88 – compared with costs of £32.50 and £55.30 estimated by the Department of Health (DH). Overall sessional costs were 3.15 times the Government estimates.
The authors said this backs up a recent report suggesting the cost per session of IAPT exceeds previous estimates and, on top of their findings successful outcomes, ‘raises questions about the original cost benefit claims for IAPT’.
Lead author Steve Griffiths, senior research fellow at CPTPC, told Pulse: ‘The message for GPs and for GP commissioners is that they need to look behind the optimistic message that 44% of IAPT patients are “moving to recovery”. Our data clearly indicates that the true figure is 12% moving to recovery based on the total number of referrals into IAPT.
He added: ‘Of course commissioners need to know what happened to all the patients they referred rather than a small proportion of them. Our second paper looks at higher sessional costs than the DH estimated and that needs to be seen in the context of fewer sessions being delivered than recommended by NICE, with real implications for sustainability of recovery.
‘These are some of the doubts that are gathering about the original economic case for IAPT, in a context of rightly increased resources for psychological therapies. Some CCGs, using IAPT resources, are introducing much greater diversity of provision in a way that really does reach a far wider population, and we need to learn from that.’
Dr Henk Parmentier, a GP in Hammersmith, west London, and primary care lead of the South London and South East Hub of the Mental Health Research Network, said the reviews findings matched what he found as a practising GP
He said: Only a minority of patients will “recover” - my clinical estimate around 15-20%. Most patients will not be accepted or drop out due to long waiting times before they can get some counselling. Local commissioners and the Government have to reconsider the actual cost versus benefit ratio since other (third sector) providers might provide a much better service.’
But Professor David Clark, professor of experimental psychology at the University of Oxford and a key proponent of the IAPT programme, said the analyses were flawed.
Professor Clark said IAPT is actually costing slightly less than expected – less than £660 per person treated, compared with the original estimate of £750 – while recovery rates were ‘moving in line with expectations’.
He added that it was inappropriate to consider all people referred to the service as many would not end up being treated, while those who did not complete treatment were people who had one session of treatment and advice, ‘in many cases entirely appropriately’.
He told Pulse: ‘It was always intended that a substantial number of people will receive a one-off assessment and advice and will not need to enter a formal course of therapy.’
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