IAPT waiting list targets

This section is for discussion relating to the Layard report, and subsequent schemes like Improving Access to Psychological Therapies where lower intensity inteventions are offered in primary care
Post Reply
Posts: 14
Joined: Thu Aug 14, 2014 11:50 pm

IAPT waiting list targets

Post by serioussham »

TL:DR IAPT services don't seem to follow current waiting list guidance.

I am currently working in an NHS managed IAPT service.

As some of you may know, the government introduced targets for waiting lists in IAPT. 'The new waiting time standard requires that 75% of people with common mental health conditions referred to the Improved Access to Psychological Therapies programme will be treated within 6 weeks of referral, and 95% will be treated within 18 weeks of referral.' (ref: https://www.england.nhs.uk/wp-content/u ... e-guid.pdf pg. 14).

Based on the official data, found at http://content.digital.nhs.uk/iaptreports (please note the information doesn't seem to be working at present as the website is in Beta, but hopefully this will be up soon) IAPT services seem to be hitting this target. From memory, I believe 90%~ were reported as being treated by 6 weeks.

In order to count as treated/entering treatment, people need to be seen for a minimum of 2 or more treatment sessions, 'Waits from referral to the start of a course of treatment i.e. for those people who have two or more treatment sessions.' (ref: https://www.england.nhs.uk/wp-content/u ... s-guid.pdf pg. 5).

The guidance attempts to stop potential book cooking, 'A number of additional measures will be captured in national reports to guard against the introduction of perverse incentives into local commissioning arrangements by:
 Giving a larger proportion of patients a single session of assessment and advice,
rather than a course of therapy;
 Reducing the average number of sessions that are given to people who need to
have a course of therapy;
 Employing artificial treatment starts where patients have an early appointment but
are then put on an ‘internal’ waiting list before a full course of treatment starts; or
 Introducing long waits into pathways where patients are ‘stepped up’ to a higher
intensity treatment package.'

In the service in which I work, all assessments are marked as 'assessment and treatment' (this is on PC-MIS but I assume IAPTUS also has a similar feature), which to me seems like a 'perverse incentive' as mentioned above, which is designed to manipulate the data. When I discussed this concern with management, I was told that 'NHS England have told us to do it this way' which would indicate either that the service is willfully lying or the NHS England are actually aware of this and are allowing the data to be manipulated. It should be noted that the service only marks those that enter the service as 'assessment and treatment', whereas those that are passed back to GP/referred to secondary care/signposted as marked a 'assessment'.

The guidance also states '13.Question: How is first treatment defined? Answer: The decision on what is treatment is a local decision that should to be clearly laid out in written, local pathways and have senior clinical sign off in the organisation. Such protocols should also clarify when an appointment should not be recorded as treatment. The final decision on whether a particular appointment is the start of treatment should not be a blanket decision but be made by the healthcare professional undertaking the appointment in the knowledge of those pathways. It is important to ensure the ‘Appointment purpose’ field is completed on clinical systems as this is a mandatory field.' (https://www.england.nhs.uk/wp-content/u ... s-guid.pdf pg. 15). Our service currently has no pathway or protocol in place to cover this, and the final decision is a blanket decision, made by the service, outside of the discretion of the assessing practitioner. When I highlighted this to management, it was reiterated that NHS England says its ok and concern was expressed about why i'm asking so many questions!

I am just looking to see what others are experiencing in their services regarding this?, I can only assume that this is a practice occurring in other services as well in order to meet KPIs etc.

Its frustrating that IAPT services beat the drum about evidence based practice, but the reality is that this is only lip service.
Posts: 284
Joined: Wed Jun 02, 2010 9:13 am

Re: IAPT waiting list targets

Post by LIWY »

Hello, good to hear someone else talking about this.

This practice is certainly rife in the South East where I know services. The one service that I know that was honest got absolutely slated in their local press for their wait times but they were no worse than anywhere else, they were just honest.

It sickens me because we all know that IAPT services are horribly short staffed, full of staff suffering burnout and patients not being offered full courses of treatment according to NICE guidelines recommended number of sessions yet, because wait times are reported as being met, it gives the government a get out to not up budgets. Put this together with the services that up their apparent numbers accessing by starting new treatment episodes and you've another reason for the government to not up budgets.

I have written to various government officers/offices about it and not received a single reply. Everyone just seems to want to keep a lid on it as the truth means more money to be spent, especially now they've promised to up access from 15% to 25%.

It has made me wonder if any government figures can be trusted, the Audit Office themselves recently said " Nationally, the access and waiting times for IAPT are already being met " - https://www.nao.org.uk/report/mental-he ... ng-access/ - how can the Audit office put out a statement that includes IAPT services when no one audits IAPT numbers that are sent in from services?!
Post Reply