Psychological Therapies 2012 Minister Full Speech
Psychological therapies in the NHS
Thursday, 29 November 2012
Hello to you all, and thanks for inviting me to speak here today.
Mental health has an institutional disadvantage in health and care services.
So when I started this job, the first thing I wanted to know was how we could put that right. Not through words and sentiment. But through action.
The backing that we are giving to the IAPT programmes is a step in the right direction.
This year, based on the good outcomes they have provided for over one million patients since 2008, we are investing over £250million in IAPT Services in the NHS.
You’ll have seen the excellent report by the Schizophrenia Commission a few weeks back. One of its key recommendations was to increase psychological therapies for people with Severe Mental Illness. I am therefore pleased that there are pilots underway which are looking at how best we can deliver IAPT for this group.
And fifteen long-term condition pilots have been set up with £2m of central funding. They are looking into exactly what the benefits are when psychological therapies are available to patients with long-term conditions, and how best to train IAPT staff and long term conditions professionals.
The facts show that IAPT services are becoming increasingly effective. Recovery rates have increased as the services have grown, current recovery rates of over 45% are close to expectations set out in clinical trials.
But that’s not to say that the IAPT initiative isn’t still delicate.
It’s still new, and it looks like progress might be slowing down a bit in some areas. I am looking at that urgently and I will do everything I can to get it back on track.
I want government to lead from the front. So all across Whitehall, we can support this programme.
Tomorrow, my ministerial colleague Lord Freud will be here on behalf of the DWP to help with that.
He is helping to launch the “Working for Wellbeing in Employment” toolkit.
The toolkit helps Work Programme Employment Advisors to identify the mental health needs of the unemployed people they support.
It also outlines the options for emotional support and where to find it.
It goes without saying that those advisors need to know about psychological therapy services.
And I will be meeting Lord Freud very soon to explore what we can do across Government to help IAPT and employment services join up better on the ground. I am convinced that there is much more that can be done, and excited by the potential benefits to be had.
The three year report shows that IAPT services have remarkable potential for success. It is not only an encouraging indication of what has been done so far, but a tantalising glimpse of progress that is yet to come.
We are exploring the possibility of Payment by Results in both adult IAPT and Children and Adult Mental Health Services.
If that project blossoms as we hope it might, then it will transform the commissioning process in a way we simply haven’t seen before.
It will push up standards throughout the system and encourage innovation, invention and inspiration.
But it will also change where the money goes in the NHS.
The current tariffs for physical health have shown us that PbR can really shift money into different priority services. But the block contracts for mental health services mean that they only get what is left over after that.
I am desperate to see tariffs in mental health too. So more money is dedicated to the areas you work on.
And once we have PbR in mental health, it will pave the way for introducing choice in mental health.
One of the first things I asked about when I came into post, was why the last Government specifically excluded Mental Health from its policy on patient choice.
This is a very clear example of a lack of parity between physical and mental health services.
It seems to me that if any group of patients can benefit from being empowered by being able to choose their provider or which therapy they would like, then it is people with mental ill health.
I have asked officials to look at whether this exemption on choice can be removed and I very much hope I can say more about this soon.
I also want to say a little bit about the Children’s and Young Persons’ initiative more specifically.
As you know, it was introduced just over a year ago by Paul Burstow, my predecessor as health minister.
Some of the progress that has been made over the past year has been truly remarkable.
I was very impressed to hear that the programme was shortlisted for an award in the 2012 Civil Service Awards – meaning it was one of the best of more than 700 nominated projects.
That simply would not have happened without the towering support of everyone involved in the project.
Academics, clinical and service leaders, staff, stakeholders, local authorities – they all pulled their weight, and then some.
For instance, I know that people like Anne York, Duncan Law and Margaret Murphy have given up their time to bring on children and young people’s IAPT, and I am immensely grateful.
Your work will improve not only the mental health of children and young people, but their entire life chances.
So I was really pleased when earlier this year, the Department of Health said yes to up to an extra £22million over the next three years.
By 2013, over a third of under-19s, four million in total, will live in places where CAMHS has been transformed through the CYP IAPT model.
And we have been clear that we want to go even further than that.
So I’ve said a bit about what is happening with IAPT. But beyond that, the first ever NHS Mandate, published earlier this month, places an expectation on the NHS to move towards parity of esteem for all services.
So that institutional disadvantage becomes a thing of the past.
The Mandate goes further than ever before making clear the priority that the Government places on mental health.
The NHS can no longer be in any doubt about this.
When I first saw the draft mandate, it struck me that it had only one small, separate section on mental health. And it put no new requirements on the NHS. I was determined to send a much stronger signal than this.
So I was delighted that in a much smaller final document, we were able to go much further on mental health.
It is up front as one of the top five priorities for the NHS and there requirements related to mental health in every single section thereafter.
I wanted to get the message across to the NHS, that good mental health care must be part of the fabric of all aspects of NHS care – not just treated as a separate institution.
I personally feel very strongly about access and waiting times in particular. Much like what I was saying about choice, I simply cannot understand why mental health was excluded from the previous Government’s flagship waiting times policy.
Someone needing a hip replacement knows they wont be left in pain, unable to walk. They know they will get their operation within a maximum of 18 weeks. Patients have even stronger rights if they have cancer – and this is all to be commended.
But it cannot be right that someone who is very ill with depression or OCD or schizophrenia might have to wait months and months, letting their condition deteriorate, often living in great distress, and at great detriment to their health.
I know from my constituency casework and from personal experience of my friends and family that there are people being told to wait for months on end with nowhere to turn for the help they need.
And they are further disempowered by knowing that they have no rights to address the situation.
Not only do we not have the same access standards in mental health as we do in physical health, but we don’t even have any way of measuring the scale of the problem.
When I heard that we don’t even collect this data, it was yet another very powerful signal that that system simply does not treat mental health equally.
This is why the mandate requires the NHS to do the preliminary work to identify the scale of the problem of waits for mental health services – including IAPT services.
This is a major first step to working out how we can introduce proper standards and entitlements in mental health.
The mandate also makes clear that the NHS will continue to deliver IAPT services, with specific reference to meeting the programme’s access and recovery rate target trajectories, and to protecting the brilliant children’s programme which I spoke about earlier.
I know that there has been some concern in the sector about how the NHS Commissioning Board will take on the delivery of the IAPT programme.
And I will admit that I share some of those concerns. I am not going to pretend that the transition won’t present challenges.
The Commissioning Board is still in the process of drawing up its detailed plans for operation of the programme. But whatever the programme looks like in the future, I have been very clear about what I expect it to deliver.
And crucially, the Mandate will allow the Government, Parliament and the Public to hold the NHS to account to ensure it delivers the programme.
I don’t have to tell you the potential of IAPT services, both for children and adults.
But I do want to thank you for all the hard work you have put into it.
I know how much of a matter of pride it is.
IAPT is only three years old, and it has achieved so much in a short time already, helping over a million people.
But I believe we are still only at the beginning. Our current ambition is to allow access to psychological therapies for 15% of people who could benefit. This is an ambitious starting point. But it surely can’t be the end point?
There is so much potential for psychological therapies to help people of all ages, to help people get back into work, and to help people with a whole range of different conditions – and with a wider range of therapies.
So in many ways we are still only near the beginning of the IAPT journey. I want to make sure in my time as Minister that I help to take it as far as I can and to further build on the foundations to allow it to fulfil its clear potential.
Download: Norman Lamb Full Speech30 November 2012