12 News analysis


EXCLUSIVE: HI magazine uncovers six month waits for NHS counselling n Treatments recommended by NICE unavailable in a third of areas


MADELEINE DAVIES n Postcode determines whether patients wait days or months for therapy


Thousands of patients with depression are still waiting more than six months for NHS counselling and other talking therapies, despite the Government’s £170m investment in improving access to treatment, Health Insurance can reveal. At least 10 primary care trusts (PCTs) in England are reporting waits of more than six months


to see a trained counsellor. Patients referred for cognitive behavioural therapy (CBT) – the main talking therapy recommended by the National Institute for Health and Clinical Excellence (NICE) – are waiting for more than six months in at least eight PCTs. The findings lend weight to the business case for employers to fund access to therapy. Mental


ill-health, including anxiety, stress and depression, is the leading cause of long-term absence in the UK and is estimated to cost employers on average £1,035 per employee per year, through sickness absence, staff turnover and reduced productivity.


POSTCODE LOTTERY AND LIMITED CHOICE The data, collected from 120 PCTs under the Freedom of Information Act, shows that waiting times have increased in some areas since 2009, when Health Insurance conducted a similar investigation. Today, 41% of 85 PCTs report waits of more than three months for counselling, compared to 29% of 90 PCTs in 2009. Patients wait for more than three months for CBT in a quarter (27%) of PCTs, a similar proportion to 2009. While some authorities offer immediate access to


a trained mental health professional, others report waits of more than a year. Patients are waiting up to 54 weeks for counselling in Central and Eastern Cheshire and up to 67 weeks for CBT in the Wirral. Both are available with no wait or in a matter of days in other areas. The survey also shows that the range of talking therapies recommended by NICE for mild


to moderate depression is unavailable in many parts of the country, despite the fact that CBT is not appropriate for everyone diagnosed with the condition and the Government’s commitment to delivering patient choice. Interpersonal therapy – a treatment designed to address relationship problems – is not provided


by 45 PCTs while 61 do not offer behavioural couples therapy. Psychodynamic therapy, which focuses on causes of depression rooted in childhood, is unavailable in 56 PCTs.


WHAT THE EXPERTS SAY


Phillip Hodson, British Association for Counselling and Psychotherapy “Despite the best intentions, mental health services remain a Cinderella service and vulnerable to cuts. Improving Access to Psychological Therapies is helping to address this but it is very hit and miss and in some areas services that existed


prior to the programme have been closed, which Lord Layard for the Labour Government said was never the intention. “CBT has a huge role to play in managing the treatment of some


depressions and phobias but the problem is that it will not work for all patients – perhaps up to a third. To treat everyone, we need to deploy the whole family of therapies. CBT remains important and useful. It was previously underfunded. We would not be without it. But CBT is no panacea and it will in the long run prove costly and damaging to patient confidence to pretend that it is.”


HealthInsurance DID YOU KNOW?


Counselling is the most widely provided employee benefit


(CIPD absence management survey, 2010)


Vicki Nash, head of policy and campaigns, Mind “Waiting times for treatment can make the difference between someone making a swift recovery, to someone having every area of their life fall apart. It seems so wrong that the outcome all depends on where in the country you live.”


Dr Seamus Dagens, consultant occupational health physician at corporate adviser PMI Health Group “The NHS, like all organisations, has finite resources. In many areas there is therefore an imbalance between supply and demand with regard to appropriate treatment. While employers have no legal obligation to provide or fund medical treatment for their employees, many acknowledge that there is a benefit in providing psychological therapies such as CBT for their staff as prompt access to treatment often dramatically shortens the course of their illness which in turn facilitates a more timely return to normal every day activities and work. In such cases this is obviously advantageous for both employee and employer.”


HI www.hi-mag.com August 2011


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