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Research update: T e New Savoy Confe


Peter Stratton In November, the fifth New Savoy


Conference was held. This sequence of conferences was initiated by a group including several members of the UKCP research committee and set up under the heading of ‘Psychological Therapies in the NHS’ but, by the first conference in 2007, had become a showcase for the newly funded IAPT (Improving Access to Psychological Therapies). The audience has always had a strong representation from third and voluntary sector counsellors and therapists and, under the chairmanship of Jeremy Clarke, has progressively come to offer a more varied consideration of provision of psychological therapies. Sponsors of the conference managed to agree on a consensus statement that, despite complex negotiations, did include the statement that, “Concerns have been raised, however, about whether the range and balance of evidence considered and treatments currently recommended is too restrictive”. Websites that offer extra detail are listed at the end, and overheads and audio of the presenters mentioned in this report are available on the New Savoy website. There was much of interest, and Jeni


Webster has written a report of the whole conference. There is also an extensive report on the UKCP website from its research-faculty committee. I was deputed to the conference by UKCP to support the full range of psychotherapies and I want to focus on the research aspects from this perspective. As reported in the previous research update, UKCP had organised a roundtable discussion to generate material for a panel discussion at the Savoy and I submitted eleven questions especially to offer to Sir Michael Rawlins, chair of NICE. In the event, none of them was chosen, perhaps they were too challenging; or too obscure. But I don’t like effort to go to waste so I have put


them on the AFT website research page in case they are of interest or use to you. In the panel, Sir Michael made his


usual strong defence of randomised control trials but did also accept the role of qualitative practice-based research though, rather oddly, only, “When there is a biologically plausible basis for a treatment’s use”. Nancy Cartwright argued equally strongly that RCTs only tell you what happened in that trial and say nothing about whether a treatment will work in a diff erent context. I chose not to ask one of the three approved questions and, instead, asked: “NICE works f om a tradition of recommending only the one therapy that has the strongest evidence. In practice, NICE guidelines are interpreted by those who rely on them as advising against every therapy that is not explicitly recommended. A massive weight of evidence now shows that the great majority of psychotherapies are just as eff ective as the limited list obtained by NICE’s ‘fi rst past the post’ system. Could NICE consider taking responsibility for helping GPs and IAPT be aware of those therapies which have until now been provided within the NHS and about which there are no grounds for claiming that they are less eff ective than the current ‘short list’?” Sir Michael handed the question to Steven Pilling who, I felt, did not answer it. Paul Burstow (minister for care


services) made a very positive opening speech about the commitment to parity of esteem between physical and mental health. He, and Gregor Henderson later, introduced a new document on health and wellbeing boards. Burstow appeared to accept that provision for families needs to be wider than NICE/IAPT currently approve, and he announced £32 million funding for child IAPT. Sheila Shribman in the child IAPT session pointed out that government funding for adult mental health is £11,260,000 and for child and


adolescent is £527,000; one of many who were pointing to research findings that a major contribution to adult mental health would be made by tackling psychological problems of children. She also quoted an interesting research of global mental health challenges (Collins et al., 2011). That extensive study, published in Nature, concluded with four recommendations that have quite a systemic ring: • Use a life-course approach to study • Use system-wide approaches to address suffering


• Use evidence-based interventions • Understand environmental inf luences Paul Burstow offered 50% success


as a target for IAPT therapies but accepted that actual performance is very variable. Some very interesting data were presented by Nick Cape from the new National Audit. 46% of patients did not have a recorded diagnosis and 23% had a diagnosis that did not have a NICE recommended treatment. To me, that means only 31% were eligible for a NICE recommendation based on RCTs. Also, 70% of high intensity patients did not receive the recommended minimum number of sessions. There was recognition of the “perverse incentive” that encourages IAPT services to reject difficult cases and only report success rates for the minority who complete treatment. Estimates of successful treatment, when all referrals are considered, ranged upwards from 5%. Rufaro Kausi, commissioning and provider development project-manager for IAPT, Department of Health, reported a pilot for a new model for IAPT evaluation that first requires a statistically reliable change, then bases payment on amount of change. It “removes the perverse incentive to take people who are mildly depressed and count them as recovered when the PHQ changes from 11 (clinical) to 9 (below threshold)”.


Advertise your vacancy in Context and on www.aſt .org.uk, and your advert will reach a targeted a systemic psychotherapists throughout the UK. Call Louise Norris on 01457 872722 or email l.norr


54 Context February 2012


The New Savoy Conference


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