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Paul Burstow speech: Improving access to psychological therapies

December 6, 2010 10:17 AM
Originally published by UK Liberal Democrats

Liberal Democrat Care Minister Paul Burstow has announced Government plans to extend its mental health services by making psychological therapies more accessible to those in the NHS.

He made the announcement in a speech to the New Savoy Partnership, which can be read below:

One of the first rules of politics is that new governments never talk about past successes.

We focus on change, not continuity. On what's wrong, not what's right. On where we're going, not where we've been.

I want to break with that convention today. Mental health has moved forward significantly in recent years.

And we should acknowledge this.

I'm afraid the politician in me means I can't resist saying 'not before time' and 'not far enough' …

But the point stands: some major steps have been taken.

Acute mental health services lifted out of obscurity. Better community support. Better outreach. More crisis services for those with the most severe mental illness.

And psychological therapies - breaking new ground. Transforming how we think about depression, anxiety and other common mental disorders. And giving GPs more options and patients more hope of recovery.

Real progress.

And progress that's down to you.

To the members of the New Savoy Partnership and the We Need To Talk coalition - thank you for campaigning so effectively for change.

And to all of the therapists and professional leaders in the room today - thank you for delivering it in practice.

Still work to do, of course.

Yes, there are issues in acute care. Issues around community treatment. Around variability of standards. Around co-ordination of local services.

Yes, we need to raise the profile of mental health, particularly amongst GPs and commissioners, which is a point I'll return to later.

And yes, we need to reduce the persistent gap in outcomes between different social groups.

A gap highlighted by today's report on the five year Delivering Race Equality programme, which I hope we can all learn from.


Reducing these inequalities will be central to the new strategy for mental health when it's published early next year.

The other thing this strategy will do is project a much broader vision for mental health.

A vision grounded in wellbeing.

And a vision that sees mental illness as one of the big social challenges of our time.

No longer just a Department of Health issue, or even just a Government issue.

A challenge borne by our society, and to be tackled throughout our society.

Mental illness is endemic.

- One in six have a mental illness at any given point.

- Four in ten on incapacity benefit have a mental health problem.

- Depression, stress and other mental disorders costing the NHS more than £10 billion.

- And costing our wider economy at least ten times that amount.

You've been asking for a more radical approach - and the Coalition Government is now answering that call.

David Cameron saying that general wellbeing should now become a key measure of our success is highly symbolic.

Why? Simply because what a Government measures affects what it does.

So this commitment really defines the Coalition's approach to social policy.

Yes, we need economic growth, absolutely.

But after a painful recession, we also need to heal emotional wounds.

We need a psychological recovery alongside economic recovery.


And IAPT is key to this. By reaching into people's lives, and reaching out across the services that support them, you can be a powerful point of connection. Brokers, if you like, of this new approach to mental health and wellbeing.

I had the pleasure of meeting some of your professional colleagues at a centre in Reading a few months ago.

I spoke to the service users, learnt about how these therapies had changed their lives, transformed their confidence, their outlook, their aspirations for the future.

There was a time when diagnosis of a mental health problem was the end as far as work goes. IAPT is changing that.

Everyone I met there had had their lives turned round by the services they received.

One lady had suffered a serious physical illness and had to leave her job. Going in and out of hospital, and then being stuck at home, she became depressed and withdrawn.

And so when she'd recovered her physical health, she was paralysed with fear and anxiety and couldn't return to work.

Therapy made all the difference. She regained her confidence, she eased herself back to work, she got back to her normal self.

I know that stories like this inspire the work you do.

We need them to inspire others. To have the courage to come forward. To be open about their illness. To ask for help.

And this is where Sue's [Baker, chair of Time To Talk] organisation comes in.

Reducing stigma. Puncturing myths. Dispelling prejudice. This is absolutely key to the change we need to see.

But, of course, opening people's minds to mental illness is only half the battle.

People need to get the right support when they do come forward.

And today I want to share our plans for IAPT: how we plan to extend choice, improve access and start to mainstream the use of talking therapies within the NHS.


First, we need to complete the existing training programme.

Two-thirds of the country already covered.

By the end of this financial year, 3,700 newly trained staff will be on board.

We will then go much further.

The funding we're releasing from the Spending Review will mean that by 2015, every patient in the country should be able to get timely access to proven psychological therapies.

And, wherever possible, they should have real choice of approved therapies.

At the moment, IAPT is a little too much like Henry Ford's business philosophy … you can have any therapy as long as it's CBT.

To be fair, it wasn't a bad model to get us on the road. But we do need to diversify. To open the door for other, equally effective therapies to help people with different needs.

So we'll invest the money and work with the local NHS to upskill staff across four other NICE-approved therapies:

- In counselling

- interpersonal therapy

- brief dynamic therapy; and

- couples therapy

Something the last government promised 12 months ago. We'll actually deliver it.

But choice isn't just about the type of therapy we offer. It's really about autonomy. About giving people options about how they receive services, from whom, at a time and in a setting that suits them.

So IAPT sites need to deliver truly personalised care, as some are already starting to do.

And if choice is one side of the coin, then equity is the other.

IAPT must now reach out to a much broader range of people - old and young, and across the illness spectrum.


You all know the value of intervening early. The cost of reaching out too late.

Up to half of all mental illness starts before the age of 14.

Untreated disorders can blight a child's school years and future prospects in ways that are terribly difficult to recover from.

So we now want to develop a psychological therapies model for children.

We'll do so by setting up pilot sites, where teams will train up staff to provide appropriate therapies for younger people.

And asking the crucial questions.

What's the level of unmet needs?

Where and how should we offer these therapies.

How do we work with schools and children's services most effectively?

The ambition here is very clear: to take the same step forward in access for children and young people that we have in adult services.

With psychological services designed for children, and to a significant extent designed by them.

We will use the knowledge and expertise of organisations like Young Minds and others.

To make sure this IAPT programme genuinely speaks to the needs of children, young people and their families.

What about the other end of the age range?

Analysis shows that over 65s made up just 4 per cent of those using IAPT. By our estimates, it should be nearer 12 per cent.

Why is this? Is stigma a problem?

Are GPs attentive enough to depression amongst older people?

Are we offering support in the right places - do we need to start offering home visits, for instance?

And how can we link this up with our Dementia strategy

We need to find the right answers and we need to do it quickly.

There's an added urgency here, given that the ban on age discrimination in health starts from April 2012. No time to lose.

Again we will need the help of key organisations to help us understand and overcome the barriers.


There are two other major groups not benefiting from IAPT.

The first is the one-and-a-half million people who suffer with severe mental illnesses like schizophrenia and bi-polar and personality disorder.

The National Institute of Clinical Excellence recommends psychological therapies, yet research by Rethink suggests that half of those with these conditions have never been offered these therapies.

Again, we need to do better, and again I want the voluntary sector and the professional community to lead us to the right solutions.

We'll bring together Rethink, the Royal Colleges and other professional bodies to look at existing capacity, and develop appropriate training for their members and for practising therapists.


The other excluded group are those with medically unexplained symptoms and with long-term physical conditions.

People with diabetes, hypertension and heart disease have twice the rate of mental illness.

If you have two or more health conditions, you're seven times more likely to have depression.

And this is reciprocal. Where the depression isn't treated, your physical recovery suffers too.

Studies show diabetics with depression cost the NHS between 50 and 75 per cent more to treat than those in good mental health.

Which is a pretty active demonstration of the adage that there's "no health without mental health."

And that's a principle that must be etched on the hearts of NHS commissioners.

We can no longer have a health service that patches people up physically, but leaves them struggling mentally.

We need a big shift in emphasis. Mental health on a par with physical health in the NHS.

The big question is how do we make this happen in practice?' How do we ensure mental health doesn't slip back in tougher times? To be blunt, how do we ensure there's life after IAPT?


Politicians talk in priorities. It's our natural language. The problem is that we want to say everything is a priority, and that devalues the language.

So my advice is look at what politicians do, rather than what we say. That's where you get the true picture.

Look at what we've done with IAPT.

- Mentioned in both party manifestos and in the final Coalition Programme;

- £70 million announced within weeks of the new Government to continue roll-out;

- Another clear commitment made in the Chancellor's Spending Review;

- This speech from me today outlining the detail and making a number of firm commitments;

- And in the mental health strategy, we will make the funding available to deliver these IAPT commitments.

Be in no doubt. The momentum and the political will is there. This is a deep commitment - for me, for my party, and for the Government.

And the importance I attach to psychological therapies will be made clear in the NHS Operating Framework when it's published in a few weeks time.


I know many are concerned psychological therapy is vulnerable in these tighter times.

And that concern is understandable.

Mental health services have had a tendency to be 'last in and first out' in the NHS of the past.

But not this time. The policy landscape is completely changed. And changed, I believe, in your favour.

Firstly, the shift from targets to outcomes will give mental health a new prominence in how the NHS is judged.

The new Outcomes Framework will paint a picture of what good care looks like.

In terms of patient experience. In terms of hard results. In terms of quality. But absolutely not in terms of process targets.

To give you a simple example. Under an outcomes model, the NHS isn't tested on the speed at which you get your knee operation.

It's tested on how quickly you get back on your feet. How quickly you're pain-free. How quickly you can return to work. Real measures that matter to people.

And that broader outlook opens the door, it means that people's mental health cannot be ignored if you want to secure the right outcomes. A very clear signal to commissioners.

The second thing we're developing is a new tariff for talking therapies linked directly to the Outcomes Framework and ensuring providers are paid according to the contributions they make to those outcomes.

This will give commissioning teams a clear rationale for investing in psychological therapies.

Helping them to make sense of how these services contribute to better outcomes across the populations they support.


It's hard to break old habits. Commissioners, like everyone else, tend to stick to what they know best.

Some really 'get' it, really understand psychological therapies and the difference you can make. I think you'll hear from a GP immediately after me, who fits that description.

Others need persuading. And that's partly up to you. To start having conversations.

To understand the agendas and processes of emerging consortia.

To start building a compelling case for why investing in psychological therapies is worthwhile.

Don't sit back and wait. Because the policy landscape is changing in another very significant sense.

Power is shifting. Moving away from the centre. With less prescription. Less command and control. More decisions taken locally. More flexibility for NHS leaders and their local government partners to run the show.

Now you could see this as a threat - that without central protection, you won't get a look in during local decision-making.

But I'd sound a warning to the pessimists. The big danger if we allow this gloominess to take root is that it becomes a self-fulfilling prophecy.

We need strong, active, positive leadership.

Not just from the centre, and not just in terms of politicians like me making speeches.

But at all levels, in every part of the country, putting forward the case for psychological therapies.


Evidence is the ace up your sleeves.

Session-by-session outcome monitoring, in place across 90% of all patients, gives us a formidable picture of how these therapies improve a person's recovery.

We need to make sure this is understood and heard by commissioners. Particularly in the context of QIPP. And particularly in the context of Joint Strategic Needs Assessment.

You can make an extremely strong case for why investing in therapies now can save costs down the line. Costs to acute care. And costs to social care and other public services.

So my message is this. Don't simply wait for me to make that case, or for officials in Whitehall to come up with a new guidance or directives.

That simply isn't the world we live in now.

It's up to you, tapping into organisations like the New Savoy Partnership and others, to get the message across.


And if we really want to open people up to talking therapies, then talking therapies themselves need to open up to people.

Greater transparency for patients and professionals.

Better information on what to expect from services and what to expect from different treatment options.

More meaningful data on the strengths and weaknesses of different providers

So, finally, we will publish the outcomes that different services have achieved.

We want to create a new ratings system for IAPT that allows people to compare local success rates.


Let me sum up before I hand over to you.

It's human nature to be suspicious of change. I know many people are worried about the future.

But you have a clear and strong track record of success.

And so you should have good reason to be confident.

I've said very clear today. We want to build a mentally healthy society.

This commitment starts in Number 10, and reaches across and beyond Government, as you'll see in the mental health strategy.

You're a central part of that commitment.

We believe in IAPT. We believe in life after IAPT.

We trust in you. In your integrity. And in the work you do.

There is much to be optimistic about.

So be confident. Be positive. Embrace the NHS reforms. Embrace these plans for IAPT.

And together we can make it all happen.

Better services. More choice. Less stigma. Greater hope for the many affected by mental illness in our society. Thank you.