What is this about?
PCT Commissioners for Derbyshire have put forward proposals for Psychological Therapy Services which would lead to the de-commissioning of the NHS Frontline Psychodynamic Psychotherapy Service and the Psychodynamic Group Therapy Programme within the Derbyshire Healthcare Foundation Trust (DHFT). The consultation on these proposals will close on 30th October 2011.
There is great concern about the damaging impact these proposals would have on patient care if accepted.
There is great concern that the proposal document is flawed. It is not written in a way that is accessible and informative for service users, their families and the general public. It misrepresents the case for these proposals and misrepresents what would be the outcome of these proposals if they were accepted.
There is great concern the consultation is not being conducted in an open and inclusive way that allows people to know it is happening and informs them how they can make their contribution.
Who will be affected by these proposals?
The Psychodynamic Psychotherapy Service treats vulnerable adults profoundly affected by histories of physical and sexual abuse, trauma and neglect, often with lifelong histories of mental ill-health, self-harm and multiple use of services. Psychotherapy can help treat their distress and move them towards recovery. Therapists know through feedback from service users how highly they value the service. Many of them move out of the mental health system following treatment. As such the Service is very cost-effective. If these proposals were to be accepted there are serious consequences and concerns:
● The existing Psychodynamic Psychotherapy Service as a whole will be lost.
● Over 330 vulnerable adults may be faced with a premature end to their therapies. These are people who have been assessed as needing longer term Psychodynamic Psychotherapy which therapists, on behalf of the Trust, have already contracted with them to provide.
● The care of service users may be compromised. Proposals need to allow for adequate time for closure of therapies and for alternative arrangements to be made. To date the messages about this have been so worrying to staff that they have regarded the process as clinically unsafe and they have raised their concerns formally with Mike Shewan, Chief Executive of the DHFT, under the Raising Concerns at Work (“Whistleblowing”) Policy.
● Choice will be removed. Service users need the opportunity to be matched to the therapy best suited to their needs as this is a crucial factor in the successful outcome of a therapy. Future service users will not have this option for treatment.
In the proposal document there is no admission these proposals would lead to a huge cut in available therapy with an entire therapy service being de-commissioned and spell an end to the availability of longer term Psychotherapy in the Trust. It is not at all about “developing a more cohesive mode of delivery” and one that is “equitable across Derby County and Derby City” as the document suggests. There are no plans to invest any savings made through these planned cuts in therapy services in the north of the County. In these ways the document grossly misleads the reader.
What is the demand for this service?
Demand for Psychodynamic Psychotherapy is very high such that the Service is only able to see a limited proportion of the referrals currently made to it. In order not to build long waiting lists a system of prioritisation of referrals of service users has been implemented with the result that many people whose needs are fully appropriate to the role of the Service have regularly to be turned away. Unmet need is enormous and growing.
If the service is cut then surely there are others who can see them?
The Trust’s Mental Health Services are already overstretched and there is no spare capacity within the Trust teams to absorb this number of service users with these kinds of difficulties and provide the kind of therapy they need which has already been assessed as Psychodynamic Psychotherapy. There is nowhere else for these service users to go for the type of therapy they require.
The Service has thirty years of experience of providing Psychodynamic Psychotherapy in the Trust and there are a number of service users who may already have had alternative treatments and therapies for whom Psychodynamic Psychotherapy is the only realistic and appropriate option for their care and treatment.
The therapists who staff this service are experienced mental health professionals who have undertaken further specialist training over a four year period in order to become qualified Psychodynamic Psychotherapists. They have a proven record of high quality practice. Their work has a robust research evidence base, contrary to what is said in the proposal document. These proposals would lead to a terrible waste of their professional capacity, their many years of experience of this work and of their evident ability to help service users. Once dismantled the Service would take many years to rebuild given the training required.
Were these proposals developed through good consultation?
No. The list of those not consulted in the development of these proposals is long.
Within the Trust, why were Trust Governors, Psychotherapists, Psychiatrists, Pathfinder Teams, Recovery Teams, Crisis Teams, Substance Abuse Teams and above all patients not consulted? Beyond the Trust why were Local Councillors, MPs, GPs, Service Users, Stakeholder Charities and the wider public in general not consulted?
These proposals and the initial attempt to rush them through show that the Commissioners do not understand the service they are intending to de-commission and the vital place it has within an NHS Mental Health Service. They do not understand the needs of the vulnerable adults who engage in long term NHS Psychodynamic Psychotherapy.
Proposals do not have to be created in this way on the basis of totally inadequate understanding and consultation and without the advice being sought of those front line clinicians who actually do the job on the ground and have daily to live with clinical realities, and without the voice of those service users directly affected by the change.
Why is a there a consultation now?
The PCT Commissioners have been forced to hold this consultation contrary to their wishes.
Initially these plans to de-commission the service were put into immediate effect. Staff were called to a meeting on 20th July 2011 where they were formally put at risk and given 90 day notice of redundancy. They were led to believe that all Psychodynamic Psychotherapies would need to come to an end by 20th October 2011. It was clear that these ‘proposals’ were in fact plans already being put into operation on the ground.
However the Derby City Council Overview and Scrutiny Committee met to consider these ‘proposals’ with the PCT Commissioners on 25th July 2011. UNITE, the Staffs Trade Union, was able to make a presentation to the Committee. The committee voiced their deep concern about the lack of an evident and clear consultation process and made two recommendations:
1. That the decommissioning of Psychodynamic Psychotherapy be immediately halted.
2. That the PCT Commissioners engage in a three months consultation with all relevant stakeholders to inform their decision making adequately.
As a result of the Committee’s pressure we now have a consultation process……..but you might be forgiven for wondering where it is and how to make a contribution as little or no information has been made available to date.
The proposal document can be found on the website : www.derbyshirecounty.nhs.uk and click on Tier 4 Psychological Therapies.
So what can I do?
Contact the Lead PCT Commissioner asking for a full and open process of consultation with all relevant stakeholders. Ask him to specify exactly what form a consultation would take and how staff, service users and the public will be able to contribute their views. The PCT Commissioner to contact is David Gardner, Head of Mental Health Procurement and Commissioning, Park Hill, Hilton Road, Egginton, Derbyshire. DE65 6GU. Telephone 01283 731321. E mail: david.gardner@derbyshirecountypct.nhs.uk
Contact your MP and your local councillor.
Contact the Chief Executive of Derbyshire Healthcare Foundation Trust, Mike Shewan at Trust Headquarters, Bramble House, Kingsway Site, Derby. DE22 3LZ. Tel: 01332 623700.
Contact the Chair of the Derby City Council Overview and Scrutiny Committee, Councillor Fareed Hussain to share your concern at: 44 Breedon Hill Road, Derby. DE23 6TG. Tel: 01332 296134.
The Overview and Scrutiny Committee meet again on 5th September 2011 and members of the public are able to attend.
