ADULTS
HEALTH AND HOUSING COMMISSION
31 October 2011
31 October 2011
Derby City Council
Report of
the Adults Health and Housing Commission
ITEM 10
Review of
proposals to reconfigure Psychodynamic Psychotherapy Services
RECOMMENDATION
1.1 After
having considered the evidence on the proposals for reconfiguration of
psychodynamic psychotherapy services in Derby and Derbyshire the
Commission recommends:
psychodynamic psychotherapy services in Derby and Derbyshire the
Commission recommends:
1. The
Trust retains psychodynamic psychotherapy services as part of a
balanced treatment service.
balanced treatment service.
2. That
access to psychodynamic psychotherapy services is made fair and
equitable across Derby and Derbyshire.
equitable across Derby and Derbyshire.
3. That
the Trust should seek to equalise rather than reduce the level and
quality of service provision in Derby and Derbyshire.
quality of service provision in Derby and Derbyshire.
SUPPORTING
INFORMATION
2.1
Derbyshire County PCT cluster completed and submitted an NHS Service
Reconfiguration Consultation document to the July meeting of this commission
which proposed initially reducing and ultimately withdrawing psychodynamic
psychotherapy services. The PCT had intended to conduct a two month
consultation however the Commission felt this was too short especially falling
during summer holiday period when many people are likely to be away. The
Commission therefore recommended extending this to three months for all
relevant stakeholders.
Reconfiguration Consultation document to the July meeting of this commission
which proposed initially reducing and ultimately withdrawing psychodynamic
psychotherapy services. The PCT had intended to conduct a two month
consultation however the Commission felt this was too short especially falling
during summer holiday period when many people are likely to be away. The
Commission therefore recommended extending this to three months for all
relevant stakeholders.
2.2 At
the July meeting the Commission also agreed to gather independent
evidence on psychotherapy services which would be submitted to the PCT to
assist them with their decisions on psychodynamic psychotherapy services.
This was collected from the following individuals and organisations:
evidence on psychotherapy services which would be submitted to the PCT to
assist them with their decisions on psychodynamic psychotherapy services.
This was collected from the following individuals and organisations:
· Derbyshire County PCT cluster
· Professor Diane Waller, OBE
· Unite Union
· Derbyshire Voice
· Service User
· NICE
2.3 The
Commission has considered the evidence and gives its recommendations
to the PCT.
to the PCT.
For more
information contact:
Background papers:
List of appendices:
Mahroof Hussain 01332 643647 e-mail Mahroof.hussain@derby.gov.uk
None
Background papers:
List of appendices:
Mahroof Hussain 01332 643647 e-mail Mahroof.hussain@derby.gov.uk
None
Appendix
1 – Implications
Appendix
2 – Report
Appendix
1
IMPLICATIONS
Financial
and Value for Money
1.1 None
arising directly from this report.
Legal
2.1 The
Health and Social Care Act 2001 gives health scrutiny committees powers
to review any matter relating to the planning, provision and operation of health
services.
to review any matter relating to the planning, provision and operation of health
services.
Personnel
3.1 None
arising directly from this report for Derby city Council. However, the
changes proposed by the PCT Cluster could affect staff employed by Derbyshire Healthcare NHS Foundation Trust delivering Psychodynamic Psychotherapy Services.
changes proposed by the PCT Cluster could affect staff employed by Derbyshire Healthcare NHS Foundation Trust delivering Psychodynamic Psychotherapy Services.
Equalities
Impact
4.1
Effective scrutiny benefits all Derby people.
Health
and Safety
5.1 None
arising directly from this report.
Environmental
Sustainability
6.1 None
arising directly from this report.
Asset
Management
7.1 None
arising directly from this report.
Risk
Management
8.1 None
arising directly from this report.
Corporate objectives and priorities for change
Corporate objectives and priorities for change
9.1 Our
aim is to work together so that all people in Derby will enjoy Good health
and well-being.
and well-being.
Review of
proposals to reconfigure Psychodynamic Psychotherapy Services
Introduction
1.
Derbyshire County PCT submitted a service reconfiguration document to the
July meeting of the Adults, Health and Housing Commission on their proposals
to reconfigure of psychodynamic psychotherapy services. The proposals
involved initially reducing and eventually phasing out psychodynamic
psychotherapy services whilst proposing an increase in Cognitive Behaviour
Therapy (CBT) and Dialectical Behaviour Therapy (DBT) to „reflect lack of
clinical evidence‟ for a range of conditions. The Commission was informed that
the specialist psychotherapy services were only available in Derby and South of
the County area and the Trust plans to make them equitably available to the
entire city and county area. It was stated that these proposals had been fully
scrutinised and agreed by the PCT Trust Board as part of the Quality,
Innovation, Productivity and Prevention (QIPP) programme.
July meeting of the Adults, Health and Housing Commission on their proposals
to reconfigure of psychodynamic psychotherapy services. The proposals
involved initially reducing and eventually phasing out psychodynamic
psychotherapy services whilst proposing an increase in Cognitive Behaviour
Therapy (CBT) and Dialectical Behaviour Therapy (DBT) to „reflect lack of
clinical evidence‟ for a range of conditions. The Commission was informed that
the specialist psychotherapy services were only available in Derby and South of
the County area and the Trust plans to make them equitably available to the
entire city and county area. It was stated that these proposals had been fully
scrutinised and agreed by the PCT Trust Board as part of the Quality,
Innovation, Productivity and Prevention (QIPP) programme.
2. The
consultation document stated that there would be redundancies although
the final numbers were not known. The Mental Health trust was conducting
workforce analysis to establish which staff could be retained in specific evidence
based therapies. It was also stated that the PCT had consulted with each
clinical lead for the consortium, Derbyshire MH Commissioning Group and had
informed GP‟s at a QIPP meeting. The PCT was planning further consultation
with clinicians and informing service users to give them an opportunity to
provide feedback.
the final numbers were not known. The Mental Health trust was conducting
workforce analysis to establish which staff could be retained in specific evidence
based therapies. It was also stated that the PCT had consulted with each
clinical lead for the consortium, Derbyshire MH Commissioning Group and had
informed GP‟s at a QIPP meeting. The PCT was planning further consultation
with clinicians and informing service users to give them an opportunity to
provide feedback.
3. The
Commission invited the PCT to the July meeting to present their proposals.
Following detailed discussions the Commission made the following
recommendations to the PCT:
Following detailed discussions the Commission made the following
recommendations to the PCT:
· All stakeholders should be
properly consulted and their views taken into
account during reconfiguration of the service
account during reconfiguration of the service
· The current process for
decommissioning is halted and decommissioning
should not proceed until responses from consultation have been received
and evaluated
should not proceed until responses from consultation have been received
and evaluated
· The PCT should undertake a
proper three month consultation process
rather than the proposed two months as this is a substantial
reconfiguration of a service and the consultation is scheduled to take
place when many people are likely to be away on summer holiday.
rather than the proposed two months as this is a substantial
reconfiguration of a service and the consultation is scheduled to take
place when many people are likely to be away on summer holiday.
4. At the
July meeting, the Commission also resolved to look at independent
evidence on psychodynamic psychotherapy services in conjunction with
Derbyshire County Council‟s overview and scrutiny committee before submitting
a response on the proposals.
evidence on psychodynamic psychotherapy services in conjunction with
Derbyshire County Council‟s overview and scrutiny committee before submitting
a response on the proposals.
5. The
Commission has sought and received evidence from a range of individuals
and organisations including professor Diane Waller OBE an eminent
psychologist; Derbyshire Voice, a local voluntary sector organisation supporting
service users; Unite Union; a service user; the National Institute of Clinical
Excellence (NICE) Field Team on the interpretation of evidence produced by
NICE on psychodynamic psychotherapy services. The Commission also heard
from a team of officers from Derbyshire County PCT about the service
specification and their consultation process. Evidence has also been submitted
by a clinician.
and organisations including professor Diane Waller OBE an eminent
psychologist; Derbyshire Voice, a local voluntary sector organisation supporting
service users; Unite Union; a service user; the National Institute of Clinical
Excellence (NICE) Field Team on the interpretation of evidence produced by
NICE on psychodynamic psychotherapy services. The Commission also heard
from a team of officers from Derbyshire County PCT about the service
specification and their consultation process. Evidence has also been submitted
by a clinician.
Summary
of Evidence
Derbyshire
County PCT
6. The
Derbyshire County PCT submitted two service reconfiguration documents
to the July meeting of the Adults, Health and Housing Commission on
reconfiguration of psychodynamic psychotherapy services. The PCT has also
subsequently published a service specification on their website. It has
recognised the need to retain some psychodynamic psychotherapy services.
to the July meeting of the Adults, Health and Housing Commission on
reconfiguration of psychodynamic psychotherapy services. The PCT has also
subsequently published a service specification on their website. It has
recognised the need to retain some psychodynamic psychotherapy services.
7. The
PCT has acted on the Commission‟s recommendations and extended its
consultation from two months to three ending on 31 October 2011.
consultation from two months to three ending on 31 October 2011.
Professor
Dianne Waller OBE
8.
Written evidence to the Commission was provided by Professor Diane Waller
OBE who is a former member of steering groups working with National Institute
for Mental Health (NIMH) and DoH on the IAPT project.
OBE who is a former member of steering groups working with National Institute
for Mental Health (NIMH) and DoH on the IAPT project.
9.
Professor Waller states that she supports the PCT‟s desire to improve access to
psychological therapies across the county. Although some therapies do lend
themselves more easily to the kind of research evidence on cognitive based
psychotherapies, NICE is clear that its guidance cannot provide the full picture
across the range of patient groups at any one time.
psychological therapies across the county. Although some therapies do lend
themselves more easily to the kind of research evidence on cognitive based
psychotherapies, NICE is clear that its guidance cannot provide the full picture
across the range of patient groups at any one time.
10. There
is a large amount of evidence to support the inclusion of psychodynamic
psychotherapy as an effective therapy for a range of patient groups. However it
is often a matter of luck as to whether patients can access a psychological
therapy, let alone have a choice. With IAPT current provision, CBT has tended
to be much more widely available than before.
psychotherapy as an effective therapy for a range of patient groups. However it
is often a matter of luck as to whether patients can access a psychological
therapy, let alone have a choice. With IAPT current provision, CBT has tended
to be much more widely available than before.
11. There
is evidence for psychodynamic psychotherapy but this is not helped by
insufficient engagement due to small size of their teams by psychodynamic
psychotherapy clinicians with academics to build evidence base of their
modality.
insufficient engagement due to small size of their teams by psychodynamic
psychotherapy clinicians with academics to build evidence base of their
modality.
12.
Combined with the need for a relatively long period (in NHS terms) of therapy,
and perhaps less obvious „results‟ than with CBT, it is not surprising that
psychodynamic psychotherapy can be perceived as not only insufficiently
evidence based but also „too expensive‟ for the NHS. However, for some
patients it is the only approach that can work and the only approach that can work
and perhaps less obvious „results‟ than with CBT, it is not surprising that
psychodynamic psychotherapy can be perceived as not only insufficiently
evidence based but also „too expensive‟ for the NHS. However, for some
patients it is the only approach that can work and the only approach that can work
and the long term results are in many cases more durable (ie prevent frequent re-admissions).
13.
Professor Waller urges the PCT to revisit the suggestion to diminish the
psychodynamic psychotherapy service and instead retain current provision.
Professor Waller asks the PCT to engage actively with other clinicians and
researchers to augment this literature through projects that can be quite small
yet well-thought through.
psychodynamic psychotherapy service and instead retain current provision.
Professor Waller asks the PCT to engage actively with other clinicians and
researchers to augment this literature through projects that can be quite small
yet well-thought through.
A Service
User’s perspective
14. A
service users had been invited to give evidence to the Commission. The
Commission accepted her wish to remain anonymous. She stated that for years
prior to accessing therapy she was extremely ill. She was unable to work,
unable to look after herself and was entirely dysfunctional. She was unable to
cope with anything but the very simplest of tasks. She lived in a state of
perpetual fear, answering the telephone or the door was often too much for her.
She said she couldn‟t face people, was mostly housebound and hated her life.
She made numerous active attempts at suicide over the years and regularly
presented in a state of crisis at front-line services.
Commission accepted her wish to remain anonymous. She stated that for years
prior to accessing therapy she was extremely ill. She was unable to work,
unable to look after herself and was entirely dysfunctional. She was unable to
cope with anything but the very simplest of tasks. She lived in a state of
perpetual fear, answering the telephone or the door was often too much for her.
She said she couldn‟t face people, was mostly housebound and hated her life.
She made numerous active attempts at suicide over the years and regularly
presented in a state of crisis at front-line services.
15. She
stated that given the nature of her problem, psychoactive medications were
ineffectual for her. She had many attempts at Cognitive Behavioural Therapy
(CBT) over the years and beyond tackling some of her simpler problems, her
phobias, it was not successful for her. She received Dialectic Behavioural
Therapy (DBT) from a Psychologist in Derby which was useful as a stop-gap
measure to stabilise her enough to handle the long term psychodynamic
psychotherapy.
ineffectual for her. She had many attempts at Cognitive Behavioural Therapy
(CBT) over the years and beyond tackling some of her simpler problems, her
phobias, it was not successful for her. She received Dialectic Behavioural
Therapy (DBT) from a Psychologist in Derby which was useful as a stop-gap
measure to stabilise her enough to handle the long term psychodynamic
psychotherapy.
16. She
had been turned down for psychodynamic psychotherapy on many
occasions, even though all professionals directly involved in her case were clear
that her need for such a service was great and that she was suitable. It took her
four years and considerable pushing and assistance from outside organisations
to finally access the therapy.
occasions, even though all professionals directly involved in her case were clear
that her need for such a service was great and that she was suitable. It took her
four years and considerable pushing and assistance from outside organisations
to finally access the therapy.
17. She
understood that access to long-term psychodynamic psychotherapy in
Derby is already exceptionally limited with very few of those who require it and
are deemed suitable for such therapy receive it. CBT and DBT have their role in
the treatment process, however they are not a complete substitute for long-term
Psychodynamic work, which was clearly effective in her case and in many
others.
Derby is already exceptionally limited with very few of those who require it and
are deemed suitable for such therapy receive it. CBT and DBT have their role in
the treatment process, however they are not a complete substitute for long-term
Psychodynamic work, which was clearly effective in her case and in many
others.
18. The
service users said she had many concerns about the consultation process,
from a service user‟s perspective. For most people ill enough to need therapy,
simply putting pen to paper, sending an e-mail, or making a telephone call, is
naturally going to be too much let alone attending emotive public consultations
meetings.
from a service user‟s perspective. For most people ill enough to need therapy,
simply putting pen to paper, sending an e-mail, or making a telephone call, is
naturally going to be too much let alone attending emotive public consultations
meetings.
Derbyshire
Voice
19.
Catherine Ingram, Chief Executive of Derbyshire Voice presented evidence on
behalf of Derbyshire Voice. This organisation supports users and receivers of
mental health services to be involved in the commissioning and development of
services.
behalf of Derbyshire Voice. This organisation supports users and receivers of
mental health services to be involved in the commissioning and development of
services.
20. Ms
Ingram clarified that Derbyshire Voice did not support the proposals for
reconfiguration as presented by the PCT to Overview and Scrutiny in July and
this error had now been corrected.
reconfiguration as presented by the PCT to Overview and Scrutiny in July and
this error had now been corrected.
21. Ms
Ingram provided an interim report and stated that as of the 5th of October
2011:
37 people
have made written submissions
24 people have telephoned
46 people have talked to us face to face
24 people have telephoned
46 people have talked to us face to face
22. The
respondents are both past and present users of the service and participants
in both individual and group therapy. A number of people have been assessed
as needing therapy and are on the waiting list. Two respondents were from the
North of Derbyshire and currently unable to access psychodynamic
psychotherapy.
in both individual and group therapy. A number of people have been assessed
as needing therapy and are on the waiting list. Two respondents were from the
North of Derbyshire and currently unable to access psychodynamic
psychotherapy.
23. Every
contributor to the consultation has made positive comments about the
psychodynamic psychotherapy service. Derbyshire Voice had not received a
single criticism or concern and in the context of mental health
treatments/services which is highly unusual. People felt it important to
communicate about the benefits they felt from receiving psychodynamic
psychotherapy.
psychodynamic psychotherapy service. Derbyshire Voice had not received a
single criticism or concern and in the context of mental health
treatments/services which is highly unusual. People felt it important to
communicate about the benefits they felt from receiving psychodynamic
psychotherapy.
24. Ms
Ingram stated that many people mentioned that they believed
psychodynamic psychotherapy was a more positive and long-term intervention
than their time spent without liberty on psychiatric wards or than taking
psychiatric drugs with their negative side effects. A very significant number of
people told us that they believed that the therapy they had received had
prevented them from committing suicide or from hurting themselves. A number
also mentioned that they had also been able to control and not act on their
feelings of hurting others. A common comment in written submissions was
“Without this therapy I would not be writing this now”
psychodynamic psychotherapy was a more positive and long-term intervention
than their time spent without liberty on psychiatric wards or than taking
psychiatric drugs with their negative side effects. A very significant number of
people told us that they believed that the therapy they had received had
prevented them from committing suicide or from hurting themselves. A number
also mentioned that they had also been able to control and not act on their
feelings of hurting others. A common comment in written submissions was
“Without this therapy I would not be writing this now”
25.
People stated that it had taken them a considerable number of years to access
the service and felt that time and money were wasted on other interventions.
CBT and DBT (which are the therapies mentioned in the new service
specification) were both mentioned as other interventions that people had
previously tried but that had not been successful.
the service and felt that time and money were wasted on other interventions.
CBT and DBT (which are the therapies mentioned in the new service
specification) were both mentioned as other interventions that people had
previously tried but that had not been successful.
26.
People strongly believe that the loss or reduction of the service would be
hugely
detrimental to themselves and other potential service users in the future. They
consistently said;
detrimental to themselves and other potential service users in the future. They
consistently said;
· We should have a choice of
therapy
· To end it would be a
betrayal/catastrophic/illegal/dangerous
· Withdrawing any of this service
will further damage already damaged people
· Psychodynamic psychotherapy will
not always be effective if its is only short
term as some people need more than 40 sessions
term as some people need more than 40 sessions
· It takes a long time to develop
trust with a therapist, particularly if the patient
has been abused and a short-term intervention will not allow this to happen
has been abused and a short-term intervention will not allow this to happen
· The NICE guidelines that inform
this proposal are invalid and medication
biased
biased
· Local services should be
designed for local people and should not pander to
badly researched national guidelines
badly researched national guidelines
· If changes are to be made there
should be more of this service not less.
27. There
were many people who were no longer receiving said they wanted to fight
for other service users to have the right to get the help that they had received
because of the significant change it had made in their lives.
for other service users to have the right to get the help that they had received
because of the significant change it had made in their lives.
28.
People felt very angry that despite the Government saying that NHS funding
would not be cut it was apparent this was happening to a service they received
and highly valued. Many wanted to stress that they believed saving money on
psychodynamic psychotherapy was a false economy because long term it could
cost the NHS more in expensive drugs and hospital stays than the therapy
would. Others went further to mention that therapy kept them in work and
supporting their families and the affect of them not being able to contribute
financially would obviously have wider economic effects, as they would need to
depend on other services.
would not be cut it was apparent this was happening to a service they received
and highly valued. Many wanted to stress that they believed saving money on
psychodynamic psychotherapy was a false economy because long term it could
cost the NHS more in expensive drugs and hospital stays than the therapy
would. Others went further to mention that therapy kept them in work and
supporting their families and the affect of them not being able to contribute
financially would obviously have wider economic effects, as they would need to
depend on other services.
29. Many
people who had received them were critical of other forms of therapy such
as CBT and DBT and told us that these were no help or were only of use when
used with a psychodynamic approach. People were also concerned that other
therapy services would be put under pressure due to them having to pick up
cases that would previously have been treated within psychodynamic
psychotherapy.
as CBT and DBT and told us that these were no help or were only of use when
used with a psychodynamic approach. People were also concerned that other
therapy services would be put under pressure due to them having to pick up
cases that would previously have been treated within psychodynamic
psychotherapy.
30. A few
patients who have knowledge of diversity and equality issues noted that
an equalities impact assessment has not been carried out on the proposals.
an equalities impact assessment has not been carried out on the proposals.
31. On
Consultation many patients told Derbyshire Voice that they do not
understand the proposals. The format and language of the papers are not clear
or accessible. The PCT were informed of this and at their request produced a
paper on understanding the proposals but this has not greatly assisted people.
understand the proposals. The format and language of the papers are not clear
or accessible. The PCT were informed of this and at their request produced a
paper on understanding the proposals but this has not greatly assisted people.
32. There
was strong feeling that promises of keeping people informed have not
been kept by the NHS. We are told that people have made complaints about
this but have either received dismissive responses or that their complaints have
not even been acknowledged. Many people felt that there had not been enough
communication with people and that they had relied on Derbyshire Voice and
fliers we had left in waiting rooms rather than receiving direct communication
from the NHS. The availability of information has been described as “luck” or a
“lottery”.
been kept by the NHS. We are told that people have made complaints about
this but have either received dismissive responses or that their complaints have
not even been acknowledged. Many people felt that there had not been enough
communication with people and that they had relied on Derbyshire Voice and
fliers we had left in waiting rooms rather than receiving direct communication
from the NHS. The availability of information has been described as “luck” or a
“lottery”.
33. Some of the more vulnerable people were not able to write, call or attend
meetings and that they didn‟t believe any consideration had been given to these
people.
34. Concerns were raised about an online questionnaire that is written in jargon and
that not one person has claimed to understand. This has been fed back to the
PCT.
35. There was significant concern that two public consultation events were
cancelled due to lack of numbers. People tell us they could not book places, as
they did not know the events were being held.
36. Many people have appreciated meeting up, attending the consultation event
hosted by the PCT and being able to write their testimony. However there is an
overwhelming feeling that decisions have already been made and that patients
views will not be heard. Although the PCT have provided answers to questions,
many people who attended the last consultation event stated that they felt their
questions were evaded.
37. Ms Ingram stated that people wanted her to tell the Commission that their
therapy had already been damaged and cut because they were spending much
of their therapy time talking about therapy stopping rather than doing the work
they should be.
Unite
Union
38. A detailed response has been received from Unite Union including this
summary. Unite states that the draft Service Specification fails to provide a
context within which to understand what is being proposed. It does not make
clear which clinical services are included and what the implications are for
service users.
39. The opportunity has been missed for a review of the whole range of
psychological therapies within Adult Mental Health services in Derbyshire, and
the Specialist Psychodynamic Psychotherapy service appears to have been
singled out to bear the brunt of the need for savings in the general mental health
budget.
40. Commissioners did not consult with clinicians to ensure they understood the
needs and vulnerability of service users currently engaged in Psychodynamic
Psychotherapy, and the adverse effect the proposals would have on them.
41. The draft Service Specification was developed without necessary dialogue with
all relevant stakeholders, and this has serious consequences for the clinical
viability of the proposals.
42. Through these proposals, the choice of therapy for service users will be
restricted to cognitive and behavioural approaches. Commissioners do not
appear to have appreciated the important part that service user choice is known
to play in the success or failure of a therapy.
43. The proposal to de-commission the Psychodynamic Psychotherapy Service is
based on a flawed analysis of the evidence base as, contrary to the assertion of
Commissioners, there is clear and objective evidence in support of
psychodynamic psychotherapy for the treatment of severe and complex
disorders. Furthermore, Department of Health guidance repeatedly asserts that
clinically indicated psychodynamic psychotherapies of appropriate length should
be provided as part of Specialist Mental Health Service provision.
44. Either there has been an exclusion of step 5 service users from this proposal or
a relegation of their clinical needs to step 4 levels of treatment. The struggle to
appreciate the severity and complexity of difficulties, and the intensity of highly
skilled treatment required is evident throughout the draft Service Specification
document.
45. At a time when there is increased funding available through the Improving
Access to Psychological Therapies (IAPT) programme for those with mild to
moderate difficulties, an appreciation of the needs of those in greatest difficulty
has become lost and they appear to have become a lesser priority.
46. The failure to recognise the costs of these proposals to service users, their
families and wider society, as well as the provision of mental healthcare in
Derbyshire is a major omission.
Conclusion
47. The Commission received evidence from a range of organisations and
individuals on the PCTs proposals to reconfigure psychodynamic psychotherapy
services. The key message from service users, staff and unions is that there
has been a high degree of confusion over the consultation process which could
have been avoided had the PCT been clear from the start about its intentions
and what it wanted to achieve. The initial documents presented to the
Commission and subsequent the confirmation through email stated that the PCT
had already taken a decision to phase out psychodynamic psychotherapy
services. It also expected the provider Trusts to reassess individuals on whether
they should be receiving psychodynamic psychotherapy services. A direct
consequence of this approach was that the provider trust began issuing
redundancy notices to its staff. This was prior to the start of the consultation
from 1 August.
48. Evidence considered by the Commission provides a strong case supporting
continuation of psychodynamic psychotherapy services. However, the Scrutiny
Commission does not feel it should dictate the level of psychological therapy
services over other types of provision such as CBT to be commissioned by the
PCT.
49. The Commission does not feel it is in apposition to favour the level of provision
of psychological therapy services over other types of provision such as CBT.
There is evidence that both are effective for certain conditions and both need to
be retained to provide patient choice.
50. The Commission was also very concerned that service changes had already
begun to be implemented by the provider trust before proper consultation had
been started let alone be completed. This should not have happened. This
approach has caused anxiety and stress for service users as well as staff and
could have been avoided.
51. The
Commission is not qualified to make recommendations about the level of
Psychodynamic Psychotherapy Services to be in the city. However, it is
important for patients that require this service to be able to access it. The
Commission heard that the reason there was no demand in the North of the
County was because it was not commissioned in the north and therefore there
would be no referrals.
Psychodynamic Psychotherapy Services to be in the city. However, it is
important for patients that require this service to be able to access it. The
Commission heard that the reason there was no demand in the North of the
County was because it was not commissioned in the north and therefore there
would be no referrals.
Recommendations
52. The
Commission was concerned that this is the second time reconfiguration of a
psychological therapy services has been carried out without following proper
procedures. This is unacceptable. It has caused anxiety and stress for service
users as well as staff which could have been avoided. The Commission
recommends that the PCT follows proper procedures and consults its
stakeholders during any substantial reconfiguration of its services.
psychological therapy services has been carried out without following proper
procedures. This is unacceptable. It has caused anxiety and stress for service
users as well as staff which could have been avoided. The Commission
recommends that the PCT follows proper procedures and consults its
stakeholders during any substantial reconfiguration of its services.
53. After
having considered the evidence on the proposals for reconfiguration of
psychodynamic psychotherapy services in Derby and Derbyshire the
Commission recommends:
psychodynamic psychotherapy services in Derby and Derbyshire the
Commission recommends:
1. The
Trust retains psychodynamic psychotherapy services as part of a
balanced treatment service.
balanced treatment service.
2. That access to psychodynamic psychotherapy services is made fair and
equitable across Derby and Derbyshire.
3. That the Trust should seek to equalise rather than reduce the level and
quality of service provision in Derby and Derbyshire.
