Changes to psychotherapy services – Letter to Stuart BellPosted: February 29, 2012
PSYCHOTHERAPY SERVICES AT SOUTH LONDON & MAUDSLEY NHS FOUNDATION TRUST
This letter is sent jointly from the United Kingdom Council for Psychotherapy (UKCP) and the British Psychoanalytic Council (BPC). Please enter it into the consultation you are carrying out.
These organisations are the two leading national voluntary regulators in the field of psychotherapy and both organisations have members working in South London & Maudsley NHS Foundation Trust Psychotherapy Services. We are gravely concerned about the Trust’s proposals to restructure its psychotherapy services, and associated staff redundancies, which will lead to the effective closure of both the Maudsley Psychotherapy Service and the St Thomas Psychotherapy Service. The proposed changes would an irreparable loss to local mental health services, and would have serious consequences for the welfare of patients, both present and future.
We have four major concerns:
Firstly, the proposed “re-provision” and restructure of psychological therapies is a complete misnomer. The Trust’s recent internal consultation proposes to cut 81% adult psychotherapy posts and 57% of medical psychotherapy posts in Lambeth alone, placing 36 psychotherapist posts formally at risk. In particular, we note St Thomas psychotherapy service provides treatment to 300 patients every week through a well-established and clinically effective model of service delivery that is highly rated by service users. The service hosts over 70 honorary (i.e. unsalaried) psychotherapists, providing specialist psychotherapy training, clinical placements and professional development for experienced mental health professionals, up to and including consultant grade. Yet the proposed restructure will leave just 1.5 (whole time equivalent) posts in the service, undermining this well-established model of service provision which, it is suggested, will reduce psychotherapy treatment provision by around 80%.
Secondly, the Trust’s consultation process does not appear to have followed transparent and standard procedures of consultation and decision making. It is perplexing that the Trust’ consultation process has apparently been restricted to a small internal consultation carried out in an extraordinarily rushed period of just five weeks over the Christmas period – while many potential respondents were of course on leave. We are gravely concerned that service users whose present and future wellbeing this ‘restructure’ will mostly affect appear to have been excluded from the consultation process. (Indeed, we understand psychotherapists were explicitly asked not to inform their patients of the proposed restructure and this consultation). This lack of transparent consultation and decision-making falls significantly short of standards of public service.
Thirdly, such severe cuts to psychotherapy provision will have repercussions both to other clinical services within the Trust, and to the wider mental health field. As part of the unique Clinical Academic Group for mood, anxiety and personality, SLaM psychotherapy services has a wider involvement within King’s Health Partners Academic Health Science Centre, making a distinctive contribution to the AHSC’s purpose of delivering high quality health care, world-leading research, as well as teaching and education. The Trust’s psychotherapy services have a prestigious and international reputation for excellence in the field, and St Thomas’ is notably the international centre of Cognitive Analytic Therapy, an evidence-based therapy pioneered by Dr Anthony Ryle in the 1980s. Indeed, the psychotherapy services provide what we understand to be a highly-regarded contribution to the AHSC’s wider organisational purpose, especially in supporting therapeutic environments in challenging settings – through clinical supervision, reflective practice groups and team consultation. We are concerned that the proposed ‘restructure’ takes no account of such present and future contributions.
Fourthly, while the consultation proposes reductions across the whole Clinical Academic Group, we have serious concerns that the burden of cuts is intended to be borne by psychotherapy services. We note that just 6 clinical psychology posts have been placed at risk, yet cognitive-behavioural therapy (CBT) provision is dominant mode of psychological therapy (indeed, there appears to be a 6:1 ratio of clinical psychologists to psychotherapists across the Trust). Whilst CBT is clearly an important mode of therapy, we seriously question whether tipping the balance even further in this direction is actually based on patient choice and clinical need. The plans we have studied will undoubtedly lead to a lack of choice for patients, the maintenance of which is a key feature of one of Andrew Lansley’s ‘four steps’ consultation guidance. The provision of a choice of a range of psychological therapies is absolutely essential, and we can direct you to research demonstrating this to be the case.
To proceed with such ill-considered plans to effectively close these highly regarded psychotherapy services without proper and full consultation cannot conceivably be justified. We urge you to remedy this as a matter of urgency. NHS bodies have two separate legal duties to consult about the way that the NHS is operating and about proposed changes. The duties focus on consulting patients and the public, and consulting the local authority Overview and Scrutiny Committee.
Section 242(1B) of the National Health Service Act 2006 provides as follows:
“Each relevant English body must make arrangements, as respects health services for which it is responsible, which secure that users of those services, whether directly or through representatives, are involved (whether by being consulted or provided with information, or in other ways) in:
(a) the planning of the provision of those services,
(b) the development and consideration of proposals for changes in the way those services are provided, and
(c) decisions to be made by that body affecting the operation of those services.
Subsections (b) and (c) need only be observed if the proposals would have an impact on:
(a) the manner in which the services are delivered to users of those services; or
(b) the range of health services available to those users.”
Regulation 4 of the Local Authority (Overview and Scrutiny Committees Health Scrutiny Functions) Regulations 2002 provides that where a local NHS body has under consideration any proposal for a “substantial development of the health service” in the area of a local authority, or for a “substantial variation in the provision” of such service, it shall consult the overview and scrutiny committee of that authority.
These requirements apply before closing, or substantially restructuring or varying a service.
We therefore urge you to call a public meeting or series of meetings as soon as possible, to address both these serious failures of attention to patient welfare, and due process. In addition, we fully endorse the Rt Hon Tessa Jowell’s advice to you in her letter dated 10th January, asking you to carry out a full Equalities Impact Assessment and Health and Wellbeing Impact Assessment.
The recent PEDIC report on the St Thomas’ service shows a very high level of patient satisfaction. Outcomes Study funded by Guys & St Thomas’ Charity (summarised in the St Thomas Psychotherapy Service 2011 Annual Report and available on the SLAM Trust website) reports a high level of recovery over all treatment modes, with improvement continuing long after therapy has ended.