Cut Threatened to NHS Adult Psychotherapy Service in Derbyshire
What is this about? NHS Commissioners for Derbyshire want to cut a Psychodynamic Psychotherapy Service provided by the Derbyshire Healthcare NHS Foundation Trust (DHCFT). The public consultation on this proposal is running from 10th October 2018 until 11th January 2019 and Commissioners have produced a consultation document and questionnaire to accompany it (http://www.southernderbyshireccg.nhs.uk/have-your-say/consultations/psychodynamic-psychotherapy/).
This proposed cut would remove a crucial source of help, leaving people in Derbyshire without access to a well- respected, proven and in- demand therapy.
So who does this psychotherapy service help? The Psychodynamic Psychotherapy Service provides therapy to adults profoundly affected by traumatic childhood experiences such as physical abuse, sexual abuse and neglect, with severe and enduring effects on their mental health. For many this includes self-harm, suicide attempts and multiple use of services.
Psychotherapy can help treat their distress and move them towards recovery. Therapists know through feedback how highly the service is valued. For many people it has been a literal life line. Many move out of the mental health system following therapy.
Nowhere in their consultation document do Commissioners
• acknowledge the gap that would be left if they cut this service
• answer how people in such distress would, in the future, find the therapy they need
What is the demand for this service? Demand for Psychodynamic Psychotherapy is very high. The Service is only able to accept one in three suitable referrals as accepting all would result in unacceptably long waiting lists. The result is that many people whose needs are fully appropriate are already turned away.
If the service is cut, surely there are others who can see such people in future?
There is nowhere else in the already over-stretched mental health services for these patients to go for the type of therapy they require. Many people who are referred to the service have already tried alternative therapies and, for them, this Psychodynamic Psychotherapy Service is the only realistic and appropriate option.
Is there a problem with the consultation process?
Commissioners have produced this proposal and begun this consultation without taking advice.
But they do not have the kind of detailed knowledge of psychotherapies in Derbyshire that would allow them to make for themselves, without assistance, well informed judgements about what services are needed and what gaps a cut like this would create.
And they have failed since 2005 to carry out a thorough review of the range of therapies, the role each type of therapy plays and the gap that would be left if any one therapy service was cut.
And they have failed since 2011 to create a service plan for psychotherapies in Derbyshire.
NHS Psychotherapy services in Derbyshire have been hindered in their development for several years now by the lack of clear Commissioner engagement and joint planning.
How long has there been this threat to the service? Commissioners conducted the same consultation in 2011 and the outcome was very positive for this service. So, UNITE does not understand why Commissioners are now repeating this consultation.
In September 2017 Commissioners announced they planned to start a public consultation. Since then four potential starting times for the consultation have come and gone. By the time this Consultation has closed and a decision reached in March 2019, the service will have been under threat for 18 months.
Commissioners seem, at the very least, insensitive to the effects on the Service, both on the people who come for therapy and on their therapists, of such a long and protracted threat to therapies.
UNITE understands that Commissioners are now planning to engage in a review of all therapies in Derbyshire, a review that might lead to the development of new proposals, different to this one.
Clinicians, Unions and Health Service Managers have asked Commissioners to withdraw this proposal and wait to see what more informed and evidence- based proposals emerge from a full review.
So it is unclear: ‘why are we still having this consultation?’
How well do Commissioners understand the needs of people who use this service?
Commissioners describe the Psychodynamic Psychotherapy Service as a ‘nice to have’ but not ‘must do’ service. This inappropriate and insensitive language suggests that Commissioners do not adequately understand the depth and intensity of the work that people do in this type of therapy, in which the painful experiences of sustained childhood trauma and its severe and enduring effects are worked with and associated risks are managed. This proposal has created immense anxiety and insecurity among the 136 people who currently attend for therapy, increasing for some the risk of self-harm. Current care has been compromised unacceptably. Commissioners seem to lack awareness of the crucial importance for any therapy of a sufficiently stable environment in which this demanding and challenging work can be done.Therapists and those who attend for therapy deserve better than this insensitive, insufficiently informed and unnecessarily protracted process.
How important is it to have a choice of therapy? Commissioners are proceeding with this consultation as if it is optional to offer people a choice of the type of therapy they will receive. In fact, denying people such a choice runs contrary to clear guidance and evidence.
People coming for therapy need the opportunity to be matched to the therapy best suited to their needs. This is a crucial factor in the successful outcome of any therapy. If this service is cut, then meaningful choice will have been removed.
Is there a problem with equal access to the service across Derbyshire?
This service is not as available in the North of the County as it is in the South of the County and this is a reason Commissioners have put forward for cutting the service. Commissioners appear to be saying that, in the interest of equality, everyone in Derbyshire should be equally deprived of this service. This cannot be the only option. Commissioners could explore ways of making the service more available in the North of the County.
What about the financial cost of this service?
Any short- term savings made by cutting this service would be outweighed by increased long term costs.
This is because this service helps people to move towards recovery, facilitates them to remain in work or return to work, reduces demands on wider mental health services and GPs and supports the mental health of families and children. The Service aims to produce lasting change in people’s lives.
The potential length of therapies is vital in preventing the kind of ‘revolving door’ experience many people have in which help that is too short in length results in their needing to keep coming back. The effectiveness of the work is demonstrated through a variety of outcome measures that the service uses.
Is there an evidence base for this therapy?
The summary of research evidence provided by Commissioners seriously misrepresents what NICE guidelines say about Psychodynamic Psychotherapy. There is clear evidence that this type of therapy is effective and makes a difference to peoples’ lives.
In fact, Commissioners appear to agree because, at a meeting of County Councillors in July 2018, Commissioners stated that they accepted that the service has an evidence base for its work and, as a result, Commissioners would no longer be arguing that it should be cut due to a lack of evidence.
Is more money being spent on Psychological therapies in Derbyshire?
While funding has increased over the past four years for short term therapies, funding has decreased for people whose therapies need to be longer than six sessions due to the extent of their childhood trauma. Now, this proposal would see their specialist therapy service cut altogether.
There are three questions that UNITE believes Commissioners need to be challenged to answer:
1. When did those in the most need become a lesser priority for funding?”
2. Where are such people to go in future for the therapy they urgently need if the service is cut?
3. With all that we now know from the media about the extent and effect of the historic abuse of children, can this really be the time to cut a therapy service that specialises in treating adults so profoundly affected by their childhood trauma?
In summary, UNITE cannot see the sense of Commissioners:
….seeking to cut this psychotherapy service before conducting, in partnership, a full review of all NHS psychotherapies in Derbyshire out of which more informed and evidence-based proposals could emerge
….cutting a valued service which is in high demand and has an excellent record of helping adults whose mental health has been profoundly affected by childhood trauma
….failing to address anywhere in their consultation document the gap in therapy services that this cut would create
….failing to put forward any ideas about how such people with severe and enduring needs would find the therapy they need in the future
….treating people in most need as a lesser funding priority compared to those whose needs might be me in short term therapies.
….resolving inequity by ensuring everyone in Derbyshire is equally deprived of the service
….making savings in the short term that will lead to increased costs in the long term
….taking away from people the opportunity to be matched to a therapy that suits their needs.
So, what can I do?
Sign the petition: https://you.38degrees.org.uk/petitions/save-derbyshires-nhs-specialist-psychotherapy-service
Complete the Commissioner questionnaire https://www.surveymonkey.co.uk/r/PPtherapy
Contact your MP: to find your MP follow the link https://www.theyworkforyou.
Contact your Local Councillor: https://www.gov.uk/find-your-local-councillors/
Contact the Chairs of the City and County Committees with scrutiny roles:
• David Taylor, Chair of Derbyshire Improvement and Scrutiny for Health Committee, County Hall, Matlock, Derbyshire. DE4 3AG email: firstname.lastname@example.org
• Jangir Khan, Chair of the Adults and Health Review Board, Council House, Corporation Street, Derby. DE1 2FS. Email: email@example.com
Contact the Lead Commissioner to raise your concern: Dr Chris Clayton, Derbyshire Clinical Commissioning Group, 1st Floor North Point, Cardinal Square, 10 Nottingham Road, Derby. DE13QT. Tel: 01332 888080 email firstname.lastname@example.org
Current or former therapy patient? HealthWatch Derbyshire would like to hear your views and will present a summary on your behalf to Commissioners at the end of the consultation. Contact details: Suite 14, Riverside Business Centre, Foundry Lane, Milford, Belper, Derbyshire. DE56 0RN Tel: 01773 880786 Enquiries@healthwatchderbyshire.co.uk
If you feel able to share your views or experiences of the value of Psychodynamic Psychotherapy with local newspapers or TV, please contact me. I can help you set up the contact so that your voice can be heard. Interviews can be anonymous.
Please feel free to copy me into any correspondence you send to MPs or Councillors or Commissioners so that UNITE can keep an overview of the feedback they are receiving.
Want more information?
Its available at:
2 Pride point Drive, Pride Park, Derby DE24 8BX
Tel: 01332 548 400