The Government has committed to spend an additional £400 million over the next four years on a limited range of National Institute for Health and Clinical Excellence approved talking therapies, despite a recovery rate of only around 15% of all referrals. The Department of Health (DH) is currently working to develop the regulatory criteria for increasing the supply of adult talking therapy. A number of Primary Care Trusts (PCTs) have elected to become pathfinders in establishing this precedent. This paper is therefore particularly written for decision makers in these early processes, and those involved in subsequent national iterations.
This paper proposes a means by which choice and access can be significantly improved to enable more people to recover from mental illness and avoid dependency and despair. We recommend using a Payment by Outcome commissioning approach, whereby voluntary and private sector providers of talking therapy are commissioned by the NHS to work at their own financial risk (delivering therapies recognised by the NHS) until they have achieved a proven effective outcome with each client. Minimum standards are essential for the safe delivery of therapy but the Payment by Outcome mechanism would obviate the need, in this area of healthcare, for the higher barrier of NICE guidelines. The need to comply with NICE guidelines severely limits the types of therapies that can be widely delivered through the IAPT programme.