Here’s the first of our ‘Guest Blogs’ this week from people working in the NHS
I am a psychologist. I trained for 7 years. I treat adult patients in a primary care setting. I am supposed to work with depression, anxiety, OCD, PTSD. Increasingly I have to work with more complex cases; personality disorders, psychosis, eating disorders….
The number of sessions of therapy provided is going down but waiting times are going up!
In 2010 the Trust that I trained at offered patients up to 20 sessions to treat, say, anxiety or depression. Now they offer up to 12 (NICE guidelines state 25 sessions). This would be less of an issue if people were being seen quickly but a 6 month waiting time from referral to first appointment is currently the norm. In order to minimise waiting times Trust have adopted some ‘sharp’ practices that are not in the best interest of the patient. These include “a cancelled session counts as a session”, that is, if you are offered 8 sessions and cancel one then you have 7 left. If you simply fail to turn up (“DNA”, Did Not Attend), you will be discharged. This is obviously unfair on patients struggling with issues such as agoraphobia.
Services have to be ‘competitive’ to retain contracts
Services are also under increased pressure to meet targets (in order to retain contracts). This in turn leads to more sharp practices. These include redefining what “entering treatment” means (a milestone in terms of payments). Entering treatment used to mean “having 2 sessions within 28 days”, now it has been redefined to be having the first session. The Trust that I currently work in has taken to offering all referred patients a telephone-based assessment (a good thing) but therapists are encouraged to make the session as therapeutic as possible. This means that the assessment can then be categorized as “assessment and treatment” and payment can be collected. That therapy may be as little as providing the phone number of Samaritans. Services are also pressured to take on more and more clients (despite little prospect of treatment for them) and it is not uncommon to have flyers put into free newspapers in order to drum up business. Staffs are under increasing pressure. My professional body states that I should have no more than 25 contacts per week with patients and no more than 5 per day. 24 is the norm in the service but often that is 6 per day. This becomes an issue in finding time to write up notes, deal with other agencies, etc. Clinical supervision used to be offered weekly, the trust I current work at provides it monthly.
Ever service is struggling meaning that patients often get passed around.
All services are overloaded, secondary care services are unable to meet demand and so many patients who should be in secondary care are seen by us (or, at least, get added to our waiting list). It is quite normal for a specialist service such as Eating Disorder to not accept a referral until that patient has tried our service. This means that a patient with a severe ED will be referred to us, wait 6 months, have 8 sessions with us before they can then be accepted by the ED clinic (they will still need to wait to be seen by that service).