It’s a while since I looked at the Improving Access to Psychological Therapies (IAPT) data published by the Health and Social Care Information Centre (HSCIC). The latest available results for Gloucestershire and Herefordshire don’t give me any reason to jump for joy, and some of the published figures are quite baffling.
IAPT’s results are entered into computer systems by the providers, 2gether in this case, and submitted to HSCIC for quarterly publication more than a quarter in arrears. So at the time of writing the latest results are for July to September 2013 (Q2), published at the end of January 2014 — enough time for them to have been sent by paddle steamer to Australia and back. So much for computer systems.
The original idea of IAPT was to improve access to psychological therapies, so that more patients with the commonest mental illnesses, depression and various anxiety disorders, would have the choice of a treatment other than just medication. In 2008 a study was commissioned to estimate the prevalence of these common mental illnesses in the population, based on a survey carried out in 2000.
The estimates were used as a benchmark for IAPT, but as the estimates had never been updated since the survey in 2000, this benchmark was eventually dropped. For what it’s worth, the benchmark prevalence of these illnesses was estimated to be:
Different estimates of the prevalence of mental illness can be obtained from GP practice records. HSCIC’s latest published data is from 2010-11. These figures include all ages (not just 18-74), and all mental illnesses (not just depression and anxiety):
The prevalence actually recorded by GPs is wildly different from the previous estimates, and I don’t know why.
Anyway, the numbers of people referred to IAPT (or self-referred) in Q2, and compared to the old benchmark estimate of prevalence were:
The figure for Herefordshire is extraordinary! One in every 35 people in the entire population of the county were referred to IAPT in a single quarter.
Not everyone who is referred to IAPT (or who self-refers) actually starts treatment, and those who do receive treatment might end their treatment in a different quarter. So you would not expect the number of people completing treatment in Q2 to match the number of people referred and self-referred.
It would be nice to know the number of people who start treatment. In the days when IAPT had key performance indicators (KPIs) the number of people who started treatment was published as KPI4, but the KPIs are no longer in use and this number is no longer published. The number is still needed, however, to compute performance against the national targets (which NHS England calls CB_S5). I think HSCIC has made a bad decision in concealing this data.
Curiously, the number of people who complete treatment is not the same as the number of people who start. This is because people who attend just once and never return are recorded as starting treatment but not completing it. More controversially, IAPT credits itself with their recovery when the real story might be that they were so disappointed with their first appointment that they gave up. It’s easy to imagine this happening if someone is depressed.
IAPT’s target is to treat just 3.75% of prevalence per quarter (actually, 15% per annum) by 2015. It’s not 2015 yet, so interim local targets may be lower than that. Gloucestershire CCG publishes its local targets, but Herefordshire CCG doesn’t appear to:
|Q1 target||Q2 target|
CCGs are now required to determine the local prevalence of depression and anxiety, replacing the old benchmark figures. Neither Gloucestershire CCG nor Herefordshire CCG appears to publish their prevalence figures. (Herefordshire CCG publishes a figure of 13,600, which looks like it might be prevalence, but it doesn’t say what it is.) This means that when Gloucestershire CCG says the target for Q2 is 3.0%, we don’t know what it’s 3.0% of.
Gloucestershire CCG’s published results say that 2gether exceeded these targets, but again Herefordshire CCG doesn’t appear to publish its results:
|Q1 actual||Q2 actual|
For Gloucestershire in Q2, only 2.6% (see above) of the old benchmark prevalence figure were referred or self-referred, and not all of these people will have started treatment. So the only way that Gloucestershire CCG can have obtained an actual result of 3.2% is by reducing their locally determined and unpublished prevalence by quite a bit, it would seem.
Another IAPT (CB_S5) target is a 50% recovery rate among people who complete treatment. The official phrase is “moving to recovery” rather than just “recovery”, meaning that the symptoms should have become pretty infrequent even if they haven’t disappeared completely. Symptoms are assessed using standard measures appropriate for depression and anxiety disorders.
Local targets may be less than 50% prior to 2015. Gloucestershire CCG’s current target is already 50%, but again Herefordshire CCG does not appear to publish its target.
HSCIC publishes the relevant figures for Q2 but not for Q1. I think this is a mistake on HSCIC’s part, rather then deliberate concealment. According to these figures, the results achieved were:
|Q1 actual||Q2 actual|
Gloucestershire CCG publishes its results, but Herefordshire CCG again doesn’t:
|Q1 actual||Q2 actual|
Mysteriously, Gloucestershire CCG says 2gether just exceeded the target with 50.6% in Q2, while HSCIC says it failed to meet the target with only 44.2%.
Some other measures are reported monthly, but only by provider. So the data for 2gether combines Gloucestershire and Herefordshire. HSCIC’s latest report at the time of writing contains provisional data for January 2014. There appear to be 3,490 records in the system at that time.
About half have a therapy type in the record. The other half may not be receiving treatment yet.
Only 22%, however, have a provisional diagnosis in the record. This suggests that for more than half of those people receiving therapy, no one knows what they are receiving therapy for!
Curiously, about 44% of people receiving therapy have a record of what the therapy is for, and about 44% of people receiving therapy recover. I wonder whether they are the same 44%.
IAPT was supposed to be a model of transparency, with published data that would allow all the world to witness its success. It has turned out to be remarkably murky.