IAPT and targets: What has been achieved, and where next?

New data out today should answer the burning question in health policy (or at least those of us who follow mental health) – did the NHS meet the Improving Access to Psychological Therapies (IAPT) target?

Psychological or ‘talking’ therapies are recommended by NICE for treatment of anxiety disorders and depression (among other things). The IAPT programme has been an attempt to improve the numbers of people able to receive these treatments and show the benefit they gain.

The IAPT target was twofold: to treat 15% of the estimated 6.1m people with anxiety and/or depression each year by March 2015, and to achieve a recovery rate of at least 50% for those that complete treatment.

Quarterly data with official confirmation of performance against the target should be published in a few weeks – but January–March 2015 monthly data is now live. And across the quarter the vital statistics were:

• An annualised access rate of 15.6%: meeting the 15% target, through what I expect was a herculean last minute effort to get the numbers up; access exceeded 17% in March. A fantastic achievement, and a credit to IAPT services up and down the country.

• A recovery rate of 45.4%: missing the target, and continuing a plateau in recovery rates starting in 2011. 

So both a success and a failure; success in getting people in through the door, but a failure in managing to push quality high enough to increase the national recovery rate over 50%. This reflects the fact that quality is harder to improve than activity.

The figures mask huge variation: I counted 20 CCGs with recovery rates of at least 60%, while 14 CCGs had the dubious honour of less than 30% of people completing treatment recovering. 

Reflecting on how far IAPT has come – almost doubling the number of people entering treatment between the beginning of 2011 and 2015 – I am struck by what an achievement it has been. Hitting half a target when the NHS is on the edge of a financial precipice, the entire system is reorganised half way through your journey, and much of the support infrastructure has been dismantled, is quite a feat.

There will no doubt be conversations as the dust settles, including within the NHS England Mental Health Task Force, as to what happened, whether a target should have been set in the first place, and what should happen next. 

We can’t know what would have happened if there had been no target, but it is clear the target has given impetus and priority to this area which it would not have received otherwise (as previously discussed by me). The fact that the NHS was not far off the recovery target suggests it could have been achieved: meaning lack of delivery, rather than ambition, was the issue. 

What next for IAPT?

There is perhaps a danger that people see it as a ‘job done’, and move onto other issues. 

The current mandate includes an expectation that once hit, the IAPT targets are maintained. 

There is also a new target to achieve by March 2016 that 75% of people referred to the IAPT programme begin treatment within 6 weeks of referral, and 95% begin treatment within 18 weeks of referral. (Incidentally these targets are already being hit: perhaps showing a lack of central ambition for stretching performance aspirations.)

The balance of focus between hitting and maintaining performance on the ‘old’ access and recovery targets, and reducing waiting times in the future NHS climate will make a big difference to the type and quality of service people with common mental health problems can expect. Too much focus on waits could mean recovery suffers (as has arguably been the case in the push towards 15%), or provide an incentive to limit access through actions such as closing self-referral routes. The strength of the IAPT targets was the balance of activity (access) with outcomes (recovery) – I hope this balance is kept.  
 
Access to evidence-based treatment needs addressing across mental health – particularly for children and young people. However, common mental health is still the area where fewest people can access treatment: meaning further development of IAPT needs to be part of the action to address this. 

The route to further improvement of IAPT could take different paths: a locally led movement, national imperatives, support for improvement, or changing the system to favour it (e.g. through pricing structures). 

Whatever the route those thinking about the future will need to address the concurrent challenges of:

• getting access to therapy treatment for greater numbers of those who would benefit – including children, young people and people with severe mental illness

• improving quality – including reducing variation between services

• and embedding psychological support in pathways across health care – so that those with long term conditions and mental health problems all benefit.

This is a heavy list of priorities for a health system struggling with demands on all sides. But, do those of us with mental health problems really deserve anything less?

Felicity Dormon (@FelicityTHF) is a Senior Policy Fellow at the Health Foundation