Primary care trusts (PCTs) are obliged to provide funding for National Institute for Health and Clinical Excellence (NICE)-recommended computerised cognitive behavioural therapy (cCBT) packages where clinicians want to use them, but the Department of Health is not in a position to ring-fence funds specifically for cCBT because decisions about funding local services are made by local commissioners based on local needs assessments.
NICE technology appraisals (TA) are mandatory: if a clinician prescribes a product named in a TA, the PCT concerned has to make it available. Consequently, the Department recognises the important contribution that the effective provision of cCBT will make in supporting the NHS to implement the NICE guidelines and deliver effective treatment for people with depression and anxiety disorders. This is the core aim of the Department's Improving Access to Psychological Therapies (IAPT) programme.
The Department is investing significantly in the IAPT programme with annual funding rising to £173 million in the third year (2010-11), to train 3,600 extra therapists and treat 900,000 more people in those three years.
This programme is relieving distress and transforming lives by offering effective intervention and treatment choice to people with depression and anxiety disorders and improving the collection, recording and measuring of patients' health outcomes, producing data that allow further research.
25 organisations—psychological therapies professional bodies and the leading mental health charities—have signed up to the New Savoy Declaration, congratulating the Government on investing in the IAPT programme and pledging their support. CBT has the strongest evidence base and the greatest shortage of fully trained therapists, so we are addressing this shortage first. IAPT services will offer all NICE-approved therapies, including guided self-help, counselling, cCBT, behavioural activation and exercise.
cCBT is recommended by the NICE technology appraisal TA097, and the directions on NICE appraisals impose an obligation on PCTs to ensure that cCBT is “normally available” to be prescribed or supplied and administered to patients.
The Department has taken steps to support the implementation of cCBT. This has included the NHS Purchasing and Supply Agency (PASA) National Framework Agreement (March 2007) providing procurement advice to the national health service, publishing the cCBT Commissioning Guide (March 2007) which provided implementation advice to PCTs and the IAPT Commissioning Toolkit (April 2008) recommending the delivery of cCBT as an integral component of the IAPT model of care.
cCBT is integral to the IAPT model of care which seeks to enable the NHS to implement the full range of NICE guidelines for effective treatment of people with depression and anxiety disorders.
The Department's position is that while it continues to recognise the benefit of using cCBT to implement evidence-based psychological therapy services and it has acted to support the NHS in delivery, the level of uptake of cCBT is ultimately the decision of the local clinicians and NHS commissioners based on their assessment of the needs of their local populations.