Written evidence from Ultrasis UK Ltd
(COM 46)
SUMMARY
— Cost-effective and clinically effective
treatments such as computerised cognitive behavioural therapy
(cCBT) that have been recommended by NICE have been proven to
support the increased delivery of services at a much reduced cost.
Commissioners must be willing to have a broad knowledge of such
new treatments and be challenged where they do not introduce them
into routine practice. Health and social care can and should be
closely integrated with greater investment in proven health technologies
as the global benefit to both systems is closely aligned; this
is especially the case for people who are considered most vulnerable
such as those with mental health needs. cCBT and other health
technologies based on promoting self care enables patients to
be treated in non-clinical settings such as social care providers,
third sector services, public facilities such as libraries or
even from home.
— Growth in the use of the internet for
health advice is increasing rapidly and it should be the requirement
of local authorities and their health care partners to look at
solutions that encourage digital inclusion to support the delivery
of cost effective services. This in turn will help promote delivery
of cost effective solutions to people's health care needs.
— Technology delivered health care has
been proven to support commissioners to end the "post code
lottery" of care delivery associated with traditional face
to face type services and can be scaled up at massively reduced
cost thus increasing access and choice to the patient. It also
has the advantage of helping to support access in rural communities
and for those who may have difficulties accessing traditional
services.
— The Coalition Government has stated its
support to ensuring greater access to talking therapies to reduce
long term costs for the NHS.
— The use of web based health care has
a significant and growing evidence base and is supported by several
key documents that have recently been published:
A: NICE Guidance: Depression in Adults—(http://www.nice.org.uk/CG090);
B: NICE Guidance: Depression with a Chronic
Physical Health Problem—(http://www.nice.org.uk/CG091);
and
C: The Business case for Digital Inclusion—(http://www.parliamentandinternet.org.uk/uploads/Final_report.pdf)
INTRODUCTION
1. Ultrasis is a healthcare company with
core expertise in health, psychology, software development and
programme management. Amongst our services, we provide a computerised
cognitive behavioural therapy (cCBT) programme called "Beating
the Blues":
(a) in the Netherlands, commissioned through
the majority of health care insurers;
(b) in New Zealand, where the Ministry of Health
has commissioned "Beating the Blues" to be made available
through all GPs;
(c) in Northern Ireland, where again the Ministry
of Health has commissioned "Beating the Blues" on behalf
of all GP Practices; and
(d) in England "Beating the Blues"
is available in primary care, but is not yet comprehensively distributed
at the point of contact with patients—GP surgeries.
2. "Beating the Blues" was developed
in the United Kingdom by Ultrasis in conjunction with Dr Judy
Proudfoot's team at the Institute of Psychiatry, King's College
London.
3. "Beating the Blues" was recommended
by the NICE Technology Appraisal 97 (TA97) in February 2006 for
the management of mild and moderate depression. It consists of
a 15-minute introductory video and eight further one-hour sessions,
which are normally organised weekly. The programme also includes
homework projects to be completed between sessions. Progress reports
are made available to the GP or other healthcare professionals,
including anxiety, depression ratings and suicidal tendencies.
COMMISSIONING
4. Ultrasis supports the Government's move
to GP and clinician led commissioning on the basis of it improving
the delivery of evidence based and cost effective care. The current
commissioning structures of PCTs are too distant from actual patient
care and are overly influenced by professional and systemic norms
and vested interests. This has been demonstrated in the case of
"Beating the Blues" where following NICE recommendation
in 2006, Published Implementation Guidance and Department of Health
directives, less than 15% of the suggested treatments have been
commissioned. This has led to at least one million people missing
out on treatment during this period and the NHS not realising
the full cost benefit, indicated by NICE, of £126 million
per annum.
5. In November 2006, Prof Louis Appleby,
Director of Mental Health, confirmed the NICE recommendation and
stated that PCTs were expected to provide the recommended cCBT
programmes by 31 March 2007. NICE estimated that 400,000 people
per annum should benefit from CCBT. It also estimated that full
provision of cCBT would offer cost savings of up to £126
million per annum in England.
6. The White Paper "Equity and Excellence:
Liberating the NHS" announced that the Department of Health
"will develop payment systems to support the commissioning
of talking therapies." As stated above, talking therapies
such as cCBT can offer a huge saving to the taxpayer, so this
commissioning support would not only be welcomed by health care
providers but will offer a real benefit to patients and commissioners.
7. With many PCTs not currently offering
"Beating the Blues" the full cost benefits of using
cCBT are not currently being realised. There has been a massive
increase in patients requiring access to mental health services.
The lack of provision of cCBT, in particular for those with mild
and moderate depression and/or anxiety conditions, means that
these patients' needs are not being met. The PCT-led commissioning
process has clearly failed the patient and their GPs. The advent
of the new proposed commissioning arrangements is an opportunity
to rectify this—putting the decision-making at the point
of interface between GP and patient.
8. cCBT has been demonstrated to deliver
the same outcomes as traditional face to face treatments and can
be delivered at 1/10th of the cost.
9. In a recent report commissioned from
the Northeast Observatory on the provision of Improved Access
to Psychological Therapies (IAPT) it was identified that a very
small percentage of people (1.6%) seen within IAPT actually received
a level of service commensurate with NICE recommendations. They
stated that it was surprising that services that are simple to
commission, such as cCBT, were not routinely available in all
services given that they are the easiest program components to
establish.
10. NICE also recommend that cCBT should
be offered to patients before they are prescribed antidepressant
medication, Antidepressant medication is currently estimated to
be costing in excess of £350 million per annum and its usage
is increasing as many GP's feel that they have no other option
available to them, due to limited access to traditional CBT services
where it is not uncommon for a patient to have to wait in excess
of nine months for treatment.
INTEGRATED HEALTH
AND SOCIAL
CARE
11. "Beating the Blues" can play
a vital role in integrated health and social care. In Northern
Ireland, the programme is being made available from all GP practices.
In the Netherlands, the programme has been translated into Dutch
and is available from providers of psychological therapy and primary
care. Most recently, the New Zealand Ministry of Health has commissioned
"Beating the Blues" nationally on behalf of its GP's.
The New Zealand system, which is also GP-led, has embraced online
therapy, which means that a patient can be prescribed "Beating
the Blues" and begin the programme as soon as they get home.
12. The use of cCBT as a means of promoting
self-help has huge potential to reduce the burden on often over-stretched
services and to free up professionally trained people to see those
with more complex needs. It can also be delivered at home or through
existing social centres such as third sector partners, libraries
and community centres, thus reducing the pressure on busy health
clinics.
13. The White Paper also stated: "It
is essential for patient outcomes that health and social care
services are better integrated at all levels of the system. We
will be consulting widely on options to ensure health and social
care works seamlessly together to enable this." New medical
technologies will be crucial in helping to bridge the gap between
health and social care, allowing for treatment in non-clinical
settings. Again, we believe that cCBT is a proven and rigorous
example of this, at the cutting edge of e-health technology as
recognised in, for example, New Zealand, pioneers in this field.
14. Libraries are increasingly coming under
significant pressure to provide a much wider range of services
and support to people in their local communities. Provision of
cCBT through public libraries has been demonstrated to be of value
and could be an exemplar of how the Government could meet its
aspirations to "join up" health and social care provision
and "unlock efficiencies across the NHS, social care and
public health through stronger joint working". The Department
of Health commissioned a review of the potential for this and
a draft report is in circulation.
15. CONCLUSION
16. We strongly support the proposals to
move towards GP and clinician-led commissioning as it will have
a positive impact on the quality of commissioning decision making
and consequently, improving patient care.
17. Informed commissioning led by GP's and
based on clinical need should be used to avoid the current post
code lottery of care that is experienced by many patients not
being able to access NICE recommended treatments. The PCT commissioning
of cCBT has led not only to reduced patient care but significant
loss of cost benefit to the NHS.
18. It is our belief that new health care
technologies when commissioned as an integral part of clinical
decision making can support both local authorities and health
agencies to maximise their joint resources. As an example cCBT
has been shown to support people back into work and off incapacity
benefits as part of pathways to work schemes.
19. Computer delivered health care has been
proven to:
(a) increase access and choice to patients;
(b) reduce cost of delivery;
(c) provide GP's with alternatives to prescribing
medication;
(d) deliver measurable clinical outcomes;
(e) increase self-management of health care conditions
and increase patient resilience;
(f) realise cost benefits to the treasury as
stated by NICE in 2006; and
(g) deliver significant cost benefits when commissioned
at a national level as part of a joined-up approach to delivering
care across health and local authority provision such as in Northern
Ireland, New Zealand and the Netherlands.
20. We hope that the reforms outlined in
the White Paper will lead to greater provision of these computer
based cCBT health care treatments and that the NHS can benefit
from significant cost savings, and improved patient care.
October 2010
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