CCG's service cuts leave patients with 'nowhere else'

Southern Derbyshire CCG has published a consultation proposing to cut a psychodynamic psychotherapy service provided by Derbyshire Healthcare Foundation Trust next year.

The plans come amid wider financial difficulties across the four commissioners in Derbyshire, which are forecasting a combined deficit of £52m for 2018-19. The proposals to cut the service are part of the CCGs’ quality, innovation, productivity and prevention scheme.

Psychodynamic psychotherapy services offer therapy to adults with severe mental health needs, often those with personality disorders and who have suffered childhood trauma.

Local representatives from the Unite union have criticised commissioners’ proposals. A briefing seen by HSJ read: “There is nowhere else in the already overstretched mental health services for these patients to go for the type of therapy they require.”

The union also claimed proposals to cut the service have “created immense anxiety and insecurity among the 136 people who currently attend for therapy”.

It added: “Current care has been compromised unacceptably. Commissioners seem to lack awareness of the crucial importance for any therapy of a sufficiently stable environment in which this demanding and challenging work can be done.”

In its consultation, published on 10 October, Southern Derbyshire CCG argued evidence from the National Institute for Health and Clinical Excellence and other clinical studies “have not found sufficient evidence to suggest that psychodynamic psychotherapy is more effective treatment in comparison to other specialist psychological therapies”.

It added the service is currently not commissioned in North Derbyshire and, as the CCG “cannot afford” to extend the service to the whole county, it should decommission it.

HSJ understands that, in April, NHS England wrote to a staff member who raised concerns about the potential cuts. It said it did not have powers to prevent local commissioning decisions but was assured the CCGs were adhering to the mental health investment standard.

At the world mental health summit in September, Simon Stevens, chief executive of NHS England, said the NHS long-term plan would need to ensure services for common mental health needs did not come at the expense of core services and those for people with severe long-term needs. 

In a statement to HSJ, a Derbyshire Healthcare Foundation Trust spokeswoman said: “The trust is disappointed by the proposals to decommission the service. We would welcome the opportunity to work with the CCG on developing alternative care models to support the individuals who will be affected, should the service cease in the future.”

A spokesman for Southern Derbyshire CCG said: ”Derbyshire CCGs spend approximately £1.02M per annum on commissioning a wide range of psychological therapies from Derbyshire Healthcare Foundation Trust and psychodynamic psychotherapy is just one part of this”