Trust reviews 250 patients waiting to access flagship service

Southern Health Foundation Trust’s attempts to improve access to the psychological therapies (IAPT) service in North Hampshire have been hindered by high staff turnover and an “increased severity of patients”, recent board papers revealed. 

IAPT services, which provide treatment for people with conditions such as depression and anxiety, gained a high profile within mental health following the 2016 publication of the Five Year Forward View for Mental Health.

According to new waiting time targets, 75 per cent of people referred to IAPT services should start treatment within six weeks of referral, and 95 per cent should start treatment within 18 weeks of referral.

But staff turnover and more patients than expected needing more complex care has caused longer waits for up to 250 patients in North Hampshire, according to Southern Health’s board papers.

These patients are now being reviewed to make sure they have not suffered harm while waiting for treatment. As of last week, the trust had contacted 205 of the patients. Of these, 25 patients have started their therapy.

One patient, however, died while on the waiting list. The trust is investigating whether the wait was a contributing factor.

The trust has addressed the problem by hiring more IAPT practitioners for the region, and creating more senior posts to boost staff retention.

Southern Health’s chief operating officer Barry Day told HSJ the North Hampshire IAPT team was now fully staffed – albeit with two agency workers.

The board papers also noted patient choice has been suspended due to the pressures on the service. Patients are now given two “reasonable offers” of where and when to have appointments, and they are discharged to their GP if those times and locations aren’t suitable.

Meanwhile, the trust risks losing its IAPT services in south east Hampshire to another provider, as it struggles to hit waiting time targets there. 

Between July and December last year, 1,512 (87 per cent) patients accessed the service against the CCG’s target of 1,737. Once accessed, 95.66% of those patients were seen within 42 days, against the 75% national target. 

According to the trust’s February board papers, commissioners “may decide not to continue to fund this service”, due to the missed target.

Mr Day said the trust “absolutely recognised the need to improve access”.

“There would also be an impact to the patients who may not get the same level of service from an alternative provider and this would be of greater concern than any financial impact,” he said.

While the trust is missing waiting time standards, its IAPT service is “exceeding its outcome measures”, Mr Day added.

The trust is also in discussions with commissioners and local Mind charity organisations (which jointly commission the service) to address “any conflicts on interest that are impacting on [the] contract”.

Mr Day said it would not be appropriate to talk about the “specifics of these discussions”, but added the talks were “very constructive”.

Around £2.4m is spent funding IAPT services by Fareham and Gosport and South Eastern Hampshire clinical commissioning groups.

A spokesman for the CCGs said Southern Health had “regularly struggled” to achieve the access target, and that looking at whether to fund the service from that provider formed part of its “overall risk management process”.

“We are working with the current provider to identify areas of improvement and continue to support Southern Health in the achievement of this and other national standards for IAPT provision,” he said.

Asked about the conflict of interest, the spokesman said: “All of the wellbeing centres are run by various local Mind organisations and… some of the work they do has the potential to be similar to some of the work carried out by the Southern Health IAPT service.

“The CCGs have supported and continue to support both Southern Health and the local Mind organisations with positive engagement between both parties to ensure the best possible health outcome for our patients.”

Article updated at 10.52am to clarify the trust’s performance against CCG targets and national targets in South East Hampshire.