We must act!
What you can do
Please look at the guidelines. The NICE website is at http://www.nice.org.uk/
We stress that the aim of this campaign is wider than simply to change these guidelines. It will continue with vigour after the closing of the deadlines. Because the campaign is about Safeguarding Patient Choice.
We will be forming more and more alliances with other groups who are also affected by NICE recommendations. Patients groups, for example. It is not our position that psychotherapy should be exempted as a special case from the normal NICE way of thinking. It is a bigger challenge - that that way of thinking needs to expand. When limited as it is, the patient suffers.
We may feel passionate about the way NICE thinks. Others will want to know what all that fuss is about. The fuss is about ensuring that the patient has and will continue to have the most appropriate treatment.
So while you might write to NICE about the evidential base for their recommendations, MPs and others will be more concerned, and probably only concerned, about the impact of those recommendations on real people in the real world.
We ask you to (please see the Guidance Section for further suggestions):
- complete the NICE proforma for comments on guidelines
- write a letter to (or email) your MP
- write a letter to (or email) as many of the other people in our list as you can and
- email your comments to UKCP at nice@ukcp.org.uk and
- keep us informed of what you are doing and what replies you get.
The evidence base used to support the Guidelines is limited
- The DRAFT states that it has only considered evidence from Randomised Control Trials (RCTs). All other evidence appears to have been excluded. This was the approach of the American Psychological Association (APA) until 2005. But then the APA revised its position and recognised that a true scientific appraisal of the evidence requires the consideration of naturalistic effectiveness studies as well as RCT's.
- At the Savoy Conference in November 2008, Bruce Wampold successfully provided the research and evidence to win overwhelming support from the UK mental health professionals present that it was the quality of the practitioner and the relationship to the client/patient rather than the theoretical model that determined successful outcomes.
- The Guidelines are out of step with the expert consensus that has developed that a true evidence base requires a more pluralistic approach to the gathering of evidence.
- The scope of the research upon which NICE has relied is affected by decisions about research funding and these decisions were, necessarily, not guided solely by the wish to provide the best evidence about the effectiveness of all available psychological therapies.
- The short term view, which skews provision of psychological therapy in favour of CBT, takes no proper account of the complexity of the problems facing the hugely diverse group of human beings comprising the nation.
- While the need to include briefer interventions is understood, the complexity of the problems faced by many individuals is such that there is also a need for longer term psychotherapeutic inputs that address the complexity of the issues faced by that individual, couple or family.
- Limiting choice for the individual will also drive practitioners towards a narrower range of treatment and reduce the diversity of approaches available to the individual
- Development, education and training, and practice to deliver this diversity which mirrors the need of the public are all put in jeopardy.
- The impact of any NICE guidelines will be enormously enhanced by the new powers under which the Care Quality Commission will be able to require NHS Commissioners to adhere strictly to those Guidelines in any decision to commission a psychological therapy. Recent IAPT publications also refer to funding within IAPT as being dependant upon NICE compliance.
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