Sent by email to Vaughan Gethin, Health Minister, Welsh Assembly Government

Correspondence.Vaughan.Gething@gov.wales

16.2.18

CBT4WALES Letter To Welsh Government

Dear Minister,

We are writing to you on behalf of the British Association for Behavioural and Cognitive Psychotherapies, lead organisation for cognitive behavioural therapy in the UK and Ireland. We have over 11,000 members and accredit CBT training programmes throughout the UK. We write in conjunction with CBT4Wales, a division of BABCP set up to address issues of CBT access and provision in Wales.

We have written previously in relation to Matrics Cymru, during its consultation phase, to advise that the planned money set aside for implementation was below that provided for similar initiatives in England (Improving Access to Psychological Therapies, IAPT) and Scotland (The Scottish Matrix). We are writing again, now that the Matrics has been published, with ongoing significant concerns about the lack of funding and infrastructure to support effective implementation and the lack of evidence based psychological therapies, including CBT, in Wales.

BABCP is referenced within the Matrics document in relation to supporting the provision of evidence-based therapies which include CBT. Whilst we value this inclusion, we continue to believe the funding and infrastructure to be inadequate to enable equitable provision of evidence-based therapies including CBT in Wales. This is a great shame for the many people experiencing mental health difficulties for whom approaches such as CBT can be transformational. We are aware of evidence that failing to provide adequate funding and support for healthcare infrastructure is a false economy. Intervening as early as possible in mental health difficulties by offering a high-quality evidence-based intervention can change the trajectory of people’s lives and enable them to continue to participate in their employment, leisure activities, families and friendships. At present we have been made aware of concerns from both patients and clinicians that there is a postcode lottery of mental health services in Wales, and that mental health provision in Wales is substandard compared to provision in England and Scotland.

Many of the BABCP accredited practitioners living in Wales are forced to travel to England for work because of a lack of posts within Wales for CBT practitioners. Their skills and experience are consequently lost to the Welsh population and to services and service development in Wales.

In addition to concerns about the absence of funding and infrastructure available in healthcare settings, we are concerned about the sustainability of CBT education provision available in Wales. The only accredited CBT programmes in Wales are currently running at Cardiff University. The programmes have no central support and depend on local health boards paying for post-qualification training. The result is that dissemination of CBT skills throughout Wales is uneven and the programmes are at risk of closure due to unreliable student numbers. Should the Cardiff course cease there would no longer be any Postgraduate BABCP accredited courses in Wales meaning there is a danger that the pre-eminent and most recommended evidence-based form of therapy will not become established in Wales.

We would like to draw your attention to recent research published in The Lancet (available online here) which investigates outcomes in the English IAPT services. This research, led by Professor Clark, an Honorary Professor at the University of Cardiff as well as National Clinical Advisor for IAPT, shows that services focused on assessment have poorer outcomes than services focused on treatment. Whilst the Welsh Matrics refers helpfully to evidence-based psychotherapies, funding, protected staff time and training are necessary to provide these.

We realise that funding is extremely stretched in this difficult time, but we write to ask you:

1. For your stance on our concerns about the CBT courses at Cardiff University and the long-term viability of the delivery of CBT services within Wales.
2. For your thoughts on the concerns we are raising in relation to the underfunding of service provision and the launch of a Matrics, which at least for CBT provision, cannot succeed with current funding and infrastructure.
3. For more information on exactly what funding is being provided for implementation of the Matrics Cymru over the next five years?
4. For information about whether the funding you are providing is ring-fenced?

Furthermore, it is noted that BABCP is named in the Welsh Matrics document and yet was not invited to consult on the Matrics. CBT is recommended throughout the Matrics and as the lead organisation for CBT in the UK and Ireland, BABCP is happy to offer consultation on the implementation stage. We have members with skills and knowledge of service delivery in both high and low intensity CBT practice, service design and implementation.

We are happy to discuss these matters further in person and look forward to hearing from you about future plans for evidence-based psychological interventions in Wales, and in particular CBT. We will be distributing a copy of this letter to BABCP’s Welsh members and also publishing the document on our public website.

Diolch i chi am ddarllen/Thank you for reading.

Mark Lawler on behalf of CBT4Wales
pp.

Dr/Professor Chris Williams BABCP President

Dr Lucy Maddox BABCP Senior Clinical Advisor
pp.

cc. Ainsley Bladon, Strategy lead for Together for Mental Health’, Welsh Assembly Government, ainsley.bladon@gov.wales

Liz Davies, Head of Mental Health and Vulnerable Groups Division,
Elizabeth.davies025@wales.gsi.gov.uk