Only a third (37%) of those engaging in NHS Talking Therapies completed treatment in 2023/2024, with 17% of these designated as ‘reliably recovered’, according to data analysed by Bagri (2024) of the Nuffield Trust. But the Attrition issue was neither acknowledged or addressed at the recent European Association for Cognitive and Behavioural Psychotherapies (EABCT) Conference, held at the University of Glasgow, in September 2025. Instead, the Service’s prime mover [Clark (2025)] re-iterated the Services’, implausible claim of a 50% recovery rate, amongst those who attend 2 or more treatment sessions, adding that the Service was ‘spectacular’. Yet he did acknowledge that there has never been a randomised controlled trial of the effectiveness of NHS Talking Therapies, which alone would provide a definitive answer on effectiveness in routine practice. Puzzling – it seems strangely reminiscent of the TV comedy ‘Never Mind the Quality, Feel the Width’.
My own independent study, conducted as an Expert Witness to the Court, suggested only a tip-of the iceberg recovery rate, Scott (2018). With recovery defined, not by a psychometric test score, but on the basis of a reliable standardised diagnostic interview – the ‘gold standard’ in randomised controlled trials.
Low-intensity treatments accounted for 39% of all appointments [ Bagri (2024))], in 2023/24 including guided self-help and computer assisted CBT. But the evidence-base for these cheaper options is weak by comparison with high-intensity interventions. On what basis can the low intensity treatments be said to clear a ‘good enough’ threshold?
In 2023/24, a third (34%) of appointments were for CBT, Bagri (2024). The evidence base on which the other two thirds of appointments rest is lacking. With a fifth of appointments dedicated to psychoeducation, physical activity and employment support. But the Service has no expertise in these areas and was not set up originally to deliver them. The Citizen’ s Advice Bureaux is likely better placed to deliver in these domains. NHS Talking Therapies has suffered from ‘mission creep’, most recently targeting those with long-term physical conditions.
At the front door of NHS Talking Therapies in 2023/24, 20% of referrals were declared unsuitable. This is a great waste of resources but the basis for declaring ‘unsuitability’ is opaque. The decision is made by the gatekeeper, a Psychological Wellbeing Practitioner (PWP), the least qualified of all staff and not a therapist, sometimes in consultation with his/her Supervisor.
In a paper delivered by Dr Cotton to the British Sociological Association on August, 26th 2021 she claimed that 41% of those working for NHS Talking Therapies predecessor, IAPT had been asked to manipulate data about patient’s progress’ . Unsurprisingly, annual staff turnover in NHS Talking Therapies is 18%, whilst 68.6% of PWPs report burnout Westwood (2017).
Bagri, S (2024) “Does the NHS Talking Therapies service have an attrition problem?” Quality Watch: Nuffield Trust and Health Foundation.
Clark (2025) Developments in England’s NHS talking therapies for anxiety and depression: data availability and analysis. Paper delivered at the University of Glasgow, EABCT meeting, September 5th 2025.
Dr Mike Scott