The Service solicits questionnaire results from each client at every therapy session. With over a million clients a year and an average of seven treatment sessions per client for completers, that’s a massive amount of data. But to paraphrase Coleridge’s Ancient Mariner, ‘NHS Talking Therapies data everywhere and not a drop to drink’.
Talking Therapies proclaims that the data reveal a 50% recovery rate, comparable to that in randomised controlled trials of CBT for depression and anxiety disorders. The UK Government’s Office for National Statistics (ONS 2024) has stated that there are not only health benefits but that the NHS Talking Therapies treatment has led to an increase in income and reduced unemployment. However, the government’s National Audit Office (NAO) has been strangely silent on whether the Service is value for money.
But it is not possible to discern the operation of any plan in NHS Talking Therapies ministrations. There is no documentary evidence of the setting and review of homework at each therapy session. Given that CBT is distinguished from other psychological treatments by its psycho-educational nature, there is considerable doubt that CBT has in fact been administered. The National Institute for Health and Clinical Excellence (NICE) guidelines state that evidence -based-treatment should be diagnosis specific, but the service clinicians are not trained to diagnose. The meaning of the data collected is therefore opaque. Though the data collected has grown exponentially since the inception of the Service in 2008, it is no more valid than it was at the beginning. But the ONS’s conclusions assume that the NHS Talking Therapies proclaimed narrative is true. Without this solid foundation their assertion of positive economic effects crumbles.
What NHS Talking Therapies clinicians actually do is to ‘tinker’, CBT sounding phrases abound, but it is ‘All Talk and No Action’, with no evidence of the dovetailing of treatment targets with matching treatment strategies. There has been no independent assessment of treatment integrity. The Service asserts that its’ clinician’s interventions are guided by their formulations, but there is no evidence of the reliability of these plans/formulations. There is no evidence of intelligent design behind the Service. Unsurprisingly the response of a third clients is ‘thanks, but no thanks’ [ Scott (2025)], attending only one assessment/treatment session. For every ‘decliner’ two people attend two or more treatment sessions.
Tellingly the diagnostic status of NHS Talking Therapies clients has never been assessed independently by a publicly funded body using a standardised diagnostic interview. The duration of ‘recovery’ has never been assessed – psychometric tests only give a snapshot picture of the client at a particular point in time. Clients wish for real-world recovery not to be ‘tinkered’ with. My own study [Scott (2018)n] of NHS Talking Therapy clients showed only a tip of the iceberg recovery rate.
Dr Mike Scott