Why is the recovery rate of one IAPT area 13% higher than the national average? Why is the recovery rate of another 17% lower? And why is the recovery rate of the first almost double the second? In this first of a two-part series we drill into the data to reveal the IAPT postcode lottery. We ask if anything’s changed? And we show how to find and benchmark data for your area.

Estimated reading time: 6 minutes

How do services improve, and what does ‘good’ look like?

How do services improve? Come to think of it, how do practitioners improve? For me, it’s not rocket science. We determine what’s possible. Then, we assess how we’re performing relative to that. We take some steps we believe may take us closer to what’s possible. We assess our performance again. Incremental steps as part of a learning cycle. I’ve done it previously as a service manager, and I’m doing it now as an independent practitioner.

But what is possible? What does ‘good’ look like? There are many indicators we could choose. Waiting times. Dropout or attrition rates. The outcome or impact of therapy. Other indicators are available. Over the years, however, I’ve come to view dropout and impact as the most important indicators. Clients remain engaged in therapy to the point where we (and they) are able to point to a demonstrable impact or outcome. How do we improve? One way is to look at the what the best are achieving and aim for that.

The best and the worst of IAPT

The germ of this blog was a curiosity which arose after profiling the IAPT 2020 – 21 national data. I found myself wondering how my local picture might compare. In particular, how did local rates compare with the national recovery rate of 51.4%?

I’m pleased to say the local figure was easy to find. Embedded in the Psychological Therapies, Annual report on the use of IAPT services, 2020-21 is the powerful and rather addictive Annual Interactive Dashboard 2020-21. It’s the starting point for our search. Here’s the front page which holds IAPT’s headline data:

Starting page of the IAPT interactive dashboard 2020-21 showing key headline data

Clicking on the page tab at the bottom reveals a scrollable list of contents with jump links:

Page tab opens to display dashboard contents

I live in Brighton, and my local CCG is Brighton and Hove Clinical Commissioning Group (CCG). If you want to find the picture in your area, simply follow the steps (below) I used and select your local CCG (or provider organisation if you prefer). The data for recovery rates are summarised on page 13: Outcome measure rates for referrals finishing treatment in the year, 2020-21, shown below.

At the top of the page are percentage rates for recovery and other change categories for England nationally, including the recovery rate of 51.4%. To get to the Brighton and Hove CCG (or your preferred area) data simply check the CCG option in the Step 1: Select the type(s) of organisation box. Then, in the Step 2: Select the organisation(s) names box, select the relevant organisation. Select more than one if you wish, which is what I went on to do (more on that later). (You can get a full-screen view of the options by clicking on the Focus mode tab).

As shown above, the data for Brighton and Hove CCG is presented in both graph and table format. In contrast with the national rate of 51.4%, Brighton and Hove CCG’s rate is 34%, a 17-percentage point difference.

I’d found the answer to my original question about how my local area compares with the national data. As you might imagine, however, it led to further questions:

  1. Compared to other CCG areas, how low is 34% recovery?
  2. If this is the wrong side of the national average, what does good look like?

Compared to other CCG areas, how low is 34% recovery?

Page 14 of the dashboard provides interactive maps of recovery, reliable recovery and reliable improvement rates for English CCG’s. Colour-coded bandings make it easy to see rates of change for individual CCG areas. Hover over your chosen area and its rate (black panel, below) is displayed. Clicking on a crowded area expands the view, making individual CCG boundaries more distinct.   

Colour coded map showing variations in recovery rates for England CCG's

From the recovery rate map it didn’t take me long to answer my first question – how low is 34% recovery? You’re welcome to try for yourself, but I couldn’t find one lower. If you do, please let us know in the comments section.

What does ‘good’ look like, and have things changed any?

It didn’t take much longer to find the CCG area that I believe to have the highest rate of recovery in England. If you find one higher let me know, but that accolade seems to belong to NHS Stoke on Trent CCG, with a rate of 64%. 13 percent above the national average and, at 30 percentage points above Brighton and Hove CCG, nearly double its rate of recovery.

So there you have it. The highs and lows of the IAPT postcode lottery.

Three years ago I wrote a blog about IAPT performance in which I highlighted that the best performing area achieved a recovery rate roughly double that of the poorest. Ever the optimist, I came to this subject hoping that I might see some levelling up of the IAPT postcode lottery. It’s rather depressing, then, to discover that not much seems to have changed.

From bad to worse

If you think this IAPT geographical variation is as bad as it gets, I have some bad news. It gets worse. Much worse. In the national IAPT data, those clients that recovered represent just 21 percent of referrals that ended in the year. One in five. That’s bad enough. But, for one of the two services I’ve profiled here, that number is just 11 percent. That service was able to demonstrate recovery for only around one in ten clients whose referrals ended in the year.

Which service it was we’ll reveal in the next blog. As ever, we welcome your comments, including anything interesting you may discover from using the Annual Interactive Dashboard 2020-21!

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Posted by:Barry McInnes