ieso has had four contracts with steps2change since commencing partnership in 2016. In that time it has seen 528 patients in the county, 70% of whom went on to complete the course of treatment.
The main driver for steps2change commissioning ieso is to provide urgent additional capacity to relieve waiting lists over the vast geographical area the service spans. This is in addition to patient choice, out of hours provision and digital innovation drivers.
It is estimated that 105,838 adults aged 16 and over suffer from a common mental disorder; this equates to 17% of the total adult population. Nationally, 4.4% of adults screened positive for post-traumatic stress disorder (PTSD), which represents 27,417 adults across Lincolnshire. Prevalence of depression in Lincolnshire is above average at 10.06% (63,763 patients) compared to 9.09% nationally. Prevalence of mental health in Lincolnshire has risen slightly from 0.76% in 2015/16 to 0.79% in 2016/17 based on QOF registered outcomes. During the same period, prevalence of registered depression has also increased from 9.06% to 10.06%. Prevalence increases for both mental health and depression in Lincolnshire are in line with national increases.
The rates of suicide in Lincolnshire have been higher than nationally for the majority of the last 20 years. The most recent data, calculated as 3 year rolling averages (2015-17), shows that Lincolnshire rates (9.78 per 100,000 population) are currently very similar to the England rates (9.57 per 100,000 population). In Lincolnshire, suicide rates are the highest among people from areas classed as the most deprived in England: 17.09 per 100,000 population which is nearly twice the national average (9.6 per 100,000 population) and nearly 3 times as high as in the least deprived areas.
Lincolnshire Partnership NHS Foundation Trust provides a variety of mental health and community health services, across Lincolnshire for adults of working age, older adults and Tier 4 services for children and young people. The trust provides these services across nine registered locations across Lincolnshire and covers a geographic region spanning 2,720 square miles where it serves a population of approximately 750,000 people. The trust has an annual expenditure budget of £100 million (2018/19) and receives 56,000 referrals a year.
steps2change is the lead provider of Psychological therapies (IAPT) for Lincolnshire Partnership NHS Foundation Trust and provides mental health services for adults of working age that are referred for Step2 and Step 3 therapy, in particular talking therapies for people experiencing problems with mild to moderate mental health problems such as anxiety, depression, stress and help with issues like bereavement or the impact of a traumatic event.
The Steps2Change team consists of qualified Cognitive Behavioural Therapists, Counsellors, Interpersonal Therapists, Psychological Wellbeing Practitioners and Employment Advisors; all employed by Lincolnshire Partnership NHS Foundation Trust to provide psychological treatment on behalf of Lincolnshire Clinical Commissioning Groups. Patients can access treatment through self-referral or through a GP or health professional.
1. Rapidly deploy additional therapist resources to address long waiting lists and meet budget utilisation deadlines
With growing numbers of patients needing to access talking therapy, the waiting list had become significant and needed to be addressed urgently. Budget was allocated with deadlines for when the budget needed to be utilised. Mobilisation through recruitment processes or hiring agency staff can take weeks, sometimes months. Once under contract ieso can mobilize within 24 hours and with a recognised framework. In terms of budget utilisation, agency staff must build up a caseload at the start of the contract and wind it down at the end of the contract period, resulting in unused capacity. ieso’s fees are on a per patient basis which avoids this issue.
2. Overcome scepticism from GPs and health professionals about the quality of therapy delivered remotely by text messaging
steps2change first implemented ieso’s service platform in 2016, at a time when online CBT was fairly new and as such many of Lincolnshire’s clinicians were sceptical, believing that effective therapy can only be delivered face to face, in the same physical location. Though sceptical, steps2change faced an immediate need and were assured by evidence and recovery rates that it could match Step2Change recovery rates. The concern was addressed through a Service Level Agreement and the ieso’s service platform was deployed. Once the clinical results came through any prior scepticism disappeared. Ieso’s clinical outcomes were as promised.
Nick Harwood, steps2change Service Manager, Lincolnshire
“We initially invited ieso to join a tender process for a waiting list initiative. We had some waiting lists that had become longer than we’d like for CBT in some areas due to growing numbers of patients. The challenge with having long wait lists and some newly allocated budgets with spend deadlines attached is how to turn the money into seeing patients, with recruitment being a process that doesn't happen overnight. Budgets are often non-recurrent and short-term, so it was important to use the money as efficiently and rapidly as possible to reduce waiting times for our patients. We were aware of ieso offering online CBT and were interested in using the service as an alternative to the usual agency staff approach to this short term fix.
“The flexibility that could be offered was something that we hadn’t considered. We had a reason for wanting to use ieso but through conversations we discovered an added benefit to using it. Having the service running remotely online became an empowering advantage in giving our patients flexibility around times they could choose to access therapy. Generally, our service is 9-5, Monday to Friday. ieso is accessible in the evenings, middle of the night, and weekends. This offer added unexpected benefits for people who couldn't get to our bases for whatever reason, be it transport, work commitments, childcare commitments or co-morbid conditions limiting mobility.
“Around that time digital was a relatively new option to mental health services. We had many clinicians with the attitude that therapy is best delivered face to face in the same physical location. The evidence was suggesting that online, text-based CBT is just as effective but our therapists didn’t agree at that point in time, they hadn’t seen the results for themselves. The idea that a patient would never actually go and see their therapist and only have a conversation online and only through a text-based service was novel. We were all a little cynical and skeptical but overriding that was an interest in how this could really work as effectively as face to face so we allocated the budget to online CBT and the long waiting times disappeared with results exactly as we had hoped.
“Now that we have been working with ieso for a while we don’t have any second thoughts about using them when we have a budget available to reduce waiting lists. We don’t have any hesitation from clinicians either. Digital solutions are becoming more important as they offer patient choice about access.
“We’ve used ieso for the past 5 years now to reduce waiting lists. It’s reassuring to know that we've got the backup from ieso as an extra resource that we can pull in. In terms of being able to mobilize quickly versus internal recruitment processes or taking on agency staff, it can take weeks or months. Whereas with an ieso contract in place I can say “Can we have ieso access tomorrow please” and ieso can mobilize quickly and with a recognised framework. Within a day of mobilizing with ieso we can start making referrals and patients get into treatment as soon as possible.
“Feedback from patients is good. It doesn’t appeal to everybody but patients who do engage with ieso are positive. People are increasingly accessing their world through smartphones and tablets so why not therapy? We don’t discriminate with who we offer ieso to but we take personal preferences into consideration. In terms of who accepts it, it would be easy to assume it would be all young people but in reality, it is quite cross sectional. With our own computerized CBT we have had patients as old as 87. Longer term we’d like to be able to offer all suitable patients online CBT through ieso or similar, all year-round.”
1. Online CBT is as effective in the treatment of patients as face to face therapy.
2. ieso’s service platform offers our patients flexibility and choice in terms of the time and location of their therapy.
3. Online CBT can be mobilised rapidly to significantly reduce waiting times.
1. Never be afraid to try something new when faced with a repeating challenge!
2. Embrace technology; used correctly it can significantly improve patient services and reduce resourcing admin time.
3. Mental health is not a 9-5, Monday to Friday problem so offering patients choice on access helps get patients into therapy who can’t manage in normal work times.
By working with over half of all NHS CCGs, ieso is already one of the UK’s most trusted online therapy providers.
With our sessions being typed or taking place over video, and available around the clock, we’re able to reach patients like never before. While patients get better access to mental healthcare that is just as effective as face-to-face therapy, but that benefits from evidence-based insight gained from the tens of thousands of people we’ve already helped.
And by sharing the learnings from our network of fully-qualified clinicians with the entire NHS community, we are able to offer anyone, anywhere access to better mental healthcare, to help them get better, faster.
Find out more about ieso.
For more information email: firstname.lastname@example.org
 Lincolnshire Research Observatory Joint Strategic Needs Assessment http://www.research-lincs.org.uk/jsna-Mental-Health-Adults.aspx
 Lincolnshire Research Observatory Joint Strategic Needs Assessment http://www.research-lincs.org.uk/jsna-Suicide.aspx
Lincolnshire Partnership NHS Foundation Trust Care Quality Commission Inspection report 16/01/2019 https://www.cqc.org.uk/sites/default/files/new_reports/AAAH6645.pdf