Navigating Client Engagement in NHS Talking Therapies: The Case for Adopting New Approaches

4 min readNov 15, 2024

The NHS Talking Therapies program is essential for supporting individuals with anxiety and depression. Yet, disparities in completion and recovery rates highlight significant engagement challenges, particularly among Black and Asian communities. Could adopting customer-centric practices from the private sector offer a solution? This article explores whether these approaches could bridge gaps in client retention and experience, contributing to a more effective mental health service.

The Data: A Snapshot of Challenges

Recent data from the NHS Talking Therapies Annual Report for 2022–23 highlights discrepancies in both recovery and completion rates:

Recovery Rates: (compared to the national target of 50%)

White clients: 50.8%
Black clients: 49.1%
Asian clients: 45.4%
Mixed (all): 45%

Completion Rates:

White clients: 42% (536,181 completed treatment out of 1,288,902 referred)
Black clients: 36% (25,602 completed treatment out of 70,556 referred)
Asian clients: 35% (42,091 completed treatment out of 118,206 referred)

These figures point to a significant drop-off between the number of clients who access services and those who complete treatment. This trend is particularly pronounced among Black and Asian clients, indicating potential barriers to sustained engagement.

The Argument Against Increased Pressure

Introducing more league tables and performance metrics, while potentially beneficial for accountability, risks reinforcing a culture where service providers prioritize KPIs over genuine patient care. In such environments, systemic issues may be hidden to create an illusion of success, compromising the openness needed for improvement. This ‘behave or else’ mindset can lead to practices that prioritize appearances over impactful, long-term change.

Additionally, a rigid focus on meeting numeric targets may exacerbate inequalities, as the pressure to show positive metrics might inadvertently shift attention away from building trust with underserved communities and understanding the unique factors that contribute to their drop-off rates.

Current Feedback Mechanisms

The NHS currently uses the ‘Friends & Family Test (FFT) which asks 15 questions aimed at gauging patient satisfaction. However, response rates have been notably low, perhaps due to survey fatigue or the length of the questionnaire. Recognizing this, the CNWL PCREF team, with whom I’ve worked with, plans to pilot a new SMS-based survey with just five questions — an improvement but still potentially overwhelming for some users.

My Experience and a Gap in the System

Reflecting on my own 30 hours of using Talking Therapies, I can personally attest to the importance of client feedback. I once discontinued a six-session course at the fourth session due to not connecting with the therapist. Surprisingly, despite this drop-off, I never received any satisfaction survey from the NHS to share my experience. This gap in follow-up not only limits valuable feedback but also fails to acknowledge the client journey and potential areas for service improvement.

The Argument for a New Approach

Drawing from my private sector experience, customer-centric models like the Bain Net Promoter Score (NPS) offer an alternative way to measure satisfaction and loyalty while driving meaningful service improvements. Using the NPS helps foster a culture of transparency, honest feedback, and a commitment to real enhancements. If adapted thoughtfully for the public sector, such an approach could elevate the quality of NHS Talking Therapies by focusing on patient experience and long-term engagement rather than short-term metrics. Unlike traditional feedback methods, the Bain Net Promoter System (NPS) is a philosophy built around loyalty, transparency, and actionable insights. The system classifies respondents as promoters, passives, or detractors based on their answers to one key question: “How likely are you to recommend [this service] to a friend or colleague?” This simplicity not only encourages higher response rates but also makes the results easier to act upon. By regularly sorting clients into these groups, organizations can create an ethical feedback loop that functions as both a customer balance sheet and a moral compass.

What This Could Mean for the NHS

Integrating a Net Promoter System would mean more than just gathering data; it would shift the focus to meaningful patient relationships and sustained engagement. This could pave the way for tailored interventions and trust-building measures that resonate with clients from diverse backgrounds, ultimately improving recovery rates and client satisfaction.

Conclusion

The question remains: should the NHS adopt private sector methods like NPS to improve client engagement? While more scrutiny and league tables might yield immediate accountability, a system that values honest feedback and patient trust will drive more sustainable change. Balancing these approaches could redefine how we measure success — not by how it looks on paper, but by how it feels for the people relying on these services. Implementing feedback-driven measures like the NPS could provide a balanced path forward, ensuring patient care remains at the forefront while pushing for continual improvement.

Call to Action

This topic invites crucial debate among mental health practitioners, policymakers, and service users. What are your thoughts on integrating private sector practices into public health? Can we find a balance that prioritizes patient care and accountability in a meaningful way?