Has anyone been performance managed out of IAPT due to not meeting targets?

This section is for discussion relating to the Layard report, and subsequent schemes like Improving Access to Psychological Therapies where lower intensity inteventions are offered in primary care
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Has anyone been performance managed out of IAPT due to not meeting targets?

Post by Bookend » Tue Jul 24, 2018 8:16 pm

Particularly the recovery rates?
It hasn't come to that for me (yet) but I'm just wondering if this has actually happened to anyone?
I wonder if it could be argued that this amounts to bullying and harassment if individuals are not provided with the 'means' to meet the recovery rate (adequate number of sessions, IAPT appropriate cases etc).
I'm feeling militant.

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Re: Has anyone been performance managed out of IAPT due to not meeting targets?

Post by miriam » Wed Jul 25, 2018 4:08 pm

I'm not an IAPT person, but given you have had no replies I thought I would respond as I have line managed someone that was underperforming and looked at the process for performance management in the NHS (though in the end it wasn't used due to wider organisational changes and the person being re-provisioned elsewhere).

Firstly I do need to say that being told that you are not meeting the requirements of the post is not bullying or harassment, unless there is more to the situation (eg your performance is the same as another member of staff who is not being told this, and/or there have been comments made about your gender, sexuality, race, religion, disability or other protected characteristic in relation to this under performance, and/or it has been part of a wider campaign to single you out and shame you in front of your peers, or something like that). They also don't have to give you more sessions or easier cases than any of your peers to make your job easier (unless you have a disability that requires this as a reasonable adjustment). However, performance management does have to set clear targets and give you opportunities to gain the skills you need to achieve them, before it can lead to a permanent contract being ended. So I would hope that the relevant manager is following and documenting that process, with the support of HR.

In the nicest possible way, I'd try to get out of the "militant" mindset, and look at whether there is a kernel of truth in their position (eg that you haven't been meeting targets that other people in similar roles are meeting) and put your energy into either finding a way to improve your performance, or finding a job where this isn't the expectation. Getting bogged down in a battle won't help you or change services.

That isn't to say that there aren't wider contextual issues. Everyone knows that there are problems with supply and demand in mental health after so many years of austerity, that a lot of staff are experiencing burnout or lowered morale. We also know that IAPT is a fast throughput system in which the demands on staff are high, and the level of complexity of referrals higher than the "mild to moderate" remit it is supposed to fulfil. However, I'm not sure that the way to raise those issues is by claiming that performance management is bullying or harassment (unless it is, see above). It might be more constructive to find a role that is less prescriptive, and/or to talk to peers and managers about service expectations, and/or to write a letter or paper about the nature of IAPT services and how the minimum ration of service from minimally qualified staff is being expected to resolve issues created from adversity, austerity, inequality, deficits in higher tiers of mental health provision, etc etc.

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Re: Has anyone been performance managed out of IAPT due to not meeting targets?

Post by Bookend » Wed Jul 25, 2018 5:33 pm

Thanks Miriam - I appreciate your reply, but I disagree. My original post relates more to recovery rates, which from my experience are rife with issues generally, including in terms of how they are used to batter down the morale of staff. I'd say demanding a 50% recovery rate in a service where therapists are only allowed to provide sub-therapeutic 'dose' (ugh, hate that word) of sessions as outlined in the protocols is bullying, and I've heard of this happening in other services (thankfully not mine). I can't remember the wording but I'm sure there is something in most bullying policies about bullying being indicated when people are not given the fair means to do their job, I'd say this comes under that heading. Personally I'd say a militant mindset is entirely appropriate. I'd also add that you seem to have jumped to the conclusion that I'm being performance managed - I'm not.

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Re: Has anyone been performance managed out of IAPT due to not meeting targets?

Post by hawke » Wed Jul 25, 2018 7:15 pm

Like it or not, IAPT (or its commissioner) is obsessed with targets!

You talk about being given 'the means' to meet the recovery rate - appropriate cases, number of sessions etc. In many ways, these are just IAPT-wide (NHS-wide?) issues. So while definitely unfair (to staff and patients!), I am not sure it would count as 'bullying' as it is not targeted at any one individual? If we're all provided with the same sub-par conditions, our performance can still be measured within the service and beyond.

Hopefully any manager would be comparing their staff against the service performance, rather than the rigid national targets. A good manager would allow some wiggle room for within-service variations - e.g. working in a particularly socially deprived part of the area, or a GP surgery notorious for inappropriate referrals, trainees vs qualified staff, or even just a month of poor health. A very good manager would be doing something to try and prevent these some of these issues impacting in the first place - e.g. assigning trainees suitable cases, moving people around surgeries so they don't get burnt out in the most difficult part of town, proactively getting out to promote the service remit etc.

When I was a full-time clinical in IAPT, I had a spreadsheet to track my own and the service's recovery rates. This meant that line management was never a surprise to me, as I already knew what my performance was that month and what overall performance I was being compared to. If I had a bad month, it meant I could fight their stats with my own - if you're dealing with someone who is obsessed with numerical targets, come back at them in the same language. Interestingly, my recovery rates were at their highest when I was trying to record sessions for the university course and therefore doing very rigid IAPT sessions. My assumption would have been that this was not going to work for a lot of patients, so the numbers did inform my practice too.

If you are not fortunate enough to have that very good manager, I have found much greater success going in with solutions to the problems, rather than a militant mindset. In fact, I have found working hard at a positive team spirit to be the most helpful thing. The culture needs to be about the team overcoming difficulties together, rather than individuals fighting against their managers. Individuals can be performance managed out - a team can't be.

I also think transparency is really important in IAPT. We had one occasion where our clinical hours target was raised, and our manager had been planning to tell us all individually in line management and work out new diaries with us there. The first couple of people this happened to freaked out though and told everyone else, causing mass contagion panic in the team. It only settled down after we hashed it out in a whole team meeting. Even after that, people kept secretly comparing diaries to try and make sure they were doing the right amount. So push for transparency! Ask for policies, procedures, performance targets to be discussed in meetings, not just line management.

So my suggestion (rightly or wrongly) is to CBT those feelings of militancy! It must feel pretty rubbish for you, and I would guess you'll get further at least presenting a different attitude. But I am about to flee the world of IAPT, so what do I know!

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