On my very first day as an NHS Cognitive Behavioural Therapy (CBT) therapist, I was shown around the office by a senior colleague.
It was during this induction that they told me they were actually leaving the NHS to work as a private therapist. At the time I didn’t think much of it, staff turnover in the NHS is nothing new.
Years later, I recognise it was one example of what I can see is a growing trend among therapists.
The road to becoming a therapist can be a long one. After I initially graduated university I did years of unpaid voluntary work, ‘experience gathering’ roles and further postgraduate qualifications, before even being accepted onto a training course to become a therapist.
When I finally qualified I was elated, envisioning the stereotype of the calm therapist, head cocked, empathically nodding while taking their time to listen and help someone in need.
I had finally started the journey towards my dream job.
However, I was soon asked to see more and more patients each day, offer them shorter appointments and fewer sessions overall so the next patient on the waiting list could start.
By the end of each day, I was feeling frazzled from the increasing pressures, trying to squeeze the last drop from my reserves of empathy. I was beginning to wonder whether I was just a bad therapist for not being able to easily cope with this.
I love the job that I do – I think it’s the best job in the world. There’s generous holiday allowance, good pension, ongoing training opportunities, and supportive colleagues.
General mental health awareness is increasing, and there is an army of practitioners that have been trained and qualified to help patients experiencing common mental health problems such as depression, generalised anxiety disorder, social anxiety, post-traumatic stress disorder, health anxiety, panic attacks, phobias, obsessive-compulsive disorder and more.
In terms of the actual day-to-day, I have the privilege of hearing people’s difficulties and of working with them to help them through what can be some of their darkest times.
I also love the idea of the NHS – it’s free for everyone and we all have access to therapy. In fact, if I won the lottery, I would still do my job (although maybe just part-time).
It’s not all good news though.
In some areas of the country, I’ve seen that patients are being offered fewer than the NICE (National Institute for Health and Care Excellence) recommended numbers of therapy sessions. This means that therapy can feel rushed, and so can be less helpful than it should be.
In general, targets are a constant focus, I’ve heard from colleagues that waiting list numbers are creatively reported to make it appear that patients have started therapy sooner than they actually have, staff are offered ‘stress management’ workshops during their lunch breaks and we are given pin badges lauding ‘thank you NHS’.
But NHS staff are not heroes. We are real people with bills to pay, families to support and personal lives to try to lead.
Salaries for NHS CBT therapists start at £40,057. This is by no means low-paid compared to the average UK salary.
The thing is, over the past year, my inbox on LinkedIn has filled with private therapy companies offering better pay (£50,000 and over), with lower caseloads of patients, and the flexibility to offer greater numbers of sessions to each patient.
With the cost of living ever increasing and little prospect of the Government readily paying NHS staff appropriately, I have accepted one of these offers on a part-time basis, for now.
Better pay for less work, who wouldn’t want that?
Because of my love for the NHS, I hope it becomes viable for me to stay
The ironic thing is; where can these private companies get their referrals from? The NHS. Some NHS trusts commission private therapy companies to help manage waiting lists. Then the private companies can pay a higher salary to the therapists they employ.
I recently caught up with an ex-colleague who started their own independent therapy practice, earning double their former NHS salary. Anecdotally, this seems to be the trend – few therapists I know now work solely full time in the NHS.
If the NHS is to recruit and retain therapists – not to mention reduce waiting lists – then NHS pay needs to be appropriate to staff’s expertise and responsibility. It should be comparable to what they could earn elsewhere, with caseloads that are manageable – otherwise the lure of more attractive offers will pull therapists away from the NHS.
Therapists spend all day teaching others how to value themselves, and therefore are potentially the least likely of NHS professionals to endure mistreatment. Ultimately, it’s patients who will pay the price – disproportionately, the poorer ones who can’t afford private therapy.
So, what does the future hold for NHS therapists?
Personally, I have one foot out of the door following the recent blanket £1,400 pay increase across all NHS pay bands. But I’m waiting to see if the predictable forthcoming strikes do anything to wake the Government up before I decide whether to work privately full-time. Because of my love for the NHS, I hope it becomes viable for me to stay.
NHS pay, nursing shortages, ambulance waiting times and dentistry shortages have been highlighted recently, but what about mental health provision for patients? I have written to the last three health secretaries attempting to raise a warning about an impending crisis in mental health care and access to therapy within the NHS. Hopefully the current one is reading.
My message to the Health Secretary is this: if you don’t want patients to wait longer – with the only therapists left burnt out, underpaid, running on fumes of empathy and blind loyalty to the NHS ideal of free therapy available for all – then address this now, or at least reply to one of my emails and discuss the issue.
And if you won’t do it for the obvious moral and ethical reasons, then do it for the economic ones.
The name of the author has been changed.
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