A70Delivery risk: AmberGate: pending
Get effective depression treatment to adults missing out
Existing action A70, assessed at the same scope.
Not stated in the review record; treated as a provisional single-reviewer assessment, not an approved business case.
- Who and where
- Adults in England with depression for whom NICE recommends psychological therapy, starting with integrated care boards covering the most deprived tenth of areas, where reliable recovery is lowest. (from the action record) Jurisdiction: England.
- Result so far
- Range if completed: 19.0–22.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))
- Funded now (baseline)
- Funded baseline: NHS Talking Therapies (1.81m referrals and 674,683 finished courses in England in 2025–26), with ring-fenced funding and a planning target of 805,000 courses by the end of 2026/27 and 915,000 by 2028/29. Targeting extra capacity at the areas with the lowest completion and recovery is a UK Facts proposal, not government policy. (from the action record)
- The change assessed (marginal)
- Close a verified access gap for clinically appropriate NICE-recommended adult depression treatment, with supervision and an escalation route. (from the 6 October review)
- Domain home: Health
- In the national plan: Wellbeing list
What the evidence supports—and the next decision
NICE supports clinically appropriate treatments; that evidence does not quantify the effect or budget of expanding a particular local service.
AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.
- Define the change
- Identify an underserved adult depression cohort and a specified NICE-consistent treatment pathway with supervision and escalation.
- Test whether it works
- Symptoms, functioning, recovery, deterioration and access against commissioned care, with follow-up and appropriate clinical oversight.
- Establish the cost
- Triage, treatment sessions, supervision, follow-up and escalation × realistic caseloads; cost-effectiveness is distinct from the available budget.
- Protect against harm
- Use shared decisions, safeguard patients and protect provision for severe or complex needs.
Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.
Full assessment of Get effective depression treatment to adults missing out: ten criteria, scenarios, delivery, costs and monitoring
The ten criteria (0–3)
Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.
Scale and severity (Sc)3 of 3 — Severe harm across a broad population
Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery
Confidence in the proposed action (Ev)2 of 3 — Relevant evaluated evidence with limitations
Expected incremental benefit (Bn)2 of 3 — Material for the target population
Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards
Incremental affordability (Co)Not yet assessed
Delivery capacity (Ca)1 of 3 — Binding scarce resource
Distribution (Fa)3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens
Meaningful first outcome (Ti)2 of 3 — More than one and up to three years
Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step
Four weightings
Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.
- Equal weights: Range if completed: 19.0–22.0 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
- Evidence doubled: Range if completed: 19.1–21.8 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
- Scale doubled: Range if completed: 20.0–22.7 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
- Cost ignored (the funding gate still applies): Range if completed: 21.1–21.1 out of 30. Not yet assessed: incremental affordability (Co). The missing criteria carry no weight here, so the ends meet; the record is still incomplete. Funding gate: not passed.
Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.
Delivery risk and gate
Delivery risk shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.
Review’s reason: Verify unmet clinical need and commissioned care; cost therapists, supervision, triage, follow-up and escalation; monitor symptoms, functioning, deterioration and access. Proposed owners: NHS commissioners and providers; jurisdiction-specific.
Why it is not Green yet
- Scope (population, place and increment) not verified against the delivery baseline.
- No verified owner with the powers in place.
- Delivery capacity not verified.
- Lifetime incremental costs not complete.
- No credible funding (a committed allocation for the scope).
- Safeguards not specified.
- Monitoring lacks a metric, a data source or a baseline.
Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.
Gate: Pending — appraisal incomplete (review label: “Pending baseline verification, incremental costing and funding; not a rollout approval”).
Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).
The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.
Cost and funding
Lifetime costing: Not established. Review: “Not fully costed in this review”.
Still to cost: Verify unmet clinical need and commissioned care; cost therapists, supervision, triage, follow-up and escalation; monitor symptoms, functioning, deterioration and access. Proposed owners: NHS commissioners and providers; jurisdiction-specific.
Funding status: not identified.
Owner, powers and capacity
Proposed owner: NHS commissioners and providers; jurisdiction-specific (proposed, unverified).
Powers: needs a decision or allocation. Capacity: binding constraint.
Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).
- England:
- NHS England and integrated care boards, with NHS Talking Therapies providers (action record)
- Scotland:
- not assessed
- Wales:
- not assessed
- Northern Ireland:
- not assessed
Scotland reports psychological therapies against an 18-week standard (80.7% started within 18 weeks, quarter ending June 2026, against 90%); Wales provides primary-care mental health services under the Mental Health (Wales) Measure 2010; Northern Ireland was not checked. Not comparable with NHS Talking Therapies.
Dependencies, safeguards and risks
Depends on: None recorded.
Safeguards
None specified yet.
Monitoring and measured results
Metric: Define and baseline the outcome described in delivery requirements before approval.
Data source: Not yet named. Baseline: Not yet established.
Measures already on the domain page
- Reliable recovery in Talking Therapies, most deprived tenth of areas: latest 40.7% (least deprived 52.7%) (2025–26); baseline not published (England).
- NHS Talking Therapies courses finished: latest 674,683 (2025–26); baseline 670,419 (2024–25) (England).
A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.
Evidence for the outcome
Outcome: Define and baseline the outcome described in delivery requirements before approval.
NICE provides treatment evidence and clinical recommendations. They do not establish that a new access pathway reaches additional patients or that sufficient therapists are available.
Sources: nice.org.uk (P-GC-NICE-NG222)
Review record
Assessment status: Not stated in the review record; treated as a provisional single-reviewer assessment, not an approved business case.
Reviewer: Original assessment author (name not supplied). Reviewed: 6 October 2026.
Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.
An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.