Colour Breathing Relaxation Technique® (CBRT™) 1
“Providing Patients with an effective system to relax themselves naturally”
CBRT™ NHS Training Initiative 2012 - Overview Statement
This QIPP2 and focused Training Initiative will train your staff to provide structured,
relaxation support sessions, with a new Innovation3 in Mindfulness approach for Patient
groups and individuals, who would benefit from learning to relax naturally, and/or who have
symptoms of mild depression or anxiety related conditions. This Training Programme based
Initiative also promotes CPD provision in training and is “a natural partnership with research
and innovation to improve health outcomes.” (Liberating the NHS: Developing the Healthcare
Workforce4 ) 10.01.2010
Initiative Name:
CBRT NHS Training Initiative 5
Cost per participating Trust:
£45,127.70 + VAT
Estimated QIPP savings per Trust :
c. £2.2 million per annum
Initial initiative implementation:
October - December 2012
National Director:
Alison Bourne6 , CBRT International Ltd
KEY POINTS:
 CBRT will train 25 staff members at your location in the CBRT Technique - CBRT
Practitioner Training Programme* (2 days.) 7
 Staff to complete their Training Programme content with 40 question Assessment Paper
and 10 Case Studies of provision of CBRT to individuals and groups . (4 – 6 weeks.)
Above papers marked and certificates of training returned. (3 weeks/15 working days.)
 Five trained staff then selected to attend further “Train the Trainer “Training Programme
in January/February 2013.
 Each Trust will receive in Phase 3 100 CBRT Training Kits for their own use.
 The CBRT Training Programme is in preparation for CPD Accreditation by The Royal
College of Nursing 8 and The College of Occupational Therapists 9.
 Colour Breathing tool kit and system is in preparation for CE marking10 and ISO: 1348511
Class 1 medical device status.
 The NIHR NHS Research Design Team South West
12
(Bournemouth University) is
involved the development of an NHS led clinical research programme into CBRT,
Depression, Dementia and Delirium - to prepare the pathway for CBRT to become a NICE
approved relaxation technique.
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
1. CBRT NHS Training Initiative Overview
CBRT™ (Colour Breathing Relaxation Technique) provides individuals from all
backgrounds with a comprehensive, very effective and easy to learn “Relaxation Support
Technique” (CBRT RSS). A patent holding, UK invention 13, CBRT has been in
consistent and progressive development stages since 1997. What started out as a
simple idea as a self-help relaxation book kit using Colour Breathing Disks as a focus
tool, was soon discovered to aid individuals and peer groups experiencing low to
moderate depression and anxiety disorders. A series of one day workshops in 2002
within two years became a Practitioner Training Programme recognised by the BCMA
(British Complementary Medicine Association 14.
Patients are provided with a “Colour Breathing Disks Easel Chart” 15 as a visual tool to
focus on (also see image on top of front page) containing a set of seven coloured disks
whilst a) becoming aware of their natural breathing pattern and b) relaxing their body in
seven stages. The product is very safe to use, being of printed matter.
The seven “Colour Breathing Disks®” have been specially designed with subtle gradient
effects for individuals to use with ease. They are a physical item to see and hold, yet
visual point of focus, for individual and group led relaxation support sessions. Individuals
enjoy using CBRT as a relaxation technique and using colour as a means of expressing
how they feel.
The Initial Colour Breathing® Trials of 1999 – 2000 16 involved over 120 members of the
public engaged in a controlled comparison trial in the use of the Colour Breathing Disks
and visualisation. Research has since involved training a wide group of mental health,
education and complementary professionals – the majority from within the UK, who have
provided valuable case studies and feedback. Their valuable data includes a wide range
of presented conditions and social care case studies including insomnia, GAD, the full
spectrum for depression including PTSD and suicide tendencies.
CBRT is a practical, low cost, simple and versatile innovation. In March 2011, CBRT
scored 92.53% with the NHS National Innovation Centre Technology Scorecard.17 The
CBRT NHS Training Initiative is Patient-centred, recovery focused and promotes SelfCare.
NHS Staff will be trained to be able to deliver structured and effective CBRT Relaxation
Support Sessions to either individuals - or groups of between 5 - 20 Patients at a time,
within 30 – 45 minutes.
NHS Staff will be able to use CBRT to engage with individuals or groups of Patients as
part of their existing work schedule. This Training Initiative will provide training for 25 -28
members of your staff , with 5 of these receiving an additional two day “Train the Trainer”
programme – to enable self training of all future CBRT Training Programmes.
CBRT is a Mind-Body Relaxation Technique 18 which combines breathing techniques 19 ,
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CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
Mindfulness approach 20 , positive thinking 21, self-help and guided self-help 22 , MBSR
(Mindfulness –based stress reduction) 23, Mind-body interventions 24 , creative
visualisation 25, meditation 26, group therapy 27 , anxiety breathing techniques 28
(including controlled breathing) all supported by NHS Evidence 29 as being beneficial
components to mental health, preventative health and wellbeing programmes. (The aim
of controlled breathing is to slow down your breathing and heart rate, relax tension in the
muscles, quieten the mind and empty it of worrying thoughts.)
The many associated benefits to having structured CBRT Relaxation Support Sessions
available to both Patients and NHS Staff are many. Feedback from existing CBRT
Practitioners is very positive, with CBRT being a popular and effective relaxation
technique for men, women and children of all abilities who wish to lead healthier lives.
CBRT is simple and safe to use (being non invasive or pharmacy lead) and encourages
dialogue. Working with the Patients and getting them involved in the selection of their
own affirmations for positive thinking is also both popular and beneficial..
The proactive management of people with long-term conditions, including the promotion
of self-care by patients, is a key priority for the NHS. CBRT provides active support for a
positive approach to management of long term conditions 30 and primary prevention
through focusing on a natural relaxation process for better self care.
2. Current mental health provision status within the NHS.
“Mental illness 'under-treated by NHS' ” 31 (18.06.12) is a report carried in the NHS
Choices website 32 . The report was written by the London School of Economics Centre
for Economic Performance 33 Mental Health Policy Group Think Tank. The report, How
Mental Illness Loses Out in the NHS 34 was produced by a distinguished team of
economists, psychologists, doctors and NHS managers convened by Professor Lord
Layard 35 of the LSE Centre for Economic Performance.
The report says that mental illness is widespread and is generally more debilitating than
most chronic physical conditions. The researchers report that a third of all families in
Britain have a family member with mental illness. Additionally, nearly half of all ill health
in those younger than 65 years is due to mental illness and only a quarter of those
needing treatment receive it.
The report estimates that 6 million adults have depression or anxiety and 700,000
children have a mental health disorder. The report also found that mental health
problems account for nearly half of absenteeism at work and a similar proportion of
people on incapacity benefits.
ii. Another report in Mental Health - “Patchy Progress shown for Mental Health
Treatment” 36 states that according to the official IAPT statistics, of the six million people
in England who have depression or anxiety problems, only 2% received talking
therapies between April and June 2011. Of these:


210,540 were referred for psychological therapies
123,065 entered treatment
Page 3 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012

92,638 are waiting more than 28 days for treatment
iii. The “NICE Guideline on the Treatment and Management of Depression in Adults” 37
(2010, page 293) states: “Low-intensity interventions are clinically and cost effective for
subthreshold depressive symptoms and mild depression, and therefore are to be
preferred over individual and group CBT (and other high-intensity psychological
interventions) as the initial treatment for subthreshold depressive symptoms and mild
depression. Group CBT is an effective treatment for mild depression but, given the
duration of the group and the staffing of such groups, it was viewed on costminimisation grounds as less cost effective than low-intensity interventions but more
cost effective than individual CBT, and so was placed between them in the steppedcare model.”
With stress and anxiety affecting many millions of people in the current economic
climate, mild to moderate mental health needs require support . The provision of CBRT
Relaxation Support Sessions used as a health and social care interface is a practical and
common sense approach to the above situation which can also support a diverse
population, with individual and community support service needs. CBRT received an
extremely positive and excellent response from NHS management attending the DH
Healthcare Innovation Expo 201138 – which has resulted in this CBRT NHS Initiative
being written.
Provider groups will benefit having an effective solution and providing an additional
Patient Care based service - to quickly increase capacity to care - for the growing
numbers of individuals and groups requiring mental health and wellbeing support. Staff
undertaking the Training Programme will benefit from feeling valued through having CPD
training and enhanced skill sets. All NHS Staff will benefit from provision of CBRT RSS in
their place of work, whether they work in the offices or A & E.
3. CBRT Brief History and Background 39
1997 – 1998 Colour Breathing Disks invented and prototypes created for UK Patent.
1999 – 2000 First Research Programme
2000 - UK Patent granted
2001 – 2004 Frankfurt, Australian, American, UK Book Publishing Fairs
2002 - First products production run and workshops including Denver, US.
2002 – 2004 Colour Breathing Practitioner Training Programme written
2003 – 2006 Colour Breathing part of EI Education Programme in Hampshire
2004 – Colour Breathing first speech at ISMA (International Stress Management
Association ) Annual Conference - London
2004 - “Colour Breathing” CBRT Training Programme was first acknowledged as a
relaxation technique by the BCMA British Complementary Medicine Association
2004 – First Colour Breathing Practitioner Training Programme
2005 – 2011 – Over 250 individuals trained in Colour Breathing technique in UK and
Page 4 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
Australia.
2005 – 2008 Action Mental Health Northern Ireland 40
2009 – 2012 – Southern Health Community Trust, Northern Ireland 41
2010 – Colour Breathing becomes acronym “CBRT” in preparation for NHS entry.
2011 – CBRT showcases at DH Healthcare Innovation Expo during which the CBRT
products and evidence based case studies attracted great interest from the hundreds of
healthcare professionals attending.
2011 – Present. CBRT has completed the NHS NIC Technology Scorecard in March
2012 (92.53% score) and is preparing for NHS entry with support from the DH Innovation
Procurement & Commercial Division with this Initiative.
Improving outcomes
CBRT provides a practical means of improving outcomes, including excluded groups in
society, in contact with secondary mental health services. CBRT intends to work with the
NHS NIHR Research Team to enable CBRT to become a NICE approved relaxation
technique. This would enable CBRT in the future to be considered for future mental
health funding for psychological services such as “No health without mental health: A
cross-government mental health outcomes strategy for people of all ages” 42; and
“Talking therapies: A four-year plan of action” 43. CBRT intends to support provider
groups with an agenda for Positive Outcomes and is a QIPP focused 2 initiative providing
Patients with better services, new self-care initiatives, innovation, and cost savings.
Recent changes brought to the NHS procurement landscape as of January 2011 are
provided in the websites www.innovateuk.org/health 44 and www.healthktn.org.uk 45
which states “Each SHA holds a legal duty to promote innovation, raising the profile of
innovation and encouraging a more rapid adoption of innovation throughout the health
service. ‘Innovation leads’ are employed in each Authority to deliver this requirement.
This focus on encouraging the entry of innovation into the NHS is also underpinned in
“Innovation Health & Wealth 3 (June 2012 version) Accelerating Adoption & diffusion in
the NHS” - mentioned at the beginning of this Initiative.
4. CBRT Research
CBRT is working with the NHIR NHS Research Design Service Team South West 12
on research grant programmes and applications with Dr. Sarah Thomas, Dr. Zoe
Shephard with additional support from Dr. Paul Ewings. One proposed area for research
is Depression, Dementia and Delirium. CBRT have also met Professor Anthea Innes
Head of The Institute of Dementia 46 in Bournemouth.
The CBRT Research Team 47 comprises Professor Stephen Westland, Dr. Vien
Cheung, (Leeds University) Dr.Ute Leonards (Bristol University) , Dr. Sophie Weurger
(Liverpool University.) Since 1997, Alison Bourne has been supported by many leading
medical, academic, healthcare, mental health and education specialists from across the
UK and USA. During the R & D stages, over 250 professionals from the UK, Germany,
Australia, Canada and Brazil have undertaken the CBRT Training Programme, using
Page 5 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
CBRT in their work, providing feedback and case studies. Since 2001 support has been
received from leading academics from: Universities of Leeds, Bristol, Essex,
Southampton, Oxford University, Faculty of the Mind, Royal Holloway, University of
London.
The CBRT Apparatus is a UK invention and healthcare technology with a current UK
Patent, International Trademarks and Copyright. The international interest in CBRT
underlines the importance of this CBRT NHS Training Initiative; CBRT International Ltd
has taken advice and worked closely with many government bodies including SEHTA
(South East Health Technologies Alliance) 48 South East Business Innovation Growth
Team 49 UKTI (UK Trade & Investment) 50 – over 20 meetings with Healthcare Sector
Specialists from Europe and major countries e.g. USA, India, China, The Middle East.
Examples of over 70 individuals and groups CBRT Case Studies 51 can be viewed
online.
The CBRT Practitioners Code of Conduct 52 is based on the Midwifery Code.
You can read the Colour Breathing Book Foreword 53 by Consultant Gynaecologist
Mr. M. Dooley MMs FFSRH FRCOG. 54
5. CBRT NHS Training Initiative - Goals and Benefits
•
To provide additional benefits to Patients and a toolkit and system for self-care.55,56
•
A simple and effective relaxation technique which anyone can learn.
•
CBRT provides a caring interface for Staff and Patients.57
•
CBRT Initial Response Sheets© used by professional are said to provide Patients
with a form of talking therapy provision -Talking therapies: A four-year plan of action.58,59
•
Reducing referrals for medically unexplained symptoms 60
•
Patient Choice. Satisfaction from knowing that they have played a part in helping
themselves relax - “Personal Health Budgets Report 60
•
Reducing referrals for medically unexplained symptoms 61
•
Staff trained in CBRT will learn a new skill to help their colleagues and Patients
relax. “Health and Social Care Provider Units in Healthcare 62
•
Help children and young people - read “The Discovery Initiative” (CBRT in
Education and Pre-school sectors) 63
•
Relaxation Support Sessions could provide a visible and tangible positive wellbeing
effect for Patients –(including those with Personal Health Budgets.) 64, 65,
•
A service to help Patients with measurable improvement towards individual
recovery goals.
•
Support for those with Dementia and their carers “Living well with dementia: A
national Dementia Strategy” 66
•
Less chance of Patient relapses through having additional support.
•
Patient Choice for those who do not wish (nor require) to start medication.67
•
More appropriate use of healthcare resources and time.
•
Potential savings for fewer GP appointments could lead to shorter waiting times.
•
An all-inclusive and anti-discriminatory new service provision.
•
The Initiative estimates that each Trust with 125 staff trained, it is possible to
provide additional support to c.12, 000 Patients per annum.
Page 6 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
Potential cost savings per Trust are estimated c. £2.2million per annum through
reducing GP appointments, a reduction in the requirement for medication, self care
support and preventative health measures.
6.Target datelines for the initial CBRT NHS Training Initiative:
1. The CBRT National Training Team will train 25 of your staff members during the
Autumn/Winter of 2012 / 2012. Please advise us of your preferred dates as soon as
possible.
2. It is the responsibility of the provider group to ensure that all assessment papers
and case studies by staff members are completed by the agreed date.
3. The CBRT National Training Team will train 5 members per group provider to
become CBRT Trainers in January/February 2013. These will be permitted to train
further CBRT Practitioners in their own group provider region/boundaries only.
4. We suggest each CBRT Trainer aim to train an additional 20 staff each in 2013.
The CBRT National Training Team may monitor and observe these initial training
programmes. In the future, each NHS CBRT Trainer may train as many individuals as
they wish, from within the boundaries of their group provider region, with supplies and
stock available for purchase with NHS discount through CBRT International Ltd.
It is hoped that future CBRT Training Programmes will be offered to individuals from
within 3rd sector support groups who could benefit from being able to provide the CBRT
service e.g.: public health, local government, voluntary and community organisations,
Social Services, Education sector, Prisons/Institutions. The Training provider is
permitted to charge appropriate fees for this service. CBRT Relaxation Support
Sessions can provide support for wider social care in the community; Job Centres,
Prisons, Youth Offenders Units, etc
5. If a Trust wishes, all CBRT products may be customised to contain local logos,
NHS addresses, local message to Patients, contact details and images, in full colour.
CBRT products may be produced in different languages, font sizes, Braille, at
additional cost.
7. Initiative Interdependencies and Inputs
Having your staff trained in CBRT will provide a Primary care intervention to help
people with mental health problems, through structured relaxation support sessions
(care) which optimises engagement, prevents or anticipates crisis, and reduces risk.
“The Coalition – Our Programme for Government (May 2010) 68 included the
government’s commitment to talking therapies to reduce long-term NHS costs. The
White Paper Equity and Excellence: Liberating the NHS (July 2010) 69 aims to:
• Enable long term savings to the NHS
• Meet local and individual needs while enabling equitable access for all
• Collect good quality data to inform future service delivery
1. The Spending Review (October 2010) 70 specifically stated that the health settlement
will enable Department of Health to 'expand access to psychological therapies.’
Page 7 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
2. Equality Act 2010 71 requires all services to promote equality across their
communities and to publish information in a way that the public can judge how it has
been used to eliminate discrimination, advance equality of opportunity and foster good
relations between different groups. (A socio-economic duty for public bodies and a
public sector equality duty determined over the winter of 2010, which came into force in
April 2011.)
3. Equality Focused Services:
CBRT is a non denominational, non tactile and all inclusive relaxation technique.
“Demand for evidence-based psychological therapies services remains high across all
communities. Some groups may have higher prevalence of anxiety disorders and
depression than others (e.g. the homeless, military veterans). Other groups may have
proportionately lower levels of identification despite high levels of need (e.g. people
who are gay, lesbian or bisexual). The needs of all these groups should be taken into
account alongside those with the legally protected characteristics of age, disability,
ethnicity, faith, gender, sexual orientation, pregnancy and maternity.”
8. The CBRT NHS Training Initiative also supports these policies:
1. QIPP : Liberating the NHS,
2. Self Care: An Ethical Imperative 72,
3. Health and Social Care Provider Units in Healthcare 73 ,
4. Living well with dementia: A national Dementia Strategy 74,
5. National Mental Health Workforce Strategy (sections 1 – 6) 75,
6. Commissioning Talking Therapies for 2011/12 76 from which, 1.3;
“There is strong evidence that appropriate and inclusive services and care pathways
for people with common mental health conditions reduce an individual’s usage of NHS
services leading to efficiencies and cost savings, as well as contributing to overall
mental wellbeing. This approach promotes inclusive, equitable services that meet the
needs of the whole community.” And 1.4 “Increasingly; there will be room for
innovative approaches in the services commissioned, along with flexibility
tailored to local need and to the personal needs of individuals seeking
treatment.”
7. The Kings Fund > Transforming our health care system – Ten priorities for
commissioners 77 of which relevant references include:
a) Primary Prevention:
Taking action to reduce the incidence of disease and health problems within the
population, either through universal measures that reduce lifestyle risks or by targeting
high-risk groups: The financial sustainability of the NHS in the future will depend on
more systematic primary prevention in order to reduce the overall burden of disease in
the population.
b) Secondary Prevention:
“Systematically detecting the early stages of disease and intervening before full
symptoms develop – for example... taking measures to reduce high blood pressure.”
The “How to do it” section here includes: “Working systematically with local authorities
and other partners to ensure primary care prevention forms part of a broader strategy
Page 8 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
on public health”
“Working with community and voluntary sector groups to offer interventions to patients
who do not engage well with mainstream health services”.
8. Also relevant is The Royal College of Nursing (Q.30) response to the White Paper 78
-“ How can we ensure funding streams do not act as a discentive to innovation and are
able to support changes in skill mix?” with their answer being:“Funding streams for education and training need to be linked to service commissioning
strategies and QIPP initiatives . The RCN believes that openness, fairness, equity and
publishing regular audit updates is the absolute minimum.”
10. CBRT NHS Training Initiative - Overview
1. The CBRT Training Programme is deemed suitable for NHS Staff of all levels.
(Staff will need basic skills in computer competency to be able to complete their
assessment paper and case studies online.)
2. CBRT is preparing for IS0: 13485 and CPD accreditation with the RCN and other
leading, recognised bodies and adhere to strict standards.
3. The CBRT Training Programme and Handbook has been developed following
ongoing course participant feedback following every training programme. Practitioners
will be asked to provide ongoing feedback, Trainers and Materials receive regular
updates / under constant review for ongoing quality assurance and improvements.
4. The Training facilities provision for up to 28 staff and the CBRT Trainer requires a
lecture area with enough space to enable individuals to work in pairs (with table and 2
chairs each for individual work) and group work.
5. To keep the Training Programme at a low cost, CBRT do not include the provision
of light refreshments or food for participants in their costings. Therefore a packed lunch
or use of a staff canteen facility close to the training rooms, is the usual practice.
11. CBRT NHS Training Initiative – 25 places + 3 free
CBRT International Ltd are keen that all training places are filled and will cover any
additional materials costs involved for up to 3 additional training places.
CBRT recommend the two day CBRT Training Programme be offered to 28 members
of staff, so should any member of staff be unable to attend, due to illness or staffing
reason, all 25 Training Places paid for will be filled with nil wastage of resources for the
Trust . Selection of the 25 + 3 NHS Staff to attend the Training Programme and 5 NHS
CBRT Trainers is the responsibility of each group provider.
12. Initiative Constraints
12a. Resources, Training Facilities, Timing
1. CBRT stock will be available from completion of Phase 2; product allocations will be
delivered directly to each provider group for internal distribution to trained staff.
Page 9 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
2. The CBRT NHS Training Initiative will use current product range as exhibited at the
DH Healthcare Innovation Expo March 2011.
3. NHS staff will initially be able to deliver CBRT Relaxation Support sessions to
groups of 6 patients using products provided at the Training Programme. The Case
Study examples reflect this. Trained NHS staff will be able to deliver CBRT Relaxation
Support Sessions for groups of up to 20 Patients if they wish.
4. The Training Programme will be delivered in Training Room facilities provided by
each Trust / participating provider group at no additional cost to CBRT.
5. Timing – once a Two Day Training Programme date has been agreed, dates are
fixed to the agreed schedule.
6. CBRT believe the CBRT Training Programme to be deemed suitable for NHS Staff
of all levels.
12b. Initiative Critical Success Factors (Key Performance Indicators)
1. All NHS staff to complete the Training Programme, 10 Case Studies and 40
question CBRT Assessment paper.
2. Certificates of Training will be sent to the Trust upon completion of all case studies
and assessment papers.
2. The first 500 CBRT NHS staff to be trained will create the initial 5,000 Case Studies
for NHS Evidence.
3. Trained CBRT Staff are required to provide an agreed number of 30 - 45 minutes
CBRT Relaxation Support Sessions - for a target number of 5 Patients - into their
schedule as soon as possible.
4. Encourage feedback from Patient groups and online. CBRT will work with the NHS
to create a new database for Patients’ feedback
5. Encourage Patients to use CBRT at home and keep a CBRT Observations Diary
6. NHS staff to provide regular feedback of patient’s response. Data collection rates will
be monitored on a regular basis to help ensure that Staff is achieving at least 90%
complete outcomes for the number of people who have had two or more therapeutic
sessions, to include a Patient Health Questionnaire such as PHQ-9 79 and Generalised
Anxiety Disorder GAD7 scale 80 .
7. To keep the Training Programme at a low cost, CBRT do not provide light refreshments
or food for participants. The group provider is required to provide light refreshments for all
staff attending on both days of the Training Programme and/or provide use of a staff
canteen facility close to the training rooms, as is the usual practice.
Page 10 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
12c. CBRT NHS Initiative Terms
1
As stated at the “Healthcare Innovation Expo 2011” the cost of provision of this
CBRT initiative is based on the free provision of training facilities. We train on
your home site, saving you staff costs for travel and accommodation.
2
The CBRT Training Programmes will commence from OCTOBER 2012. All
participating staff are required to have completed an information form.
3
NHS Staff attending the CBRT Training Programme will each receive the
CBRT Practitioner Kit (see Page 13 for details) and members use of the
www.colourbreathing.com website for members post training paperwork
including assessment paper and case studies.
4
1.
CBRT Practitioners agree to abide by the CBRT Practitioners "Code of
Conduct" which is based on the Midwifery Code of Conduct.
5
Individual NHS CBRT Practitioners using CBRT in their place of work will not
be required to pay any CBRT Practitioner Annual Licence fee - as they will not
be earning private income from the use of CBRT products.
All CBRT trained staff will be required to provide feedback and comments
online to maintain quality assurance and improve ongoing Patient Care.
6
All NHS Staff becoming CBRT Trainers will be trained by a CBRT National
Trainer.
7
*CBRT “Train the Trainer” Training for 5 members of staff per provider group
will take place over 2 days in January /February 2013 following completion of
their CBRT Practitioner Training Programme.
8
All NHS staff are required to provide 10 Case Studies each. Each provider
group is responsible for the return of all forms as the CBRT Training
Programme will provide 250 case studies, to be submitted to NHS Evidence.
9
Payment for the CBRT Training Programmes is payable in two stages by
BACs (see schedule on page 12 ) to secure booking and stock.
10
The CBRT National Training Team is to have completed the training of 25 NHS
Staff and 5 NHS Trainers as per an agreed schedule
11
The allocation of additional CBRT Easel Cards and products included in the
contract price (the new CBRT “CE marked” product range) will be delivered to
each group provider in Phase 2.
12
Costs shown are correct at time of printing, but may change due to unforeseen
transport, production and/or materials price increases.
Page 11 of 22
Page 12 of 22
NHS CBRT additional stock for trained staff
Available from the Summer 2012
Outers of 14 x 5 CBRT Easel Charts
(CBRT charts for Patients use in sessions.)
Allocation of 1 CBRT Book Kit for Patients Use per Staff trained in CBRT
Allocation of 1 CBRT Observation Diariy for Patients Use per Staff
125
125
125
Training and 45% products
55% products within 10 working days of receipt of CBRT NHS products.
Stage 1
Stage 2
Participation in the CBRT NHS Programme is payable in two stages:
£
£
£
20,489.40
45,127.70
24,638.30
+VAT
+ VAT
2
3
2
3
Upon receipt of products
Upon contract signature
Number of Patients to benefit weekly:
50
250
500
75
375
750
250
1,250
2,500
375
1,875
3,750
Weekly CBRT Relaxation Support Sessions delivered:
2 sessions per week
3 sessions per week
2 sessions per week
3 sessions per week
Trained staff
25
25
125
125
Y
Y
Y
Y
Y
10
932.50
37,253.45
2,343.75
14,256.20
224.00
Y
Y
Y
Patients per session below:
1
5
£
£
£
£
£
£
19,497.00
7,874.25
£
£
3,000.00
£
Y
VAT
(Offering CBRT Relaxation Support Sessions of between 30 - 45 mins each per week
7.46
18.75
419.30
8.96
194.97
600.00
£
Total
£
4,874.25
Y
£
£
£
£
£
£
Cost each
£
£
194.97
45,127.70
TOTAL
New CBRT NHS Affirmation cards Sets - for staff trained in Phase 1
25
34
CBRT equipment* to train a further 100 NHS Staff by end of 2012.
for breakdown see "NHS Trainer trains NHS Staff" chart.
100
Stock for NHS Trainers
CBRT NHS "Train the Trainer" programme.
5
Stage 2
CBRT NHS Practitioners trained - special price using original stock
CBRT NHS Programme - Included in the Phase 1 - PCT contract price
Training Targets
25
Stage 1
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
12d. CBRT NHS Initiative Cost detail
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
12e - CBRT Training Resource Kit Cost detail – (prices include NHS discount)
CBRT Practitioner Kit requirement
Example of CBRT Training Resource Kit costs - 27.08.12
CBRT Training Kit comprises:
£
1 x CBRT Book, Easel Card and Audio CD Kit*
£
18.75
1 x CBRT Practitioner Training Handbook
£
40.00
1 x CBRT Affirmation Cards selection*
£
8.96
4 x Sets of five CBRT Easel Cards @29.95 each
£
119.90
1 x CBRT Observations Diary*
£
7.46
1 x Assessment paper
£
-
1 x 10 Case Studies
£
-
1 x Certificate (upon completion)
Total
£
£
195.08
2
Product prices shown* include NHS discount based on a 3,000 print
run.
Further quantities of CBRT Training Resource Kits may be ordered with nhs discount from
nationalhealth@colourbreathing.com
3
CBRT NHS Trainers are required to mark the Assessment Paper and Case Studies
4
for each Practitioner they have trained and submit these online to CBRT International Ltd.
CBRT NHS Staff submit their Assessment Paper and Case Studies online within 4 - 6 weeks of
Training Programme.
CBRT NHS Practitioners will be exempt from payment of annual CBRT Practitioner Annual
Licence fee, but will be required to agree to not receive income from use of products and
1
5
provide ongoing Patient and quality standards feedback.
6
7
*CBRT NHS stock will be made available in Stage 2 of the CBRT NHS Pilot Initiative.
Products shown will enable an NHS member of staff to provide CBRT Relaxation Support
Sessions for up to 20 Patients
8
The prices shown above are fixed until 30.09.12
12 f - Future product launches
In 2013/4 CBRT intend to launch CBRT Affirmation Cards for use in clinics for specific
conditions, such as PTSD, GAD, COPD, weight issues, smoking cessation, and
bereavement. Other subjects such as bullying and self esteem are also planned.
12g - IPR and other information:
Registered Office: CBRT International Ltd, Transport House, Uxbridge Road, Hillingdon
Heath, Middlesex, UB10 0LY. Registered in England and Wales No 7393535. Vat
Registration No GB 119 9391 81 Colour Breathing®, The Colour Breathing Disks®,
products and CBRT Practitioner® Training Programmes are subject to International IP,
Patent, Copyright, Design and Trademark Laws. Colour Breathing Relaxation
Technique™, CBRT Relaxation Support Sessions™, CBRT, CBRT™, CBRT Practitioner
Training Handbook™, Colour Breathing at Home™, Colour Breathing Foundation Fund
and all future Color Breathing US and international generics all ©Alison m Bourne and
CBRT International Limited 1997 - 2012. Costs* correct at time of printing, but may change
due to unforeseen transport, production and/or materials price increases.
For any further information, please contact Alison Bourne on: 01425 629602 or 07977
900716 Email: nationalhealth@colourbreathing.com
Page 13 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
HEADLINE FIGURES
CBRT NHS Initiative Projected Cost Savings
1. Phase 1 provides the necessary training and preparation of 25 NHS Staff to launch
CBRT to Patients in 2012/13.
2. Phase 2 includes training of 5 staff as Trainers and additional 100 staff training kits.
Once trained, it is estimated 125 staff could provide annual saving of c. £2.2million.
3. The Staff costs shown are based on the “NHS Agenda for Change” 81 pay scales and
Primary Care Costing Template including 70% Overheads which include room
provision costs in GP practices.
CBRT NHS Initiative
Phase 1 & 2
Costs include budget for staff time used during Training.
2012 / 2013
Autumn/Winter
Timescale(s)
CBRT Training Programme cost per group (payable in two stages )
Phase 3 2013
Year 1
Spring 2013
24,638
£20,489
n/a
Phase 1 - Costs include 125 x Grade 5 - 7 Staff training cost 250 days@
£192 per day. 5 x Band 5 - 7 Staff for “Train the Trainer” Training
£48,000
Programme (10 days) and CBRT Training Programme Days for CBRT
£3,840
n/a
Practitioners each (10 days) @ £192 per day. (20 days total)
5 x CBRT Trainers (the staffing cost for days to train the 100 additional
NHS Staff above) in a group over 20 days training is included in this
allowance total. (The CBRT Training Resource Kit for Phase 1 Training
£3,840
Programmes is included in the initial Programme cost.*) Stock
requirement for Patients in phase 2 is included in these examples.
Total Cost
£100,807
£0
£129,600
n/a
Projected initiative savings per provider group
Phase 1 , Example 1
Phase 2 , Example 1
n/a
£601,800
Phase 2, Example 2
n/a
£641,520
Phase 2, Example 3
n/a
£957, 528
£28,793
£2,200,848
Estimated initiative saving
The next four pages provide examples of potential CBRT cost savings.
Page 14 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
Potential Savings Phase 1 = ≥ £129,600, per Trust.
Illustration is of potential cost saving of having 25 Staff completing CBRT Training in Autumn
/Winter 2012/13.
Example – with 25 Staff trained
25 Staff – e.g. Practice Nurses or Band 5 equivalent Staff, complete two day CBRT
Training Programme and case studies within 4 - 6 weeks of Training Programme. Upon
successful completion and marking of all case studies and assessment paper, Staff may
provide CBRT Relaxation Support Sessions to Patients as individuals or in groups of up to
20 Patients in their clinics and surgeries.
Five of the above Staff to be selected by the Trust to attend a further two day “Train the
Trainer” CBRT Training Programme in January / early spring 2013.
100 additional CBRT Training Kits are included in the Initiative cost (e.g. each provider
group will have the potential to have 125 staff trained in CBRT by the end of 2013.)
*In this example, Patients use the CBRT Staff working kit and are not provided with their
own kit "to keep."
Example 1 - Grade 5 Practice Nurse, Occupational Therapist, or equivalent
1
25
GP
Band 5
Patients
Sessions
Months
£36
£18
1
8
4
5
8
4
45
11
10
8
11
Cost of Grade 5 Practice Nurse or equivalent
25 x Nurses provide 8 x 45 mins CBRT sessions (@ £18 cost) each pcm =
25 x Nurses provide 8 x 45 mins CBRT sessions each month x 4 months =
25 x Nurses provide 8 x 45 mins CBRT sessions each month x 11 months =
Appointments
1,000
4,000
11,000
£
£
£
Number of Patients seen, based on 5 patients per session
25 x Nurses provide 8 x CBRT sessions for 5 Patients each pcm =
25 x Nurses provide 8 x CBRT sessions for 5 Patients each month x 4 months
25 x Nurses provide 8 x CBRT sessions for 5 Patients each month x 11 months
3,600
14,400
39,600
1,000
4,000
11,000
pcm
4 months
per annum
pcm
4 months
per annum
Equivalent GP Appointment Costs
1000 x GP Appointments@ £36.00 each
4000 x GP Appointments @ £36.00 each
11000 x GP Appointments @ £36.00 each
£
£
£
36,000
144,000
396,000
pcm
4 months
per annum
Total Potential Cost Savings
1000 x GP Appointments @ £36.00 each
4000 x GP Appointments @ £36.00 each
11000 x GP Appointments @ £36.00 each
£
£
£
32,400
129,600
356,400
pcm
4 months
per annum
Summary:
25 x Band 5 Nurses, or equivalent (@ £24 per hour 82) provide 8 x 45 mins* (*£18) CBRT
sessions each,*pcm (5 Patients* each session) x 4 months to end of early spring = 1,000
Patients pcm = 11,000 GP Patients appointments per annum total.
11 months per annum allows for Staff holidays and/or sickness allowance.
Patients benefit through having a full 45 minutes session with their Practice Nurse rather than
a 12 minute appointment with their GP 83. E.g. each CBRT Nurse sees 240 Patients each in a 4
months period. 25 Nurses provide 48 CBRT sessions
each = 1200 sessions for 6000 Patients.
Phase 1 ≥Potential Savings of £129,600 within a 4 months period.
Page 15 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
Potential Savings Phase 2 = ≥ £601,800 per annum, per Trust.
This illustration of potential cost savings is based on having 25 Staff (Band 7) using CBRT for
one year
Example here is based on Band 7 Psychiatric Nurses caring for mild to moderate
mental health issues.
1. Phase 2 is for the period of one year.
2.
Example is 25 x Psychiatric Community Nurses CBRT to small groups of 5 Patients.
3. GP estimated cost at £36 19 per 12 minute consultation taken from “Quality and
Outcomes Framework Programme – NICE cost impact statement July 2011.28”
Phase 2, Example 1 - Grade 7 Psychiatric Nurse * 45 mins
25
PN
Patients
Sessions
Months
£59
1
2
4
£44.25
5
8
10
250
4000
11
Weeks
1
16
48
Cost of Psychiatric Nurse for 45 minutes session
1 x P Nurse provides 2 x 45 mins CBRT sessions (@ £44.25* cost) each week =
25 x P Nurse provides 2 x 45 mins CBRT sessions (@ £44.25* cost) each week =
25 x P Nurses provide 8 x 45 mins CBRT sessions each month x 4 months =
25 x P Nurses provide 8 x 45 mins CBRT sessions each month x 11 months =
£
£
£
£
Number of Patients seen, based on 5 patients per session
1 x P Nurse provides 2 x CBRT sessions for 5 Patients each week =
25 x P Nurses provide 2 x CBRT sessions for 5 Patients each week =
25 x P Nurses provide 2 x CBRT sessions for 5 Patients each month x 4 months =
25 x P Nurses provide 2 x CBRT sessions for 5 Patients each month x 11 months =
89
2,213
35,400
97,350
10
250
4,000
11,000
per week
per week
4 months
per annum
per week
per week
4 months
per annum
Cost of normal Psychiatric Nurse Service (for Individual) per hour
1 x Individual P Nurse x 10 Appointments@ £59.00 each =
25 x P Nurses x 10 Individual Nurse Appointments @ £59.00 each =
25 x P Nurses x 2 Individual Nurse Appointments @ £59.00 each =
25 x P Nurses x 25 Individual Nurse Appointments per month @ £59.00 each =
25 x P Nurses x 25 Individual Nurse Appointments per month @ £59.00 each =
£
£
£
£
£
590
14,750
47,200
36,875
405,625
Cost per Patient for 1 x CBRT sessions per week
5 patients provided with 2 x CBRT Relaxation Support Sessions per week
£
9
COST SAVING Direct comparison 1
25 x P Nurses provide 2 x CBRT sessions for 5 Patients each week =
25 x P Nurses x 10 Individual Nurse Appointments @ £59.00 each
Total weekly Potential Saving based on 10 Patients each Nurse
Total annual Potential Saving based on 10 Patients each Nurse
£
£
£
£
2,213
14,750
12,538
601,800
per week
per week
per week
per annum
COST SAVING Direct comparison 2
25 x P Nurses x 10 Individual Nurse Appointments per month @ £59.00 each x 11 months =
25 x P Nurses provide 2 x CBRT sessions for 5 Patients each month x 11 months =
Total Annual Potential Saving based on 10 Patients each per month
£
£
£
162,250
24,338
137,913
per annum
per annum
per annum
per week
per week
4 months
per month
per annum
per week
Summary:
25 x Psychiatric Nurses 84 provide 2 x 45 mins CBRT sessions each per week, for groups of
5 Patients each session, (10 Patients in total) as an alternative to seeing the patients
individually. These sessions are also beneficial to larger peer groups.
Each CBRT Nurse is able to support 40 Patients per month. Phase 2, Example 1 - Annual
Potential Saving ≥ £601,800 per group provider, per annum.
Potential Savings Phase 2 = ≥ £601,800 per annum, per Trust.
Page 16 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
Potential Savings Phase 2, = ≥ £641,520 per annum, per group provider
Example here is based on Band 5 Practice Nurses caring for mild to moderate mental
health conditions
1. 45 x Band 5 Practice Nurses or equivalent provide 2 x 30 - 45 minutes “walk in” CBRT
Relaxation Support Sessions in GP surgeries and Clinics each week.
2. Any Patients may attend, especially those who being able to relax will help their condition
e.g. hypertension, COPD, smoking cessation, obesity, bereavement, unemployment,
insomnia, and stress related conditions. The intention here is to provide a care service to
reduce the number of Patients feeling the need to visit their GP.
Example 2 - Grade 5 Practice Nurse, Occupational Therapist, or equivalent
1
45
GP
Band 5
Patients
Sessions
Months
£36
£18
1
8
1
5
8
11
10
8
Cost of Grade 5 Practice Nurse or equivalent
45 Nurses provide 8 x 45 mins CBRT sessions (@ £18 cost) each pcm =
45 Nurses provide 8 x 45 mins CBRT sessions each month x 11 months =
Appointments
1,800
3,600
19,800
£ 6,480
pcm
£ 71,280 per annum
Number of Patients seen, based on 5 patients per session
45 Nurses provide 8 x CBRT sessions for 5 Patients each pcm =
45 Nurses provide 8 x CBRT sessions for 5 Patients each month x 11 months =
1,800
pcm
19,800 per annum
Number of Patients seen, based on 10 patients per session
45 Nurses provide 8 x CBRT sessions for 10 Patients each pcm =
45 Nurses provide 8 x CBRT sessions for 10 Patients each month x 11 months
3,600
pcm
39,600 per annum
Equivalent GP Appointment Costs
1,800 x GP Appointments @ £36.00 each
3,600 x GP Appointments @ £36.00 each
19,800 x GP Appointments @ £36.00 each
£ 64,800
pcm
£ 129,600
pcm
£ 712,800 per annum
Total Potential cost savings
19,800 x GP Appointments @ £36.00 each
45 Nurses provide 8 x 45 mins CBRT sessions each month x 11 months =
£ 712,800 per annum
£ 71,280 per annum
£ 641,520 per annum
Summary
45 x Nurses provide 2 x 30 - 45 minutes
CBRT RSS sessions each per week. The
example here is for 5 Patients – the CBRT
Nurse has enough equipment to be able to
relax up to 20 Patients per session - if
required.
Patients use the CBRT kit which belongs to
the CBRT staff; so there is therefore no
additional cost.
GP cost at £36 per 12 minute consultation 83 taken from Quality and Outcomes Framework
Programme – NICE cost impact statement July 2011.
Potential Savings Phase 2, = ≥ £641,520 per annum, per group provider
Page 17 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
Potential Savings Phase 2 = ≥ £957,528 per annum, per group provider.
Example here is based on Band 5 Nurses using CBRT to help Patients wishing to lower
their medication requirements:
1) Patients agree to attend a series of 6 x 30 - 45 min CBRT Sessions (over 3 weeks) and
receive their own CBRT kit to a) help their condition e.g. they are “borderline” whether they
need or wish to take prescribed medication or b) they wish to gradually stop taking
medication.
Example 3 - Band 5 Practice Nurse, Occupational Therapist, or equivalent
1
45
No of
No of
Medication
Band 5
Patients
Sessions
Weeks
£170
£18
5
6
3
10
CBRT Kit
£26.21
Medication for depression @ £170 15 per annum
No of 3 week
Cycles
16
Cost of Grade 5 Practice Nurse or equivalent for 45 minute session £18 each
45 Nurses provide 6 x 45 mins (1 cycle) of CBRT sessions (6 x £18) for 10 Patients, every 3 weeks
45 Nurses provide 16 cycles of 6 x CBRT sessions for 10 Patients per annum
Total
Patients
450
7,200
£
£
4,860
77,760
3 weeks
per annum
Cost of CBRT NHS Patient kits required, based on 10 patients per 3 week cycle
45 Nurses provide 1 x CBRT NHS Kit for 10 Patients per cycle =
45 Nurses provide 1 x CBRT Kit for 10 Patients for 16 cycles =
11,795
188,712
3 weeks
per annum
Cost for CBRT service
45 Nurses and 450 kits
45 Nurses and 7,200 kits
16,655
266,472
3 weeks
per annum
450
7,200
3 weeks
per annum
Number of Patients seen, based on 10 patients per 3 week cycle
45 Nurses provide 1 cycle (6 x CBRT sessions) for 10 Patients every 3 weeks =
45 Nurses provide 16 cycles of (6 x CBRT sessions) for 10 Patients every year =
Equivalent Medication Costs
450 x Annual Medication @ £170.00 each
7,200 x Annual Medication @ £170.00 each
£
76,500
£ 1,224,000
Total Equivalent Medication Cost Savings using CBRT NHS Relaxation Support Sessions
£
£
59,846
957,528
3 weeks
per annum
3 weeks
per annum
Summary
Medication for depression @ £170 per
patient, per annum taken from The Social
Exclusion Unit’s (SEU) report - Mental
Health and Social Exclusion 85, published
in June 2004 includes a useful summary of
the costs of various forms of mental health
services:
www.socialexclusion.gov.uk/downloaddoc.asp?id=134
For this initiative example, each Patient receives their own CBRT Training Resource Kit
& CBRT Observations Diary (total cost £26.21+ VAT) to use at home as part of their
healthcare programme. This additional cost has been factored into this example. The
CBRT Observations Diary allows the Patient and Nurse to monitor progress for a 3
month period. Many people find it helpful to keep a diary during therapeutic intervention.
Potential Savings Phase 2 = ≥ £957,528 per annum, per group provider
Page 18 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
References
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3.
Innovation Health & Wealth (June 2012 version) Accelerating Adoption & diffusion in the NHS
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Patchy Progress shown for Mental Health Treatment
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CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
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The CBRT Research Team http://colourbreathing.com/?page_id=296
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Page 20 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
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The Kings Fund>Transforming our health care system – Ten priorities for commissioners
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCkQFjAB&url=http%3A%2F%2Fwww.kingsfund.org.uk%2Fd
ocument.rm%3Fid%3D9100&ei=o5s7UIGbAew0QW2ioCIAQ&usg=AFQjCNE3N3vgV4ha47Myv7EkCYXobiCV1Q&sig2=iaPNrZro3v00l0fxpuP8dQ
78.
The Royal College of Nursing Q.30 Response to the White Paper PDF
http://www.rcn.org.uk/__data/assets/pdf_file/0016/341404/RCN_response_to_NHS_white_paper41.pdf
79.
Patient Health Questionnaire such as PHQ-9 “PHQ-9 http://www.patient.co.uk/doctor/Recognising-and-Screening-forDepression-in-Primary-Care.htm
80.
81.
Generalised Anxiety Disorder GAD7 scale http://www.mpho.org/resource/d/34008/GAD708.19.08Cartwright.pdf
RCN “NHS Agenda for Change” 2011 / 2012 http://www.rcn.org.uk/__data/assets/pdf_file/0005/372992/004106.pdf
82.
25 x Band 5 Nurses, or equivalent (@ £24 18 per hour) £24 per hour is based on NHS Agenda for
Change pay scales – 2011/2012 Band 5 £27,625 + costs
http://www.rcn.org.uk/__data/assets/pdf_file/0005/372992/004106.pdf in the NIHR CRN Industry Costing Template
http://www.crncc.nihr.ac.uk/
83.
GP estimated cost at £36 19 per 12 minute consultation. Quality and Outcomes Framework Programme NICE cost impact statement July 2011 Indicator area: Hypertension states “Assuming a 1.5 minute
discussion following a consultation based on £36 per 12 minute GP consultation and £12 per 15.5
minute nurse consultation.” http://www.nice.org.uk/nicemedia/live/13527/55522/55522.pdf
84.
“25 x Psychiatric Nurses http://www.crncc.nihr.ac.uk/
85.
Medication for depression @ £170 per patient, per annum taken from The Social Exclusion Unit’s (SEU)
report - Mental Health and Social Exclusion Medication for depression @ £170 per patient, per annum
taken from The Social Exclusion Unit’s (SEU) report – “Mental Health and Social Exclusion”, published
in June 2004 includes a useful summary of the costs of various forms of mental health services
including: “Community mental health team - around £59 per hour of patient contact; Specialist
community psychiatric nurse - around £70 per hour patient contact; Cost of privately obtained talking
therapy or counselling – around £732 per year; Basic cost of medication treatment for depression around £170 per year.” www.socialexclusion.gov.uk/downloaddoc.asp?id=134
Page 21 of 22
CBRT NHS Initiative September 2012 - Overview Statement v.4 2012
CBRT NHS Training Initiative Duration
Initiative Stages
Date Estimate
Stage 1: CBRT Training Programmes from:
OCTOBER 2012
Stage 2 : Train the Trainer Programmes from:
JANUARY 2013
Stage 3: CBRT NHS Trainers to have each
trained additional 20 staff
SUMMER 2013
APPROVAL and permission for contract to proceed.
I agree to the terms and conditions of this document and wish to participate in the CBRT
NHS Training Initiative.
Name and Address of Organisation
wishing to participate in the CBRT
NHS Training Initiative
Approved By:
Title
Date
Page 22 of 22