Payment by Results

Dr Alex HorneMedical Director NELFT

The White Paper

•Mandated PbR for Mental Health

•Go live April 2012

PbR Mechanism

•Cluster all patients (eventually) using the outcome measure HONOS PbR (clustering tool)

•Agree cost per intervention within each cluster at a local level

Promises

•To offer transparency on transactions

•Patient level detail

Contracts

•From PCT block contract

•Interim “cluster”/mental health commissioner and MOU

•To CCG leads

Service Delivery

•NSF 2000-10 continued to drive the move from “asylums”

•Estranged GP’s

•Led to a “behind closed doors” perception for major stakeholders

•MHS operated a kind of Wonderland

Wonderland

•Through NSF years

•Contained

•Managed symptoms and behaviour

•Maintained

•Post NSF must also achieve Enablement

Strategic Challenges

•Link PbR to

•Choice + Personalisation

•Reablement

•Quality Agenda

Challenges

•Data Quality

•Interpretation of Data

•Robust mechanism for costing

Progress in London•The London Currencies

Development Board (LCDB) chaired by Wendy Wallace

•London Health Programmes (LHP)

o Commissioner Steering Group chaired by Stuart Saw

o Programme approach

o Engaged Stakeholders

Risks

•An unhelpful destabilisation of secondary mental health care

•Vulnerable patients are not “contained” and appropriately managed

Managing risk, complexity and integration

•1990s•Individual teams•Limited facilities for inter agency and multi-profession working•Individual care plans – one size fits all

•2000s•Single case records•Increased co-ordination and communications•Niche needs (AOT, EIT)•Individual care plans (inter-agency)•Alternatives to inpatient care (Crisis Houses, Recovery Centres, CRT)

•2010s•Patient centred•Outcomes focused•Prevention and education•Personalisation•Increased Information Technology•Integrated Care Pathways

Institutional Care

Community Teams

Multi-disciplined inter-agency teams

Care Pathways System Management