Payment by Results (PbR)
Significant progress has taken place on the activity based funding approach
of PbR for mental health since the consultation ‘Options for the Future of PbR
2008-2009 to 2010-2011' highlighted mental health as a priority area for PbR
development. .
A national model for mental health currencies has been adopted from the Care
Pathways and Packages methodology originated in Yorkshire and Humber. This
approach groups service users into categories based on need and comprise a set
of 21 ‘care clusters' that together form ‘currencies', or units for contracting
and commissioning mental health services that have been included in the MHMDS.
Each cluster defines a group of service users who are relatively similar in
their care needs and therefore resource requirements.
The ultimate goal for PbR is the creation of a national tariff for these
currencies and so costing exercises are also underway to investigate the
resource implications of the currencies. Options for moving to a national
tariff will also be explored, although its feasibility is unclear.
The Department of Health published three documents in February 2010 supporting
the use of the
mental health currency from 2010/11.
This signalled that the Mental Health PbR programme is moving into the
implementation phase.
·
A Clustering Booklet for
Mental Health PbR (2010/11), outlining the Care Clusters (which are the currency
used in mental health PbR) and the supporting Mental Health Clustering Tool.
·
The Payment by Results
guidance 2010-11 (section
9 relates to mental health) looking at operational issues in using the
currencies.
·
A revised version of Practical
Guide to Preparing for Mental Health PbR, which sets out ten actions
that can be taken locally to prepare for mental health PbR.
The DH has recently
clarified the timescales that were in the Operating Framework 2010-11 by
proposing the following as the minimum requirements
• 2010/11 - The clusters are
available for use. Reference costs are returned on a cluster basis.
• 2011/12 -
o All service users
accessing mental health care (post GP or other referral) that have
traditionally been labelled working age (including early intervention services
from age 14) and older people's services, should be allocated to a cluster by
31 December 2011.
o Local prices should be
agreed for use in 2012/13 and this will require understanding of local costs
per cluster
• 2012/13 - The clusters
(with local prices) become mandatory for contracting and payment purposes.
• 2013/2014 - The earliest
possible date for a national tariff for mental health (if evidence from the use
of a national currency presents a compelling case for a national price).
Local areas may choose to
implement faster, although establishing a robust baseline to ensure the effects
of implementation are understood should be the priority.
Further development work
will take place in 2010 with the development of Quality
and Outcomes indicators for the care clusters, costing of the care clusters
using Patient Level Information and Costing, improvement
of the clustering tool through further testing and additional data items and developing a computerised algorithm that indicates most appropriate
cluster based on clustering tool scores.
Mental Health PbR will
bring significant benefits, including helping to tackle the Quality,
Innovation, Productivity and Prevention (QIPP) challenge. However, the amount
of work needed to realise these benefits will be considerable, and this means
that 2010-11 will be a crucial preparatory year.
The NHMDU Commissioning Programme is linked into
the national work through the workstreams that are identifying quality and
outcome measures for the Care Clusters, the Mental Health PbR Project Board and
the Mental Health PbR Commissioners Group and have worked with the department
in establishing a workshop targeted at both health and social care mental
health commissioners on PbR awareness and preparation to take place in London
on 10th June 2010 and in Leeds on 21st June 2010. If you wish to attend the event register your free place online here
More details on MH PbR can be found in the DH Mental Health PbR factsheets and can
be downloaded using the following link
Click here
Standard Contract
2009/10 was the first year of
the mental health and learning disability services contract.
The NHS standard contract
covers agreements between PCTs and providers for the delivery of NHS funded
services. The contract applies to agreements for:
NHS trusts
New foundation trusts and FTs
whose existing contracts have expired
New agreements between PCTs and
independent sector providers
New agreements between PCTs and
third sector providers
The NMHDU have been working in
partnership with the PCT Confederation in supporting the Department in this
work by gauging feedback from commissioners on the experience and lessons
learned from the first year.
Some of the challenges
identified included; the impact of the contract on smaller non-NHS providers,
the impact on commissioning arrangements that are joint with Local Authorities
and how to future proof for PbR, QIPP and allowing for flexibility in
responding to local change in a speedy manner.
These lessons have been used
by the Department of Health to revise and strengthen the 2010/11 mandated
contract and provide further guidance that was issued in January 2010 to
support implementation. For more details
Click here
Quality Framework
As part of the wider
implementation of the national contract specific opportunities are becoming
available to MH commissioners to incentivise change through the provision for
CQUINs and the new requirement in 2010 for Trusts to publish Quality Accounts.
There are emerging examples of the creative use of CQUINs between commissioners
and providers to bring about change and learning the lessons of these examples
is enabling accelerated spread across the system.
The 2010/11 Operating Framework strengthened CQUIN by increasing the value from
0.5% in 09/10 to 1.5% outturn contract value in 10/11, supporting the importance
of quality in the current financial environment.
The NMHDU commissioning programme has worked in collaboration with the PCT
Confederation and Department of Health in bringing together the learning from
the 09/10 mental health applicable schemes and worked up an illustrative mental
health example scheme. This illustrative example scheme and many of the
countries 2010/11 CQUIN schemes are published here:
Click here
For further information on the above contact Diane Woods