Payment by Results Dr Alex Horne Medical Director NELFT.

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Presentation transcript:

Payment by Results Dr Alex Horne Medical 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 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