1. Payment by Results Dr Alex Horne Medical Director NELFT

2. The White Paper Mandated PbR for Mental Health Go live April 2012

3. 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

4. Promises To offer transparency on transactions Patient level detail

5. Contracts From PCT block contract Interim “cluster”/mental health commissioner and MOU To CCG leads

6. 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

7. Wonderland Through NSF years Contained Managed symptoms and behaviour Maintained Post NSF must also achieve Enablement

8. Strategic Challenges Link PbR to Choice + Personalisation Reablement Quality Agenda

9. Challenges Data Quality Interpretation of Data Robust mechanism for costing

10. 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

11. Risks An unhelpful destabilisation of secondary mental health care Vulnerable patients are not “contained” and appropriately managed

12. 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