Carole Green Project Director

Mental Health PbR Developments 2003 SECTA Report Variation Complexity No link between intervention and outcome Poor data Worth developing

National Picture No international evidence of a system in use No existing classification system Mental Health Minimum Data Set completion varied Desire to move from block contracts and improve commissioning DH commitment to expand the scope of Payment by Results

Mental Health Challenges Value and ability to develop MH Health Care Resource Groups Diagnosis not a good proxy for need or care package MH more about long term needs Health & social care joint services Compulsion and choice

Acute PbR Lessons Diagnostic based HRG’s Activity based currency Intention to increase capacity/reduce waiting lists Years to develop and refine Transition funding to ease introduction

Basis for Currency Development Classification system based on need Practitioner utility Service user value and support Incentives and innovation Criteria for a currency Resource homogeneity Ability to implement Data collectable Resilient to gaming

Care Pathways & Packages Development Self selecting group of interested providers Shared local experiences and models Approaches to improve quality and consistency of care provided South West Yorkshire MH Trust Model Implemented in practice

InPAC Clinical Decision Support Tool Standard Needs Assessment Tool Empirically derived care groups Standardised Care Plans Standardised aims of interventions Standardised activities

Basis for MH PbR Initial testing across 6 provider sites in Y&H and NE Scope WAA Do the clusters (care groups) appear in other provider sites? Does the standard needs assessment tool work? Can the data be collected? Can the classification system be used as the basis for PbR?

Project Findings & Recommendations 95% service users allocated to a cluster Similar profiles of cluster allocation across sites Practitioners utility demonstrated Data able to be collected Desire to expand on a needs basis to Older Peoples services Significant support to extend to develop model for PbR

Consultation on Future of PbR CPPP report used to inform the national consultation MH identified as top area for increasing the scope CPPP Consortium formed 2008 Key objectives National currency Local tariff Quality indicators and outcome measures

Key Outputs of the Project Classification system underpinning currency model Standard needs assessment tool Cluster groups as basis for currency Initial costing work and local tariff development Developing quality indicators and outcome measures Main development site supporting ongoing refinement

Clinical Governance, Q & O Care Planning Workforce Development Service Planning/Redesign Currencies for MH PbR Access and Choice QIPP Local Models of Integration Service Line Management Cost Improvement Programme Commissionin g

National Timescales 2010/11 – The MHCT and clusters are available for use. - Reference costs returned on a cluster basis. 2011/12 – - All service users accessing mental health care (post GP or other referral) that have traditionally been labeled working age (including early intervention services from age 14) and older people’s services, should be allocated to a cluster by 31 December Local prices should be agreed for use in 2012/13 and this will require understanding of local costs per cluster

National Timescales 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).

DECISION TREE (RELATIONSHIP OF CARE CLUSTERS TO EACH OTHER) Working-aged Adults and Older People with Mental Health Problems A Non-Psychotic B Psychosis C Organic a Mild/ Moderate/ Severe b Very Severe and complex a First Episode b Ongoing or recurrent c Psychotic crisis d Very Severe engagement a Cognitive impairment C P P P

PBR Development Process: Currency Local National Tariff Local National Step 1 2 3

Describing the elements of a currency

Complex ongoing cases

Data Warehouse Based on the most recent data issued the warehouse contains: - Over 5m community activity records (contacts) Records are held on over 433k patients Almost 184k care review records (CPA reviews)

Staged costing process Stage 1 Calculate the Relative Value Unit Stage 2 Calculate weighted cost per day Stage 3 Determine period durations Stage 4 Model options For draft tariff

Quality & Outcomes National approach Outcomes and indicators cluster specific Pragmatic and developmental Replace CQUIN, link with current agendas Service user, clinical, performance C P P P

Key Linkages IAPT, Forensic, CAMH’s, LD, Addictions Personalisation, QIPP Operating Framework, Standard contract, Reference costs, MH commissioning Incentives & Best Practice

Next Steps & Issues Activity Collection – volume & quality Accuracy of Clusters Algorithm Training, support and awareness raising Assessments Commissioner input / capacity Financial implications –shadow arrangement –Speed of implementation Payment mechanism More unknown……but better than we have now

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