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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

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carole green project director
Carole Green

Project Director

mental health pbr developments
Mental Health PbR Developments
  • 2003 SECTA Report
  • Variation
  • Complexity
  • No link between intervention and outcome
  • Poor data
  • Worth developing
national picture
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
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
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
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
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
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
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
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
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
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
slide13

Local Models of Integration

Care Planning

Cost Improvement Programme

QIPP

Access and Choice

Clinical Governance, Q & O

Currencies for MH PbR

Commissioning

Workforce Development

Service Line Management

Service Planning/Redesign

national timescales
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 2011.
    • - Local prices should be agreed for use in 2012/13 and this will require understanding of local costs per cluster
national timescales1
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).
slide16

C

P

P

P

DECISION TREE

(RELATIONSHIP OF CARE CLUSTERS TO EACH OTHER)

Working-aged Adults and Older People with Mental Health Problems

C

Organic

A

Non-Psychotic

B

Psychosis

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

1

2

3

4

5

6

7

8

10

11

12

13

14

15

16

17

18

19

20

21

pbr development process
Currency

Local

National

National

Tariff

Local

Local

National

PBR Development Process:

Step

1

2

3

data warehouse
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 2

Stage 3

Stage 1

Stage 4

Calculate

Determine

Calculate the Relative

Model options

weighted

period

cost per

Value Unit

For draft tariff

durations

day

Staged costing process
quality outcomes
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

slide24

Key Linkages

  • IAPT, Forensic, CAMH’s, LD, Addictions
  • Personalisation, QIPP
  • Operating Framework, Standard contract,
  • Reference costs, MH commissioning
  • Incentives & Best Practice
next steps issues
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
contact details
Contact Details

www.cppconsortium.nhs.uk

Office: 01482 389123

Mobile: 07984 630079

Email: carole.green@humber.nhs.uk