Transcript Care Pathways & Packages Approach

Introduction to Payment
by Results (PbR) for
Mental Health
Peter Howitt, Head of Expanding the Scope of PbR
Mental Health Information: NHS Trust Forum, 26 April 2010
[email protected]
Mental Health PbR Development
Mental Health Currency Published – 22 Feb
 Mental Health Clustering Booklet –
contains the care clusters and the
clustering tool that supports allocation
of service users to the clusters.
 Section 9 of PbR guidance on mental
health – acknowledges still lots of
questions.
 Updated Practical Guide to Preparing
for Mental Health PbR
 Draft Care Transition Protocols (look
at issue of re-clustering and how
needs change due to treatment).
Commitment to
make currency
available for use
in 2010/11
fulfilled.
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Mental Health PbR Development
Timetable Clarified - 1 April
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A Dear Colleague letter from Bruce Calderwood (Director, Mental
Health Policy) and Bob Alexander (Director, NHS Finance) has
clarified the timetable.
2010/11 – The clusters are available for use. Reference costs are
returned on a cluster basis.
2011/12 –
 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.
 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).
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Mental Health PbR Development
Currencies or Prices?
 When people talk about Payment by Results they often get
currencies and prices/tariffs confused.
 Currencies = the unit for which payment is made e.g.
Healthcare Resource Groups, Outpatient Attendances,
Complexity-adjusted year of care for Cystic Fibrosis.
 Price/tariff = Set price for a given currency unit.
National
Currency
National
Price
National
Price
National
Currency
No
Currency
Can’t
do.
 Our focus is initially on developing a currency to be used across
mental health services in England. This will allow
benchmarking, comparability and transparency.
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Mental Health PbR Development
The Currency Methodology
 The Care Pathways and Packages approach,
developed initially by six mental health trusts in
the North East and Yorkshire and Humber
SHAs, is the currency that has been
developed.
 Although the currencies will be available for
use in 2010-11, its development will be an ongoing process.
 Further refinement, wider validation etc is
envisaged.
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Mental Health PbR Development
Care Pathways & Packages Approach
 Users assessed with a standard assessment tool
derived from HoNOS.
 Allocated to empirically derived care clusters/groups[1]
 These clusters are expected to be the currency unit so
that you would commission for 10 people in cluster 1, 20
people in cluster 2 etc.
 Different from acute (physical) PbR – paying for
needs/characteristics over a period of time. Shares risk
between commissioner and provider.
 Payment would be for all elements of care service suer
receives, both direct (e.g. therapies) and indirect (e.g.
care co-ordination).
[1] Methodology set out in Clinical Decision Support Tool: A rational needsbased approach to making clinical decisions, Journal of Mental Health,
February 2008, 33-48
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Mental Health PbR Development
What is the Scope of the National Project
and the clusters?
In (covered
by the
clusters)
Specialist
Mental Health
Services
(post-GP) for
working age
adults and
older people
In (not yet clear
Out (at present)
if/how clusters can
be made applicable)
Improving Access to
Psychological
Therapies
Secure Services
CAMHS
Learning
disability
Although not
included in the
national project,
people are
looking locally at
these areas
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Mental Health PbR Development
Mental Health Care Clusters
Working-aged Adults and Older People with Mental Health Problems
A
B
C
Non-Psychotic
Psychosis
Organic
a
b
a
b
c
d
a
Mild/
Very
Severe
and
complex
First
Episode
Ongoing
or
recurrent
Psychotic
crisis
Very Severe
engagement
Cognitive
impairment
Moderate/
Severe
01
02
03
04
05
06
07
08
10
11
12
13
14
15
16
17
18
19
20
21
There are two additional codes if it is not possible to allocate to a Cluster or Super Class:
Z - Unable to assign patient to Mental
Health Care Cluster Super Class
0 (Variance)
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Mental Health PbR Development
Mental Health Clustering Tool (MHCT)
 Nationally agreed and utilised tool for allocation to
Care Clusters in 2010/11
 Tool incorporates HoNOS with additional items
 Item 1 (Overactive, Aggressive, Disruptive or
Agitated Behaviour) not used for Clustering
purposes
 Items marked (H) are historical. Other items are
current (within the last two weeks)
 Historical items to be identified alphabetically rather
than numerically for distinguishing purposes
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Mental Health PbR Development
Data items within the Mental Health Clustering Tool
HoNOS
1
OVERACTIVE, AGGRESSIVE, DISRUPTIVE OR AGITATED BEHAVIOUR*
2
NON ACCIDENTAL SELF-INJURY
3
PROBLEM DRINKING OR DRUG-TAKING
4
COGNITIVE PROBLEMS
5
PHYSICAL ILLNESS OR DISABILITY PROBLEMS
6
PROBLEMS ASSOCIATED WITH HALLUCINATIONS AND DELUSIONS
7
PROBLEMS WITH DEPRESSED MOOD
8
OTHER MENTAL HEALTH AND BEHAVIOURAL DISORDERS
9
PROBLEMS WITH RELATIONSHIPS
10
ACTIVITIES OF DAILY LIVING
11
LIVING CONDITIONS
12
PROBLEMS WITH OCCUPATION AND ACTIVITIES
Summary Assessment of Characteristics (SAC)
13
STRONG UNREASONABLE BELIEFS
A
AGITATED BEHAVIOUR / EXPANSIVE MOOD (H)
B
REPEAT SELF HARM (H)
C
SAFEGUARDING CHILDREN & VULNERABLE ADULTS (H)
D
ENGAGEMENT (H)
E
VULNERABILITY (H)
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Mental Health PbR Development
Importance of Information
 For this to work, we need MHCT ratings and a care
cluster for each service user.
 This is a significant leap in the quality of individual
information available for mental health service
users.
 It is happening at the same time as many providers
are moving systems.
 There are considerable challenges e.g. linking social
care held information with NHS held information.
 We need to consider whether information will have
to become more timely i.e. more like the acute trust
situation.
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Mental Health PbR Development
Development and Implementation – Entering a
New Phase
Implementation
Development
Development will be
highly iterative, with
annual updates as we
implement.
We are here.
Implementation will
start in April 2010 with
use of clusters
(although funding not
yet attached).
2010
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M e n ta l H e a lth (M H ) P a ym e n t b y R e s u lts (P b R ) P ro je c t
G o ve rn a n c e
Mental Health PbR Development
N a tio n a l
M in is te ria l
D e c isio n s
P b R E xp e rt
A d vis o ry
G ro u p
PbR
P ro g ra m m e
B o a rd
M H PbR
E xp e rt
R e fe re n c e
Panel
M H S ys te m
R e fo rm
B o a rd
National co-ordination
of local implementation
and development.
CP&PP
P ro g ra m m e
B o a rd
M H PbR
P ro je ct
B o a rd
Key
F o rm a l rep ortin g
a rran ge m e n ts
Local
London
L o n d o n MH
MH
C u rre n c y D e v
Currency
P ro g ra m m e
Development
B o a rd
Programme
M H PbR
P ro d u ct
R e vie w G ro u p
F o r ad vice a n d
in fo rm a tion
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Mental Health PbR Development
Product Review Group and Sub-Groups
Sub-groups report into PRG.
They will be a standing item
on the PRG agenda and
periodically a sub-group
area will be the main focus
of a PRG meeting.
Quality
and
Outcomes
sub-group
Chair: Liz
Lightbown
/David
Daniel
Costing
sub-group
Chair:
Peter
Howitt
Product
Review
Group
Mental
Health
Clustering
Tool subgroup
Chair:
Norfolk
and
Waveney
Algorithm
and
Transitions
sub-group
Chair:
Lawrence
Moulin (W
Mids)
Secure
subgroup
Chair:
TBC
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Mental Health PbR Development
Other issues to address in 2010
 Future-proofing the cluster numbering.
 Link between IAPT Minimum Data Set information
and clusters.
 Personalisation agenda and social care.
 Training to support mental health professionals in
using the approach.
 Technical issues around elements included within
cluster such as first assessment.
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Mental Health PbR Development
Mental Health PbR sits at the centre of
improved mental health services
Enhanced
personalisation and choice
Reduction of
variation in
mental health
services
Value for
money/QIPP
Quality
Indicators
Mental
Health
PbR
Diverse
provision
Service
Organisation
and SLM
Improved,
comparable
data
Delivery of
national
policies e.g.
New
Horizons
Impacts across
an organisation –
not simply
finance.
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Mental Health PbR Development
Any Questions
For more information see:
http://www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/NH
SFinancialReforms/DH_4137762
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