payment by results dr alex horne medical director nelft
TRANSCRIPT
Payment by Results
Dr Alex HorneMedical 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 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
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