Payment by results

Payment-by-Results in Mental Health is required to ensure:

  • Movement from block contracts to payment for specific groups of patients
  • Greater correlation and transparency between funding and patients’ levels of need rather than, as currently occurs, it being based on mainly historical factors
  • Improve quality assurance and clinical outcome measurement of service provision (e.g. through a direct relationship with NICE guidelines and outcome measures)
  • Evidence-based interventions become more reliably and consistently delivered and interventions of limited clinical value discontinued
  • Cost-effective funding for mental health services is not used to offset pressures elsewhere in response to the adverse economic environment

Individual personal budgets are being implemented:

  • Patients, assured of receiving evidence-based interventions because of PbR, choose to expend their own personal budgets
  • On whatever they feel would be right for them linked to agreed outcomes from a menu of possibilities
  • Allocated, held and brokered through both CCGs and Local Authority

Clinical care pathways are the tools for its implementation;

  • Categories for allocating resources are been developing. These groups each have indicative diagnostic categories (see table ‘Payment-by-Results and Diagnosis’).
  • The evidence-base for psychiatric interventions is derived from studies using diagnosis but sometimes this is broad, e.g. psychosis or severe mental illness, or is based on needs, e.g. accommodation or employment.
  • Co-morbidities can also to be accommodated as these are more costly and complex to manage e.g. psychosis or bipolar disorder with substance misuse, relationship difficulties (‘personality disorders’), physical ill-health and neurodevelopmental disorders (e.g. Dyslexia, Attention Deficit Hyperactivity Disorder, Autistic Spectrum Disorders).
  • Linkage of the clusters to the evidence-base, quality standards, outcome measure and clinical guidelines (e.g. NICE) is through these broad diagnostic groups or assessed needs.