Commissioning for Payment by Results

Commissioning for Payment by Results Sarah Rushton Head of Joint Service Development for Mental Health NHS Westminster & Westminster City Council

This Presentation • The benefits of PBR for commissioners • What can be learned from the work done? • What challenges remain? • Tips on avoiding pitfalls • Next steps

1. PbR for Mental Health The benefits of PbR for commissioners

The benefits from clustering • Systematic clustering will enable us to build up a picture of levels of needs for the local population • Once allocation to a cluster is reliable and widely used, commissioners will have a basis on which to benchmark and compare levels of need between geographical areas • Realignment of investment based on need

The benefits • The care packages that are delivered will be better specified with information on both the cost of the package and the numbers of people using the packages. • Care packages could be built around a detailed assessment of the needs and preferences of service users • As HoNOS is required to deliver PbR, the HoNOS data will be widely available for its original purpose of measuring outcome

2 PbR for Mental Health What can be learned from the work done?

The learning • It is not easy to move straight from a block contract to PbR. You need steps along the way. • Engagement with your main provider needs to go further than their progress in clustering. What will performance reports look like when you have moved to full PbR? • What will performance reporting look like during the transition phases?

What will we need to know? • Total numbers in each cluster • Diagnostic profile- particularly in some of the non-psychotic clusters • Flow through clusters, where do people come from and where do they move on to? • What is the agreed care pathway for the cluster and to what extent was this adhered to?

What will we need to know? • Were the care pathway outcomes achieved? • What other outcomes have been associated with the cluster – e.g. employment, stable accommodation, recovery and service user defined outcomes. • What is the performance in each cluster in relation to quality standards or proxy measures such as CPA, delayed discharge, 7 day follow-up?

3. PbR for Mental Health What challenges remain?

The challenges • Ensuring incentives are built into the pricing mechanism that deliver care in community settings • Discussion on the use of the ‘crisis’ cluster to avoid this becoming a default ‘bed price’ • We want to be able to assess value for money – are we commissioning the best possible care for every £ spent?

The challenges • PbR will fund health and directly integrated social care such as CMHT services, how will you make it link locally with the broader care pathway and other social care funding streams and with personal budgets?

4. PbR for Mental Health Tips on avoiding pitfalls

Costing Care Packages • Identify care packages currently offered to people in each cluster and the current cost • Do the packages currently on offer provide ‘core care’ or ‘best care’? • Agree what ‘best practice’ care packages look like – at trust level or across a wider area • Price best practice packages • Understand and be transparent about any costing differences. If best practice is not cost-neutral agree what will be delivered and with what quality standards?

Avoiding pitfalls • Acknowledge that between boroughs there will be differences in cluster costs and seek to use the improved quality and outcome evidence to understand where value for money lies • Consider how you will work with providers to manage demand once the block contract methodology ceases

Avoiding pitfalls • Work actively with your main provider on data capture so there is confidence that during the transition, unclustered activity will not suddenly be clustered following price setting • Identify potential areas in your local system for double payment such as dual diagnosis with learning disability – the level of need will be high but most of the need is being met from a different funding stream

Avoiding pitfalls • Think through how you will deal with out of area placements where this is the main cost but the local trust clusters the person at a high level of need as they retain care co-ordination • If you provide services to carers, be explicit on whether these are in or outside of the cluster pricing

5. Next Steps and questions

Our proposed approach and timetable

Next steps • If you haven’t already, engage your main provider in discussion on what you will expect see in a PbR performance report and discuss how to overcome some of the pitfalls. • Make sure that you engage both internally with the PCT Finance Directorate and that they have an understanding of the issues the PCT will face in delivering Mental Health PbR. • Communicate with the local authority on how the funding stream for PbR will fit with other funding streams and with self-directed support.

Commissioning for Payment by Results