Payment by Results in Mental Health

I think I might be a bit late to the party here and everyone else might know about this already.

Apparently they are either trying to or in the process of implementing payment by results in the UK (or just England?) mental health system. It looks like this would be used at a higher service funding level than individual nurses being paid for every depressed person they cheered up.

There is a reasonably comprehensive article here:

Payment by results in mental health: the current state of play in England

‘Payment by results’ is a method of paying for the services of hospitals and other providers. Plans are well underway to use it within the National Health Service (NHS) in England, and some health authorities began to introduce it in 2005.

The author goes into more detail.

1. Payment by results has three central components. The first is activity-based funding, which contrasts with the more traditional block contract agreements. For service providers, more work will generate more income or, indeed, less work will generate less.
2. Second, the amount of work tends to be measured in the context of healthcare resource groups. These are groupings of individual cases that are sufficiently clinically similar and require similar treatment resources. In the acute healthcare sector they tend to be based on international categories of diagnosis. They also take into account procedures, complications and co-existing illnesses. Therefore any payment by results system seeks to provide a coherent manageable way of classifying the mixed cases treated within a hospital. This is why payment by results is sometimes called a system of case-mixed funding.
3. Third, payment is made according to a national tariff. This tariff is a price tag for any individual healthcare resource group. The price tends to be based on the average cost of treatment across the NHS. This national tariff means that contractual negotiations between commissioners and providers no longer require price negotiation but can concentrate on quantity and quality of care.

An article Payment by results: what does it mean for mental health? discusses some of the issues with this system:

Not for the first time, the mental health system is being required to implement a major reform designed primarily for other parts of the NHS.

Five minutes of Googling found the following:

A picture of progress: payment by results in mental health

Read to the end to find out which kind of patient you might end up being. Maybe someone should write a Facebook app for it.

Some DoH stuff here and here.

I am still trying to imagine how this might be made to work in mental health. I suspect in general nursing it is payment by results that leads to a man with a sprained thumb being seen before your ill child in A&E because he is about to exceed the 4 hour limit. Or patients being ‘discharged’ from one ward and admitted to another two floors up for no good clinical reason. Or even the reduction in waiting list times for cancer patients. So probably a mix of good and bad.

My feeling is that general nursing is often … easier to measure than mental health. In mental health it would start to generate significant amounts of new PbR paperwork, probably in addition to what we already have to do.

Things being measured will change nursing behaviour. Let us be clear if one of the outcomes measured is, for example, length of stay in an acute admissions ward. Say some management numpty decides an acute ward should be purely used for assessment then initial treatment and therefore people should not have to be admitted for more than two months. This will lead to some or all of the following:

• Some patients being discharged too early and at increased risk of early readmission.
• Patients being ‘discharged’ to another ward for no good reason.
• The ward losing funding for keeping ill people in as long as they need to be.

And probably other things.

Maybe I should actually download the documents and read up on it.