MH Payment System and Personalisation, NDTi Webinar 16 Oct 2014

8/10/2019 MH Payment System and Personalisation, NDTi Webinar 16 Oct 2014

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people lives communities


Mental health payment systems

and personalisation

NDTi webinar16 October 2014


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Welcome and introductions

What question is a new payment system the

answer to?

Does personalisation work?Where are we with the payment system in MH?

Whats needed to put this into place?

What else is going on?Discussion

Overview


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Who you are

Where youre from

What your role is

Welcome and introductions


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Real-terms spending decreased for last two

years - 1% cut in 2011/12 and a further 1% cut in

2012/13

MH providers subjected to 20% bigger cut thanacute providers from 1 April 2014

Only around 1/3 of people with a MH problem

receive any kind of formal support.

What Q are we A? (1a)


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What Q are we A? (1b)


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NHS Care Plan (in England):

54% definitelyhad views taken into account

42% said plan definitelyset out their goals

Of these, 44% said NHS MH services definitelyhelpedthem start achieving these goals

Choice and control in Scotland

People using Direct Payments as a proxy for this

37% people with physical/sensory impairments24% people with learning disabilities

19% frail older people

5% people with mental health conditions

What Q are we A? (2)


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What Q are we A? (3)

Employment for people with a MH problem

Non-disabled people is approx. 79%

Disabled people is approx. 48%

Depression is approx. 26%

Other forms of mental health conditions (e.g.

phobias) was 13%

Only 8% of adults with serious mental health

problems in employment



Put it another way



Evidence personalisation works



70%+ of people with mental health problems:Being as independent as they want

Getting the support they want

Being supported with dignity and respect

60%+ of people with mental health problems:Physical health

Mental wellbeing

Control over important things

Control over support

Less than 10% reported a negative impact onany area of their life




West Sussex:DPs process that supported discharges fromresidential care

Encouraging evidence that residential care

admissions reducedFlorida:

People spent significantly less time in psychiatricinpatient and criminal justice settings

People spent significantly higher number of days inthe community (compared to inpatient or forensicsettings) than in the year before

Similar findings in other places




Health system: PbR represents 60% of acute

hospital income (29bn) and one-third of primary

care trust budgets

Mental health identified for further roll-out2012/13 was a key year

2 fundamental features:

Currencythe unit of care for which a payment is

made

Tariffsthe prices to be paid for each currency

PbRintroduction


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Covers both hospital and community care

Episodes are more difficult to define

Diagnoses are less clear-cut

Less consensus on optimal care pathways

Complex interrelationship between mental and

physical health

DataProvision of MH service varies considerably

PbR in MHdifferences


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Clustering provides

new information

Better understanding

of quality and o/cIndividuals, not

services

Delivery beyond just

NHS providers

Supports introduction

of PHBs and IPC

PbR and Personalisationtheory

Medical model / deficitapproach

Focuses on (defined)

interventions andtreatments

Payment by Activity

Whole system?

Complementary?


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Whats the national picture?


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hfma survey

Commissioner understanding: 84% very poorfair

Open and regular dialogue w commissioners: 95%

Open and regular dialogue w service users: 40%

Cluster activity financial impact: 60% none

Contract type: 70% block with shadow tariff

No provider is using nationally specified currencies

with local prices as the primary basis for contracts

Range of opinions on the future



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Discussion paperHow PbR and Personalisation being understood andimplemented together

Seminar (with TLAP and SCIE)Opportunities and challenges of PbR andPersonalisation

Lack of good practice examples that can be shared

NHS Confederation MH Network commissioned

a practice paperSnapshot of how working in practice

Emerging approaches

Payment system & personalisation


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5 areas (identified by SHA MH leads)

Suffolk, Lambeth, Worcs, Northants, Stockport

In each area the project looked at:

What has worked wellThe difficulties encountered on the way

Critical success factors

Pitfalls to avoid

Caveat

Around 1 day in each area

Designed to be a snapshot

Method


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Creative, whole systems approach to

commissioning, contracting and service design

Recognition that traditional approaches undermine

collaborative working

Understanding that PbR puts pressure on VCS providersbut limited ways of addressing this (including social

investment)

Most attention is on systems change and more attention is

needed on market developmentFinancial pressure isnt yet leading to new approaches

Those with biggest picture viewhave more chance to be

successful

What we found (1)


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Systems and culture change to support rightPbR

Leadership, vision and commitment

Especially in solving issues

Joint capacityin commissioners and providers

Good communication, that especially avoids conflicting

messages (e.g. choice versus block contract vacancies)

Involvement of all right stakeholderseffective

mechanisms to do this

Two approaches:Think then do

JDI

On balance, JDI

What we found (2)


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Partnership and integration

No evidence that one form of joint arrangements is

better than another

Different stages of development affect joint working

E.g. where RAS is well-developed more difficult to

unpick

but could well be worth it

Bridge differences in language

E.g. RAS and PbR are both about allocating resources

Not sufficient understanding or communication of

Care Transition Protocols beyond clinicians

What we found (3)


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Inclusive and streamlined approach todevelopment

It takes a considerable amount of time and

effort from a wide range of peopleCommissioners need to leadconflict ofinterest for providers

Balancing cost and quality is very difficult

Not enough focus on outcomes or impactthat PbR can have on peoples lives andexperiences

What we found (4)


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From health assessment to FACS eligibilitywith 25% up-down discretionPbR asopportunity to improve RAS for MH PBs

Strong engagement of business support and ITstaffIntegrated health and social care budgetsprovide a good platform for developing jointassessment and local tariffs

Personal Health Budgets are more generally apositive development for PbR andpersonalisation

Practice highlights (1)


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Stockports alliance contract

Comprehensive coproductive approachincluding involvement of practitioners

Significant engagement with voluntary sectororganisations

CQUINS used to introduce enhanced primarycare services

Beginnings of a Payment by Recovery projectwith Experts by Experience monitoring PbRprocess

Practice highlights (2)


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Lessons difficult to disentangle from issues

more widely in MH

Payment system an opportunity for those

who do things really well to do something

else really well

Some have grasp of what needs to be done

Still putting it into practice

Juggernaut of Payment Systems (incl in

MH) continues irrespective

Overall reflections (1)


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Social care involvementnot very muchNeed to equip social care colleagues

Provider engagement

Overwhelmingly MH provider trustsVery strong incentive to be involved

VCS?

Whats a cluster?

Less Payment System and personalisationmore what can Payment System can learnfrom personalisation?

Overall reflections (2)


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l li i i

Contact

Rich Watts, MH Programme Lead

T: 01225 789135

E: [email protected]: @rich_w
mailto:[email protected]:[email protected]

MH Payment System and Personalisation, NDTi Webinar 16 Oct 2014

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Transcript of MH Payment System and Personalisation, NDTi Webinar 16 Oct 2014