Change that leads to better lives

What commissioners can do to support personalisation through the mental health payment system

Payment by Results is a way of funding services based on what they achieve. It has been on the agenda in mental health for over five years, and since 2012/13 the approach has been compulsory.

Reflecting on progress over the last three years, there seem to be some benefits when the new mental health payment system works well: it can deliver savings and bring in new resources, improve outcomes and encourage new ideas. The payment system can give commissioners and providers a greatly improved sense of who the people are who use services, what they want and need, and can improve people’s choice in how those needs are met. Indeed, the Department of Health indicates that the payment system in mental health has the potential to support personalisation, leading to “more personalised services and improved outcomes”.

Despite the focus on a new payment system in mental health, though, progress to date has been stuttering. For example, a survey by the Healthcare Financial Management Association (HFMA) shared the views of health finance managers and found there was little understanding of the mental health payment system amongst commissioners, and that efforts so far had had little impact on provider finances or financial arrangements in mental health.

One of the reasons often cited for a lack of progress is the skills of commissioners. Commissioners are sometimes reported to not have the capability to build relationships, make deals, resolve conflict, shape markets or manage finances in the way needed for the complex mental health payment system to work successfully. If this is true, these are big issues that can’t be solved in the short term. This is especially true when commissioners are faced with funding changes and tough reforms.

Over the last 18 months, however, NDTi has been exploring what the success factors are in areas where progress has been made on aligning the new mental health payment system with personalisation. Our learning suggests four things that commissioners can do now to support personalisation through the mental health payment system:

  • Ensure there is joint working between commissioners across health, social care and public health, as well as with providers from all sectors. The most successful areas have regular planned sessions on the mental health payment system in which all these parties talk with each other in person.
  • Ensuring there are champions for change in the mental health payment system at all levels – including clinicians, care coordinators, informatics and finance professionals. This ensures the mental health payment system isn’t just a financial change but a cultural one that everyone can play a part in.
  • Ensuring any care pathways developed reflect all phases of mental health support – community, primary and secondary – and not just secondary care. They should also take account of non care-related support, including housing and employment services.
  • Joining up the dots between the different agendas that exist. The mental health payment system can support issues such as choice in mental health, S117 aftercare arrangements, reducing out-of-area placements, implementing Personal Health Budgets and Integrated Personal Commissioning. But to do so it needs leadership from commissioners to show how these things all fit together.

A framework for success and more practical learning from five areas who are doing this well is available in our new report on the mental health payment system and personalisation.

Since this is an area of work that commissioners have to do, the opportunity should be taken to support the wider goal of developing and delivering a personalised mental health system. Not just one where the finances flow differently whilst the outcomes for people remain the same.

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