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:
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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