Monday, 3 March 2014
The College is organising a mental health tariff programme
'stock-take day' on 19 March. I am therefore using this blog to ask
all members to feed back to me their views on the opportunities and
challenges presented by the current payment by activities work.
This topic sits in the top three things members always want to
discuss with me, so I am really keen to hear from you. You can
send your thoughts in via our Policy Unit.
I am grateful for the continued listening to us and work of Dr
Geraldine Strathdee, NHS England's National Clinical Director
for Mental Health , and the ongoing efforts of the Payment by
Results (PbR) group at the College which produced this
helpful College position
statement in January.
It is really important that your
views and ways forward are fed into this day in
March. I want to hear views and ideas that reflect
all the work that we undertake as psychiatrists, leading teams
across specialities, settings and lifespan.
We all know we were invited late to the PbR
party. I know many of you are finding what you are now expected to
do in reporting your activities time consuming, cumbersome, and not
reflecting what you actually do, but we have to work with whatever
is the extant system and influence it for the better. I have
personally tried to stress that, for many of us, we are de
facto not working with a neat circumscribed single acute
episode of mono morbidity mental disorder but complex, real world,
multi morbidity, long term conditions (including in childhood). I
believe ‘year of care’ would better reflect the work we actually do
and capture the changes in outcomes across the domains of a
patient’s life over time.
And there is also the myriad of other work
we all carry out to ensure we have a well-trained next generation
of psychiatrists, a well informed public and a system where
safeguarding and quality improvement are at the fore of everyone's
thinking and practice.
So if you have been invited to this
stock-take day please try and attend. If not, feed in your
views so our lead College members can attend on your behalf and be
well informed about both continued problems and your
This is all taking place in the very
negative context of the Monitor’s ‘tariff deflator’ - a
decision which will and is already resulting in money being taken
from mental health and community care to fund the implementation of
the Francis report in acute trusts. This is in the further
unhelpful context of messages put out by NHS England that can be
and are, out on the ground in the land of CCG pressures,
interpreted six ways to Christmas, but not in favour of mental
health. This is a fundamentally flawed decision that ignores
the fact we have ‘parity’ enshrined in legislation. I am
working hard with the mental health charities and the NHS
Confederation Mental Health Network to achieve a meeting with those
who have been party to this decision across Monitor and in
particular NHS England.
I will keep you informed but if there is
not a significant shift in the current response, this is a matter
of such fundamental importance to mental health I will be
asking you to lobby your MPs. This is a real betrayal of what
we were promised about parity which mental health
professionals, patients and carers thought would, after so many
years, make us equal partners in health. Neither I nor the
President Elect will give up on this.
I know how busy everyone is and the
pressure you are under, but to influence the direction of services
we believe will best serve our patients we have to be and
remain involved, so make sure you have your say.
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