April-June
2009
The overall plan for the initiative as agreed
in Spring 2008 was to produce a consensus Statement of Principles,
to set up a website and associated literature, and to promote the
principles amongst members, policy makers, and the mental health
community in general.
Over the three months since my last report
most of my IFQO activity has been through various meetings, at
which a College presence has generally been well received. I
have talked at several College Divisional meetings or to Medical
Managers in Wales, England and Scotland and at the College Annual
Meeting. To promote the principles in England I accepted an
invitation to join the Clinical Advisory Panel for Payment by
Results (which covers the whole PBR programme, not just MH) as well
as the Expert Reference Panel for MH. I have also been
attending the MH group meetings within Connecting for Health, and a
new national group concerned with developing standard clinical
communications.
It has always been hard to summarise this
rapidly developing field but I would draw attention to some current
themes:
1. Although there are plenty
of differences between the four UK countries, if one looks past the
variations in language there is a lot that is shared when it comes
to quality and outcomes measures and their use in resource
allocation. Each country could learn from the others and
profit from the opportunities for benchmarking.
2. The call for relatively
sophisticated measures of healthcare activity and quality has never
been greater, in terms of the policy statements, yet the capacity
to deliver is not yet much improved. The lead-in time for
changes in information management is almost always
under-estimated.
3. The piecemeal development of MH
informatics has resulted in a plethora of alternative solutions to
all sorts of major and minor issues, with no authoritative central
body able to promote one version or another. A great deal of
time and opportunity has been wasted. England has probably
suffered more than the smaller countries from a lack of central
co-ordination. Scotland is further advanced in identifying
quality measures.
4. Representation of MH services
in comparison to acute and primary care is generally sparse.
It would be beneficial in the long run to encourage more younger MH
professionals to attend this sort of meeting.
5. ‘Connecting for Health’ has
been radically re-structured, with even less MH representation than
before. The future co-ordination of informatics in England is
very uncertain.
6. There is little progress to
report yet on the identification of quality measures for routine
use in England, as far as I can tell.
7. It will be important, given the
changes that are likely to happen over the next few years in the
NHS, that valuable developments are not thrown out along with those
that are disposable (not working, or outdated political
objectives). We need to be clear which is which.
With this in mind, my plans for July and
August include:
1. Preparation of a summary paper
(entitled ‘Putting it all Together’ or similar). The aim will
be to draw comparisons between the four countries, and make
proposals for the greater integration and simplification of MH
informatics; both between and within each country. This may
include greater integration of MH systems (at any rate, data
compatibility) with those used in primary care, and the proposal
for more central organisation of MH informatics where
appropriate.
2. I will continue to try to
promote the latter ideas, and be very pleased to receive input or
comment of any kind.
Appendix: Recent News from the MH PBR
Team:
‘We have recently published the following
documents on the DH website, mental health PbR development
section.
A Practical Guide to
Preparing for Mental Health Payment by Results
A 'Dear Colleague' letter
from Bob Alexander and Kathryn Tyson
A clustering booklet which
contains the assessment tool (HoNOS PbR) and
the 21 clusters developed by
the Care Pathways and Packages Project.
You can access these materials on the
‘what's new’ section of the webpage by clicking on the link
below:
NHS Financial reforms
Dr Martin Elphick 17th June 2009