PbR for Specialist Alcohol
About the Specialist Alcohol Services Assessment and
Clustering Tool and Payment by
Payment by Results (PbR) was introduced for
the acute hospital sector in 2003/04. There were concerns that
without a more transparent funding solution for mental health,
there will be disinvestment in mental health services that were not
covered by PbR. The work on Mental Health PbR began in 2005 and now
all health economies should be using the Mental Health currencies
in some form and establishing local prices.
The Mental Health Clustering Tool that
supports MH PbR was developed in partnership between the Department
of Health (DH), the (RCPsych) and the Care Pathways and Packages
Project (CPPP) to deliver a system that allows the allocation of
clients to Care Clusters and which in turn enables MH PbR.
The MHCT retains HoNOS and thus supports
providers and commissioners in measuring health and social care
outcomes in mental health without the need to collect additional
data. HoNOS was published by the RCPsych in 1996 and is now the
most widely used outcome measure in specialist mental health
services in England and overseas.
The Royal College of Psychiatrists has over 15 years experience
of training clinical staff in the use of the HoNOS and the MHCT, working with individuals and staff
teams to train them as trainers and with Trusts to develop and
support Trust wide training and implementation plans.
Alcohol PbR is seen as a natural progression as specialist
alcohol treatment is often delivered through Mental Health
contracts. Improving Health & Wellbeing UK (IHWUK) have played
a central role in the DH pilot work to develop and test the
Specialist Alcohol PbR assessment and clustering and are
experienced in supporting providers of specialist alcohol
To provide support to Specialist Alcohol service providers and
commissioners in implementing PbR for Specialist Alcohol Services,
the Royal College of Psychiatrists (RCPsych) are now developing
training courses in partnership
with IHWUK and we plan to make these available early in 2013 once
the Department of Health confirm the final details of the tools and
Background to PbR for Specialist Alcohol Services – Why
is it important?
In 2011, the National Institute for Health and Clinical
Excellence (NICE) published the guidance document
‘Alcohol use disorders: diagnosis, assessment and
management of harmful drinking and alcohol
dependence’. This offers evidence-based advice on the
diagnosis, assessment and management of harmful drinking and
alcohol dependence. The Government’s National Alcohol Strategy
published in March 2012 underlined the importance of this document
by stating that “we expect all areas to implement the
recent NICE guidance and a quality standard on the management of
harmful drinking and alcohol dependence.” This poses
a significant challenge to both commissioners and providers of
specialist alcohol treatment because generally there is a dearth of
information on the extent to which current services meet these
Key questions are:
- Do we know what interventions
are being routinely provided by the commissioned specialist alcohol
treatment services locally?
- To what extent does current
practice map onto the NICE guidance for the diagnosis, assessment
and management of harmful drinking and alcohol dependence?
- Can we differentiate locally
between different needs-based groups and are care packages based on
differing levels of need?
- How can the delivery of NICE
compliant interventions be incentivised in the commissioning
- Have we got systems in place
to routinely record different types of clinical intervention – do
we know what people are doing?
- How can commissioned
activity be linked to outcome monitoring?
PbR is intended to provide a more transparent
funding system for specialist alcohol treatment services, with
clarity as to what care is being provided, how it is paid for and
what outcomes are delivered.
At present, there is limited
understanding of the quality and quantity of care that is provided
for people requiring specialist alcohol treatment services. A more
transparent system with national currencies for specialist alcohol
treatment services would facilitate:
- More productive discussions between
commissioners and providers
- Bench-marking for providers and
- Greater investment in proven
- Better care leading to better outcomes for
PbR for Specialist Alcohol Services - Assessment and Cluster
To support Specialist Alcohol service
providers and commissioners in implementing PbR, the Royal College
of psychiatrists (RCPsych) are planning to offer training courses in partnership with
Improving Health & Wellbeing UK (IHWUK) early in 2013 once the
Department of Health confirm the final details of the tools and