PbR for Specialist Alcohol Services

About the Specialist Alcohol Services Assessment and Clustering Tool and Payment by Results

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 services.

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 clusters .

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 standards.

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 process?
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 commissioners
Greater investment in proven interventions
Better care leading to better outcomes for service users