Commissioning Outcome‐focused Mental Health Services
| DOI | https://doi.org/10.1108/13619322200600030 |
| Date | 01 September 2006 |
| Published date | 01 September 2006 |
| Pages | 31-36 |
| Author | Mike Slade |
| Subject Matter | Health & social care |
Commissioning Outcome-focused
Mental Health Services
Mike Slade
Institute of Psychiatry
King’s College London
Focus on…
he commissioning of mental health
services has traditionally been based on either poorly
specified agreements based on historical precedent
(existing services continue to be funded) or activity-
based service-level agreements. The introduction of
payment by results1(PbR) challenges these
approaches.
From a commissioning perspective, the policy
intention is to move towards funding arrangements in
which resourcing is linked directly with the impact of
the work done. This requires information about inputs
(what is being paid for) and outputs (outcomes
achieved) to the mental health system. This article
outlines some of the challenges and opportunities for
mental health commissioners in fostering this
transition, with a particular focus on understanding
and addressing the reasons why the measurement of
mental health outcomes has proved so difficult.
What is outcome? An outcome is the effect on a
patient’shealth status attributable to an intervention
by a health professional or health service (Andrews et
al, 1994). Traditionally, the outcome of mental health
carehas been assessed by clinicians using informal
methods – that is, clinical judgement. It is now
recognised in mental health policy and research
(though not practice) that a stronger approach is to
assess outcome from multiple perspectives (most
importantly, the patient’s perspective), and to use
formal ‘standardised’ methods rather than relying
on clinical judgement.
Current policy context
The general direction of travel in health care is
towards a patient-led NHS in which ‘everything is
Tmeasured by its impact on patients’ (Department of
Health, 2005). It is therefore vital to ensure outcome
data are routinely collected and used. This is being
addressed by the development of information
strategies within the NHS.
Mental health policy and best practice guidance is
consistent with this approach, illustrated in Box 1.
Overall, there is a policy consensus about the
importance of outcomes. Indeed, appropriate
measures have been developed for routine use
(Lelliott, 2000), and one – the Health of the Nation
Outcome Scale (HoNOS) (Wing et al, 1998) – is
mandated by the Mental Health Minimum Dataset for
use throughout adult mental health services. However,
staffare not using standardised outcome measures in
practice (Gilbody et al, 2002). Why is this?
Clinical resistance
Anumber of reasons have been proposed for the lack
of mental health staffand service ‘buy-in’ to the
routine collection of outcome data (Walter et al, 1998;
Slade et al, 1999; Clifford 1998; Marks, 1998):
■lack of time – filling in outcome forms is not
seen as a ‘valued clinical activity’ compared
with seeing patients
■lack of incentives – there are no adverse
consequences of non-completion
■lack of infrastructure support – IT is
insufficiently robust to support electronic
aggregation and feedback of outcome
information
■lack of consensus about what to assess (perhaps
reflecting the tensions within mental health
The Mental Health Review Volume 11 Issue 3 September 2006 ©Pavilion Jour nals (Brighton) Limited 2006 31
1See www.kingsfund.org.uk/resourses/briefings/payment_by.html for an overview of PbR and www.audit-commission.gov.uk for the October
2005 Early Lessons from Payment by Results document.
J-341-06-06MHR11.3Septinsides 23/8/06 10:43 am Page 31
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