Delaying the implementation of Payment by Results in mental health: the application of standardisation

Date14 September 2015
DOIhttps://doi.org/10.1108/MHRJ-03-2014-0008
Published date14 September 2015
Pages156-165
AuthorRuoxi Wang,Ian Shaw,Hugh Middleton
Subject MatterHealth & social care,Mental health
Delaying the implementation of Payment
by Results in mental health:
the application of standardisation
Ruoxi Wang, Ian Shaw and Hugh Middleton
Ruoxi Wang is based at the
School of Sociology and Social
Policy, University of
Nottingham, Nottingham, UK.
Ian Shaw is Professor of
Health Policy at the School of
Sociology and Social Policy,
University of Nottingham,
Nottingham, UK.
Dr Hugh Middleton is based at
School of Sociology and Social
Policy, University of
Nottingham, Nottingham, UK.
Abstract
Purpose The purpose of this paper is to explore the issues surrounding a long planned expansion
of Payment by Results (PbR) into mental health services and to highlight the factors responsible for
the delay.
Design/methodology/approach PbR relies upon standardisationof conditions and treatments.
This depends upon a scheme of classification that can realistically predict resources required to execute
treatment of any one case. Plans to fund NHS mental health services on the basis of tariffs derived in this
way have been delayed, and a key reason is the lack of high-quality data. This would require effective
standardisation-to the-averageof both a system of classification and a repertoire of costed treatment
pathways. This paper investigated the delay implementation by exploring the difficulties in applying
standardisation principles to service provision and tariff calculation.
Findings The paper identified the fundamental difficulty with PbRs implementation in applying
standardisationto practice. This is defining the mental disorder that the patient is suffering and
designing care pathways at clinical level considering the balance between practical applicability
and conceptual/constructional validity. This is necessary to enable the calcul ation of a national
tariff. The conceptual flaws of the Health of the Nation Outcome Scale led to the constructional
shortcomings which compromised the credibility and validity of Mental Health Clustering Tool
regarding making accurate classification in a standardised way. The validity and credibility of
calculating a national tariff thus became contentious on the basi s of this inaccurate clinical
classification system.
Originality/value This paper explored the driving factors of delay in implementing PbR in mental health
through connecting the recent reform with the fundamentalassumptions of standardisation-to the-average,
which provided another perspective to illustrate the current obstacles.
Keywords Mental health services, Standardisation, Delay, Payment by Results
Paper type Literature review
Introduction
An expansion of Payment by Results (PbR) into mental health service provision was initially
planned for 2013, but at the time of writing (April 2015) it had yet to become the definitive
framework for funding NHS secondary mental health services. In 2013 guidance was published
which included indicative costs for each of 21 treatment packages or clusters(Department of
Health Payment by Results Team, 2013), with a view to implementation in 2013/2014. This was
delayed until 2014/2015 (Lintern, 2013). Subsequently it was reported that implementation
was to be further delayed and the expressions dangerousand unintended outcomes
were attributed to key figures in relation to hurried implementation of PbR in this domain (Lintern,
Received 31 March 2014
Revised 4 July 2014
26 November 2014
29 April 2015
Accepted 15 June 2015
PAGE156
j
MENTALHEALTH REVIEW JOURNAL
j
VOL. 20 NO. 3 2015, pp. 156-165, © Emerald Group Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-03-2014-0008

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