Payment by Results in intellectual disability services – a vehicle for personalising healthcare
| Published date | 02 March 2012 |
| Date | 02 March 2012 |
| Pages | 89-98 |
| DOI | https://doi.org/10.1108/20441281211208455 |
| Author | Ashok Roy,Sabyasachi Bhaumik |
| Subject Matter | Education,Health & social care |
Payment by Results in intellectual
disability services – a vehicle
for personalising healthcare
Ashok Roy and Sabyasachi Bhaumik
Abstract
Purpose – Needs led person centred services are the hallmark of high quality intellectual disability
services. Commissioning mechanisms such as Payment by Results (PbR) have been established in
acute health services. An outcome focussed version of PbR will be implemented nationally from 2012 in
an incremental manner in mental health services for adults and older people. Though intellectual
disability services are currently excluded, it is proposed that needs led approaches would improve the
quality and efficiency of specialist intellectual disability services. This paper aims to suggest that this
approach could be the key to commissioning and designing personalised pathways of care.
Design/methodology/approach – Health needs are scoped and care pathways are defined as
primarily consisting of Needs, Interventions and Outcomes. The mandated cluster groupsto be used for
PbR in adult mental health and older people’sservices are extended to cover the non overlapping needs
of people with intellectual disability to provide an integrated framework of health needs usually met by
specialist services. A framework of interventions is suggested and components of ‘‘assessment’’ and
‘‘therapeutic’’ activities are outlined. An outcome framework is described. A case example illustrates
the application of these components to design a care pathway to provide a personalised, needs led
service.
Findings – It is possible to use the principles underlying PbR to commission personalised services of
high quality, improved efficiency and thus greater value.
Originality/value – The principles underlying PbR can be used to commission personalised pathways
of care in intellectual disability services at a time when this approachis being extended to mental health
services nationally.
Keywords Payment by results, Intellectual disability, Personalisation, Needs led approaches, Quality,
Quality of service, Health care, Learning disability
Paper type General review
Setting the scene
The drive to transform health services for people with intellectual disabilities has been
accelerated by a number of policy drivers.
There hasbeen an acceleration of deinstitutionalisation and the monitoringof its conclusion by
the Department of Health(2010a). It has reiterated the need to discharge inpatients that have
been in assessment and treatment services for more than a year, who are not compulsorily
detained and not undergoing a recognised evidence based treatment programme.
The ‘‘Valuing people now summary report’’ – (Department of Health, 2010c) noted that while
progress had been made with regard to recognising and meeting the health needs of people
with intellectual disability there was a wide variation in quality of health services, number of
people receiving health checks, transition planning and closure of hospitals.
Poor care for people with intellectual disability in general hospitals was highlighted in Death
by Indifference (Mencap, 2007). This was followed by the publication of Healthcare for All
(Michaels, 2008) which recommended improvements in identifying, assessing and meeting
DOI 10.1108/20441281211208455 VOL. 6 NO. 2 2012, pp. 89-98, QEmerald Group Publishing Limited, ISSN 2044-1282
j
ADVANCES IN MENTALHEALTH AND INTELLECTUAL DISABILITIES
j
PAGE 89
Ashok Roy is a Consultant
in Learning Disability
Psychiatry at Coventry and
Warwickshire Partnership
Trust, Birmingham, UK.
Sabyasachi Bhaumik
is a Medical Director
at Leicestershire
Partnership Trust,
Leicester, UK.
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