ann york rcpsych conference 19 1 - royal college of ... a.pdfdr ann york consultant child and...

Dr Ann YorkDr Ann YorkConsultant Child and Adolescent PsychiatristPsychiatristSouth West London & St George’s Mental Health NHS TrustMental Health NHS Trust

Chair of DH CAMHS PbR Expert Advisory GroupAdvisory Group

Ann.York@swlstg‐tr.nhs.uk

Ann York RCPsych conference 19 September 2012 1

CAMHS PbRCAMHS PbR

• Concepts• Approach• Provisional clusters• Provisional clusters• Next Stepsp


CAMHS PbRCAMHS PbR



Wh ?Why?

• Clear responses to needs• Clarity and choices over options• Services redesign to ones that work best for• Services redesign to ones that work best for families


B fiBenefits

For providers For commissioners• Service innovation

rewardedClarity:• care

• Clarity of funding• Efficiency

• payment • outcomesoutcomes


Ti iTiming

• Project team appointed by DH (England) autumn 2011autumn 2011

• PbR likely to start 2014/15

• Work in progress• Work in progress


SScope

• Independent of setting E cl sions• Independent of setting• NHS Trusts, Foundation

Trusts Independent Sector

Exclusions• Non‐mental health learning

disability servicesTrusts, Independent Sector and Third Sector

• Tiers 2 to 4

disability services• GP services

S b t i d• Tiers 2 to 4• Learning Disability, forensic,

dual diagnosis

• Substance misuse and Addiction services

• General social care servicesdual diagnosis• Consistent with Adult PbR

and CYP‐IAPT

• General social care services‐non‐health spending

and CYP IAPT


Ch ll f CAMHSChallenges for CAMHS

• Co‐morbidity the norm

• Systemic formulation vs diagnosis• Systemic formulation vs diagnosis

• Complex multiagency pathways

id b d ti• evidence based practice


Cl tClusters

Groupings that are similar in• Need• Resourcing• Resourcing• Cost

Useful in mental health as people are complex

10Ann York RCPsych conference 19 September 2012

Currencies and tariffs

Currency = Tariff = ythe unit for which payment ismade e g Healthcare

set price for a given currencyunitmade e.g. Healthcare

ResourceGroups Outpatient

unit

Groups, Outpatient Attendances,

l tclusters


The systemThe system

See service

Cluster Care choices

Ongoing k

Review Discharges r c user

choices work


C P k d R iCare Packages and Reviews

Care Packages Reviews

• Meet the needs of people ithi i l l t

• Planned• Unplanned (significantwithin a single cluster

• Based on clinical guidelines d C

• Unplanned (significant change)

and on NICE• Care packages guide, but Use of outcome measures

not override, clinical decisions


C i i iCommissioning

Payment links to review periodsPayment links to review periods

’10 people in cluster 1, 20 in cluster 2’

All elements of care, direct and indirect


CAMHS PbRCAMHS PbR



A t 2011 t S i 2012Autumn 2011 to Spring 2012

• Project team appointed by DH• Reviewed work to date• Developed cluster proposal• Developed cluster proposal• Wide consultation

16Ann York RCPsych conference 19 September 2012

MH PbR Project Board The Team is big!Mental Health Product Review

Group

The Team is big!

GroupChair Martin Campbell

Children’s Project Board

Expert Reference Group

Department of Health CAMHS PbR Project BoardChair: Martin Campbell

j

Expert Advisory Group

Chair: Ann York8 Other Groups (including

specialist areas – e.g., IAPT, learning

Steering Group:

Chair: Martin Campbell Chair: Ann Yorkp g , , gdisability; technical areas – e.g.,

quality and outcomes, and costing)

Wider Project Team:

g pSimon Young (Chair)

Bruce ClarkeRob SeniorP t H l

Barbara Fittallj

Tony MartinDeirdre MoroneyRoger Da ies Core Project Group:

Pat Howley

Service Users /advocatesRoger Davies Core Project Group:

Miranda Wolpert(joint project director)Panos Vostanis

Consultants:David Cottrell

StatisticianHealth Economist (as required)

/advocates

(joint project director)Andy Fugard

Paul WilkinsonAnn York RCPsych conference 19

September 2012 17

E t Ad i GExpert Advisory Group• Professional organisations• CommissionersCommissioners• Providers• Those with experience ofThose with experience of

PbR development• Data experts• Data experts• Stakeholders and Officials

Virtual Groupp• Interested, committed others


CAMHS PbRCAMHS PbR



Mental Health Care ClustersMental Health Care ClustersThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

AdultAdultnt Working-aged Adults and Older People with Mental Health Problems

AdultAdultop

men

A

N P h ti

B

P h i

C

Organic

Dev

elo Non-Psychotic Psychosis Organic

PbR

D

a

Mild/

Moderate/

b

Very Severe

and

a

First Episode

b

Ongoing or

recurrent

c

Psychotic crisis

d

Very Severe engagement

a

Cognitive impairment

Hea

lth

Severeand

complexrecurrent

ntal

HM

en01 02 03 04 05 06 07 08 10 11 12 13 14 15 16 17 18 19 20 21

Ann York RCPsych conference 19 September 2012

Z - Unable to assign patient to Mental Health Care Cluster Super Class

There are two additional codes if it is not possible to allocate to a Cluster or Super Class:

0 (Variance) 20

Mental Health Care ClustersMental Health Care ClustersThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

AdultAdultnt Working-aged Adults and Older People with Mental Health Problems

AdultAdultop

men

A

N P h ti

B

P h i

C

Organic

Dev

elo Non-Psychotic Psychosis Organic

PbR

D

a

Mild/

Moderate/

b

Very Severe

and

a

First Episode

b

Ongoing or

recurrent

c

Psychotic crisis

d

Very Severe engagement

a

Cognitive impairment

Hea

lth

Severeand

complexrecurrent

ntal

HM

en01 02 03 04 05 06 07 08 10 11 12 13 14 15 16 17 18 19 20 21

Ann York RCPsych conference 19 September 2012

Z - Unable to assign patient to Mental Health Care Cluster Super Class

There are two additional codes if it is not possible to allocate to a Cluster or Super Class:

0 (Variance) 21

Clusters for young people should y g p pbe...

•Needs based • Clinically meaningfulnot diagnosis basednot diagnosis based

•Reflect level of resources required

• Diagnosesmay fall within a cluster and

•Outcome focussed

within a cluster and inform a specific interventionintervention


Cluster Development howCluster Development‐ how...

Looked at• Existing best practice NICE id• NICE guidance

• Advice from EAGAdvice from EAG


Wh t th l t ?What are the clusters?

• Revised after data modellingwatch this space.....


CAMHS PbRCAMHS PbR



WhWhere we are now

• Ongoing data modelling on largenational retrospective datasetsdatasets

• Prospective data modelling using CYP‐IAPT data


Next

• Redesign clusters in light of data modelling• Piloting


2014/15/Indicative timings

• Final version of needs assessment/clustering tool by September 2014

• All children clustered by March 2015

• Currencies mandated for local commissioning from April 2015


W t ?Want more?DH PbR www.dh.gov.uk/en/Managingyourorganisation/NHSFinancialReforms/index.htm

www.dh.gov.uk/health/category/policy‐areas/nhs/resources‐for‐managers/payment‐by‐results/

Department of Health (February 2012) Mental Health Clustering Tool Booklet (V2.03) p y ghttp://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132656.pdf

Care Packages and Pathways Project: www cppconcortium nhs ukCare Packages and Pathways Project: www.cppconcortium.nhs.uk

Royal College of Psychiatrists informationhttp://www rcpsych ac uk/members/currentissues/ifqo/qa/qa‐8 aspxhttp://www.rcpsych.ac.uk/members/currentissues/ifqo/qa/qa‐8.aspx

Mason, Anne and Goddard Maria (2009) CHE Research Paper 50: Payment by Results in Mental Health:CHE Research Paper 50: Payment by Results in Mental Health:A Review of the International Literature and an Economic Assessment of the Approach in the

English NHS. www.york.ac.uk/inst/che/pubs.


U f l C t tUseful Contacts

DH CAMHS Expert Advisory Group Chair:Ann York: [email protected] or Ann.york@swlstg‐tr.nhs.uko : o e.yo @bt te et.co o .yo @s stg t . s.u

DH PbR: Sue Nowak: [email protected] Fittall: [email protected]

CAMHS PbR Project team: Simon Young: SYoung@tavi‐port.nhs.uk

DH CAMHS team:[email protected]@dh.gsi.gov.uk


• Royal College of Psychiatrists informationhttp://www.rcpsych.ac.uk/members/currentissues/ifqo/qa/qa‐http://www.rcpsych.ac.uk/members/currentissues/ifqo/qa/qa

8.aspx

• Care Pathways and Packages Projecthttp://www.cppconsortium.nhs.uk/http://www.cppconsortium.nhs.uk/

Equity and excellence: Liberating the NHS HM Government JulyEquity and excellence: Liberating the NHS, HM Government, July 2010, ISBN: 9780101788120


ann york rcpsych conference 19 1 - royal college of ... a.pdfdr ann york consultant child and...

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