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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
Ann York RCPsych conference 19 September 2012 3
CAMHS PbRCAMHS PbR
• Concepts• Approach• Provisional clusters• Provisional clusters• Next Stepsp
Ann York RCPsych conference 19 September 2012 4
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
Ann York RCPsych conference 19 September 2012 5
B fiBenefits
For providers For commissioners• Service innovation
rewardedClarity:• care
• Clarity of funding• Efficiency
• payment • outcomesoutcomes
Ann York RCPsych conference 19 September 2012 6
Ti iTiming
• Project team appointed by DH (England) autumn 2011autumn 2011
• PbR likely to start 2014/15
• Work in progress• Work in progress
Ann York RCPsych conference 19 September 2012 7
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
Ann York RCPsych conference 19 September 2012 8
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
Ann York RCPsych conference 19 September 2012 9
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
Ann York RCPsych conference 19 September 2012 11
The systemThe system
See service
Cluster Care choices
Ongoing k
Review Discharges r c user
choices work
Ann York RCPsych conference 19 September 2012 12
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
Ann York RCPsych conference 19 September 2012 13
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
Ann York RCPsych conference 19 September 2012 14
CAMHS PbRCAMHS PbR
• Concepts• Approach• Provisional clusters• Provisional clusters• Next Stepsp
Ann York RCPsych conference 19 September 2012 15
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
Ann York RCPsych conference 19 September 2012 18
CAMHS PbRCAMHS PbR
• Concepts• Approach• Provisional clusters• Provisional clusters• Next Stepsp
Ann York RCPsych conference 19 September 2012 19
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
Ann York RCPsych conference 19 September 2012 22
Cluster Development howCluster Development‐ how...
Looked at• Existing best practice NICE id• NICE guidance
• Advice from EAGAdvice from EAG
Ann York RCPsych conference 19 September 2012 23
Wh t th l t ?What are the clusters?
• Revised after data modellingwatch this space.....
Ann York RCPsych conference 19 September 2012 24
CAMHS PbRCAMHS PbR
• Concepts• Approach• Provisional clusters• Provisional clusters• Next Stepsp
Ann York RCPsych conference 19 September 2012 25
WhWhere we are now
• Ongoing data modelling on largenational retrospective datasetsdatasets
• Prospective data modelling using CYP‐IAPT data
Ann York RCPsych conference 19 September 2012 26
Next
• Redesign clusters in light of data modelling• Piloting
Ann York RCPsych conference 19 September 2012 27
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
Ann York RCPsych conference 19 September 2012 28
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.
Ann York RCPsych conference 19 September 2012 30
U f l C t tUseful Contacts
DH CAMHS Expert Advisory Group Chair:Ann York: Rowe.york@btinternet.com 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: sue.nowak@dh.gsi.gov.ukBarbara Fittall: Barbara.Fittall@dh.gsi.gov.uk
CAMHS PbR Project team: Simon Young: SYoung@tavi‐port.nhs.uk
DH CAMHS team:Raphael.kelvin@dh.gsi.gov.ukAnne.Spence@dh.gsi.gov.uk
Ann York RCPsych conference 19 September 2012 31
• 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 September 2012 32
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