Payment by Results: Implications for Occupational Therapy Practice

Introduction Payment by results system in mental health services Payment by Results (PbR) is 'the payment system in England under which commissioners pay health care providers for each patient seen or treated, taking into account the complexity of the patient's health care needs' (Department of Health [DH] 2012). In April 2012, the DH mandated PbR to National Health Service (NHS) mental health services in England (DH 2009, Howitt 2009). PbR offers a means of increasing accountability for targeted service delivery and documentation of outcomes in a range of service areas including occupational therapy (DH 2011a, 2011b, 2010a, 2010b, 2009). The adoption of the PbR system is based on the care pathways and care packages approach (Self et al 2008). The approach was developed by South West Yorkshire Mental Health NHS Foundation Trust as a classification system that categorized working-age and older service users based on need. Service users were allocated to one of 20 'clusters', based on scores from the Mental Health Clustering Tool (MHCT), an instrument that incorporated items from the Health of the Nations Outcome Scales (HoNOS, Wing et al 1999) and the Summary of Assessments of Risk and Need (SARN, Self et al 2008).

Section: Care Pathways and Care Package Approachesmentioning

confidence: 99%

Occupational Therapists' Perceptions of Appropriate Therapy Aims for Service Users in Mental Health: A Survey of Therapists in the United Kingdom

Lee

Morley

Garnham

et al. 2014

“…An adapted version of HoNOS, known as the Mental Health Clustering Tool (MHCT) (DH 2010d), is now being used to discriminate 20 separate clusters of service users (DH 2010a) (see Table 1). Professions are tasked with balancing cost-effectiveness and person-centredness (Horton 2007) as they create care packages to meet the needs of each cluster. Morley (2010) described how occupational therapists in England undertook an empirical study to build evidence-based care packages.…”

Section: Practice Analysismentioning

confidence: 99%

Meeting the Occupational Needs of Mental Health Service Users: Indicative Care Packages and Actual Practice

Parkinson¹,

Morley

Stewart³

et al. 2012

Payment mechanisms in English mental health services require professionals to describe treatments and demonstrate cost-effectiveness. A national occupational therapy study has prepared the way by profiling the occupational needs of service users and describing indicative care packages. This practice analysis reports on a local survey, which was conducted in parallel with the national study. Treatment aims were found to correspond with key elements of the occupational profiles. This supports the accuracy of the profiles. It also provides evidence towards the effectiveness of the service being provided by demonstrating the ability of occupational therapists to target the proven needs of service users.

“…A shift towards more community-based mental health services has reduced the number of occupational therapy mental health posts for new graduates, which have traditionally been in inpatient and day hospital settings, and often as part of a rotation. Also, in the UK, payment by results in mental health is only just starting to be implemented, but the Canadian experience provides a clear indication that it leads to a higher level of expectations of graduates (Horton 2007). Therefore, it is our contention, as occupational therapists practising, teaching and researching in the mental health field, that the time has come to review the delivery of occupational therapy education.…”

Section: Implications Of Mental Health Policy and Legislation For Thementioning

confidence: 99%

Is it Time for a Mental Health Pathway in Undergraduate Programmes?

Bannigan

Lewis

Laver‐Fawcett

et al. 2011