The Department of Health had sought to begin implementing the mandatory tariff from April 2013. However, it has now confirmed to HSJ that the national rollout will not take place within the 2013-14 financial year, although no alternative date has been given for its implementation.
Key to the success of the proposed system is the quality of data supplied by providers for use in the minimum mental health dataset, which would be used to determine funding levels. The dataset, managed by the NHS Information Centre, contains patient record level data for adults who have mental health conditions. NHS providers have been required to contribute to it since April 2003.
Under the proposed national payment by results system patients would be “clustered” into 21 categories of various severity of condition ranging from relatively mild depression to psychotic crisis and severe dementia. Funding would be attached to the cost of treatment and measures of the outcomes of care.
But there are concerns the dataset and clustering system is too unreliable to ensure providers are correctly reimbursed for the work they do.
Emma Stanton, a psychiatrist at South London and Maudsley NHS Foundation Trust and chief executive of the consultancy Beacon Health Strategies, told HSJ an analysis by Beacon of one large mental health trust’s inpatients had found 40 per cent were allocated to an incorrect payment by results cluster.
She said: “The minimum mental health dataset does not have good data quality; real life is not connected to what the data show.
“This is a wake-up call for mental health trusts and the risks of payment by results. If we have a significant number of inpatients in the wrong clusters, trusts will not be reimbursed at the correct levels. The trusts are at risk of being underfunded. Gathering data in mental health needs to be taken seriously.”
Paddy Cooney, interim director of the Mental Health Network, said: “There has been concern from some of our members that the data [for payment by results] would be solidified too early. We need a longer period to ensure we set the prices correctly. If we end up with prices below cost that would be a disaster.”
Stuart Bell, outgoing chief executive of South London and Maudsley Foundation Trust and chair of the DH’s expert advisory panel on payment by results, said 2013 was “only ever the earliest” date that a national tariff could be introduced. He added he believed it was “sensible” to introduce payment by results gradually in a “phased approach”.
A DH spokesman said 2013-14 was “never a deadline date”, adding work to roll out payment by results had started in 2012-13 and would continue. “However,” he added, “data quality will need to improve before we can start to introduce mandatory national tariffs for mental health services.
“We are working with NHS mental health service providers to improve data quality. It will be a decision for Monitor and the [NHS] Commissioning Board to agree when a national tariff should be implemented.”
Meanwhile, on Tuesday the government published the implementation framework for delivering its mental health strategy, which aims to achieve “parity of esteem” between mental and physical health. The framework suggests a range of actions clinical commissioning groups, providers, local authorities and other bodies can take to improve mental health care.
It says mental health will be one of eight key themes considered during the CCG authorisation process. Applicant CCGs will be required to demonstrate that “they have sufficient planned capacity and capability to commission improved outcomes in mental health”.
The framework also reveals a mental health dashboard will be published in the autumn. This will draw together targets from the three operating frameworks covering the NHS, social care and public health to measure progress against the strategy.