A new system of payment by results for mental health could result in care for 85 per cent of service users being covered by the system.

A new system of payment by results for mental health could result in care for 85 per cent of service users being covered by the system.

Proposals being tested by the Department of Health would mean trusts were paid for an average treatment package in one of 13 'clusters' of care. The clusters would be designed according to how much care service users require under a needs assessment.

The hypothesis is being piloted in seven mental health trusts, while 22 trusts are collecting data for the DoH Information Centre for health and social care on how much they are paid for the work they do. This is to establish if this data can be used to build a classification system.

The approach aims to tell whether groupings of patients can be established, with each 'cluster' proposing the packages that an average service user might expect to be offered.

The Sainsbury Centre for Mental Health said that even if the system worked, the 15 per cent excluded from it represented a large number of service users.

But a spokesman said that without attempts to introduce PbR for mental health, the sector would never achieve equity with other services. 'It sounds more like payment by numbers but it is better to have a system that can be further developed than wait for a perfect system that may never come,' he said.

Countries such as Australia and the United States have attempted to introduce systems similar to PbR in mental health, but have never succeeded. The wide range of presentations people with mental health can have and the number of intervention options are thought to have made them too complicated to run.

Originally the DoH said payment by results would be implemented in mental health in 2008 but this seems unlikely.

In a factsheet the DoH says it will come up with recommendations in October, and take decisions on the next steps for the pilot process in January. The project is also exploring whether social care could be included under PbR, and whether this would be best pooled or decoupled from the healthcare costs, as well as how payment would be made for 'one-off' interventions.

7ww.dh.gov.uk