Shake-up in payments system could give NHS service users wider choice

Service users could be given more choice over NHS treatments as part of the introduction of a new payments system to mental health.

Campaigners believe that the extension of payment by results (PbR) to mental health could provide a way to extend individual budgets, now being piloted in social care, to NHS services.

This is hinted at in a Department of Health newsletter, which looks at how social care costs can be accounted for if PbR is extended to mental health. The system currently applies to acute hospital care.

Andy Bell, the Sainsbury Centre for Mental Health’s director of communications, said if PbR also incorporated individual budgets and direct payments it could give service users the opportunity to extend them to health care and improve choice.

The health and social care white paper ruled out extending individual budgets to the NHS as this would undermine the principle of health being free at the point of delivery.

But Nigel Edwards, director of policy at the NHS Confederation, said including individual budgets in the mental health PbR may not go against that commitment. Individual budgets could be redefined as a way of giving users choice over services rather than a means of buying them.

Mental Health Foundation head of policy Moira Fraser said social care had to be included within mental health payment by results, as care packages could not be divided between health and social care.

She said: “When the rest of the health care system is going ahead with PbR, and mental health isn’t, we are at a risk of mental health trusts being vulnerable to funding cuts.”

Additional reading
Developing a Payment by Results Tariff for Mental Health 

Further information
Sainsbury Centre for Mental Health
Mental Health Foundation
NHS Confederation

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Payment by results
Under payment by results, health providers are paid according to how much work they carry out, based on a system of tariffs for different types of work. It replaces the system of commissioning through block agreements across much of the NHS.
The DH intends to publish its proposals for the new system for mental health in October, and introduce it by 2008-9.

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