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My Shared pathway

Background to the project

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Background to the project

Over recent years there has been a drive across NHS services to be more explicit about outcomes.Payment by Results introduced several years ago across acute care services applied the notion that services for patients could be accurately described in terms of procedures and outcomes, as well as the resources required to provide that care. This process aimed to quantify health services in order to manage resources more effectively and anticipate demand.

The application of PbR to mental health services has been more problematic as defining the currency formental health care in terms of outcomes and procedures is much more complex and variable acrossindividuals. Nevertheless the drive to become more explicit about the delivery of mental health care, its cost and effectiveness has become much more focused, and underpins much of the current DH policy in recent years. This is due to a number of reasons but the main impetus includes the following:

A growing emphasis on the need to demonstrate value for money which equates to achieving good outcomes in the most efficient way

• To place as much choice and responsibility into the hands of individuals so that they can make informed decisions about their health care, and in that way rely less heavily on health care professionals, and expensive health care systems

In recent years therefore we have seen the introduction of patient choice in a much more consumer focused health system, the introduction of PbR for mental health, the publication of hospital based outcome league tables, and commissioning guidance which promotes competition across NHS and Independent Sector providers and therefore value for money.

In partnership with these economic based initiatives has been the complimentary drive to empower individuals to drive their own care. Recovery based approaches in mental health coupled with the piloting of individual healthcare budgets and direct payments, has shifted services to adapt to an increasingly personalised approach.

In fact these objectives resonate within the most recent DH policy guidance – ‘No Health without Mental Health’ which advocates the need to put people at the heart of their own care – “No decision about me without me” – as well as a drive to focus on measurable outcomes, and choice.

These initiatives are welcome as they orientate services to become more explicit about what they are trying to provide, what outcomes they are trying to achieve with individuals in their care, and how services need to position themselves so that the individual drives their own care, based on informed choice.

These priorities are no less welcome across secure services.Within secure services the priorities of reducing costs, meeting individualised needs, and demonstrating efficiency are more critical now than they have ever been. The current trends across the secure estate is increasing every year, the costs of services have increased significantly over recent years, and the need for these specialist services appears to be growing. There is a real need to curb this growth whilst at the same time demonstrate more effective services.

My Shared Pathway work stream is part of the National Secure QIPP programme and intends to address the above in several ways:

• It aims to shift services to take a much more outcomes based approach to the delivery of care

• It will require services to focus only on those outcomes for individuals which will move them down the pathway towards less expensive community services

• It will place as much responsibility for meeting outcomes into the hands of service users so they drive their own pathway as much as possible

• A standard pathway will be developed and delivered across services so that clear outcomes can be demonstrated and benchmarked to drive efficiency and performance

• In time the funding of services will be based on how well a service delivers the pathway and achieves outcomes rather than on the current occupied bed day currency

• In time the intention is that the length of stay for individuals is reduced in secure care to a minimum,

resulting in less capacity required and reduced costs overall nationally

Principles of the Shared Pathway

The Shared Pathway is:-

• A new way of working together; it’s not just ‘what we’ve always done.’

• A way of sharing responsibility; it’s also about sharing choices.

• A way of working that uses everyday language.

• Made to help people to get to their goals.

• A way of helping people to live the life they want; it’s about now, and the future.

• Made to make recovery as important as security.

• There to make sure people stay “not a day more” than they need.

• There to be sure that we think about people as all different

• There to make sure that people keep thinking about the outside world