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Commissioners require 'significant help' with mental health tariff

An HSJ article (1st December) emphasised the importance of the implementation of the new currencies around the 21 care clusters and highlighted concerns about the preparedness of many localities to do this efficiently from April 2012. This will be a concern for many EMMHCN members, hence our 22nd March 2012 conference will have PbR as a major theme.

Commissioners will struggle to implement an operating framework requirement to pay for mental health services under tariff without “significant help”, according to the NHS Confederation’s Mental Health Network.

The framework requires commissioners to use the recently developed payment by results currencies for adult mental health services.

But network director Steve Shrubb told HSJ further guidance was required on how the tariff should be implemented.

He said: “Commissioners need help, quite significant help. This is the introductory year for the currencies…which reflects an understanding that the system needs to be tested before it’s rolled out to other areas.”

A recent report by the network found trusts had made too little progress in costing “clusters” of service users, which will be used to set local prices from next April.

Commissioners will be expected to apply the same tariff cut of “at least 1.5 per cent” for their total spend with each mental health provider as they are applying to acute providers.

Due to historical differences in block contract values, this may mean a provider initially agrees different local prices with different commissioners, according to draft guidance released in October.

But over 2012-13, providers are expected to work with commissioners to agree to a single local trust price for each “cluster” by 2013-14.

Mr Shrubb said data quality would need to be greatly improved for the policy to be successful.

Many mental health chief executives have called for the switch to PbR for years, in the belief this would provide better protection from budget cuts.

But Cumbria Partnership Foundation Trust chief executive Stephen Dalton said the tariff would not shield the sector as “the mindset that commissioners have got…[is] more important than the payment system”.

The “significant reductions” in social services investment would have a greater impact on mental health trusts, he added.

Work is ongoing regarding extending PbR to children and adolescents services, learning disabilities. forensic care and substance misuse.

In general, the operating framework was welcomed by the mental health community for its emphasis on carers, dementia and improving access to psychological therapies.