Alcohol Treatment Payment by Results

Background

Payment by Results (PbR) was first introduced in the NHS in 2003/04 for elective secondary care procedures (procedures such as hip replacements). This was a move away from sweeping block contracts that supported NHS hospitals up to that time and a move towards payment for the activity they delivered. It was always intended that the scope of PbR would increase, with the 2002 consultation document Reforming NHS Funding Flows: Payment by Results.

Mental Health PbR development began in 2005 and is now being implemented in all NHS Mental Health Trusts. Alcohol Treatment PbR is seen as a natural progression in the continuing development of Mental Health PbR as specialist alcohol treatment is often delivered through NHS Mental Health Trust contracts. Where alcohol misuse is a complicating factor in mental health need (dual diagnosis), it is already included in other areas of Mental Health PbR.

Purpose

PbR will provide a more transparent funding system for specialist alcohol treatment services, with clarity as to what care is being provided, how it is paid for and what outcomes are delivered. It is hoped that Alcohol Treatment PbR will lead to:

• More productive discussions between commissioners and providers
• Bench-marking for providers and commissioners
• Greater investment in proven interventions
• Better care leading to better outcomes for service users

The 'products' to be tested in this Alcohol Treatment PbR project include:

1. National approach to developing needs based clusters

A national approach to allocating service users to defined and distinct needs based clusters. These clusters need to be:

• Clinically meaningful
• Comparable in anticipated resource use
• Produced from agreed assessment tools
• Endorsed by the royal colleges and professional bodies

2. Best practice, needs based packages of care

Defined packages of care that follow best practice guidelines and seek to reduce unacceptable variation in practice. These will be made up of core elements essential for treating each care cluster and based on NICE guidance.

3. Individual outcome measures

Nationally developed outcome measures to gage service user's progress through treatment.

4. Appropriate minimum data set

A minimum data set that contains all relevant information to allow allocation of service users to clusters and monitor outcomes. The National Alcohol Treatment Monitoring Service (NATMS) already captures some relevant data and will be developed further to meet the broader requirements of a national PbR system for alcohol treatment.

5. Costing of best practice packages of care

The pilot programme will cost up the elements of each cluster's best practice treatment package. This will inform an agreed national cost for these packages (either average, normative or maximum).

6. Tariff development and national auditing process

Following the costing exercise, work will begin with Monitor, the NHS regulator to develop appropriate indicative tariffs for use at local level.