Practicalities of introducing PbR in mental health – Defined interventions and packages of care for each cluster

This post is one in a series on Payment by Results in mental health, written for both professional and personal reasons. The full series is introduced and linked to here, including a post with all references in it.

As highlighted in the reasons why it may be harder to adopt PbR in mental health than in acute care, there is less clinical consensus on optimal care pathways, as well as there being considerable variation in what mental health services are available in any given area (CHE, 2009:1).

Nevertheless, some localities are taking the approach of defining interventions and packages of care for each cluster. Though initially mixed progress was made on this initially – by 2011 a third of trusts had made considerable progress and half had not started (MHN, 2011b:6).

Similarly, one specialist mental health trust has developed standardised care packages for each cluster. Each package:

  • Describes what activities are needed to meet identified needs
  • Has a core element, which all users in the cluster will receive
  • Has essential elements, which only some users in the cluster will receive
  • Has variance elements, that are occasionally required  (CHE, 2009:4).

The IMHSEC project / resource also takes a similar approach –

The care packages are designed to inform, but not supersede, clinical decisions (CHE, 2009:4); they are based on both clinical guidelines and NICE guidance. The Department of Health is more generally clear that clusters themselves shouldn’t define appropriate interventions and treatments, and draws attention to the fact most interventions are well defined by NICE / SCIE professional guidelines and associated standards and outcomes (including those of CQC) (DH, 2011b:6; DH, 2013:5). RCP is also clear on this point:

“Evidence-based interventions care packages and pathways must be based on the most effective treatments and these should be delivered in a way that offers the best value. This means supporting integrated care between primary, social and mental health specialist care and providing care that conforms to evidence-based professional standards and National Institute for Health and Clinical Excellence/Social Care Institute for Excellence guidelines.” (RCP, 2012:6)

The Department of Health is also clear that what care options are available to people are developed locally (DH, 2010:7).


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Man of letters & numbers; also occasionally of action. Husband to NTW. Dad of three. Friendly geek.

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