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Advances in Dual Diagnosis

ISSN: 1757-0972

Online from: 2008

Subject Area: Health and Social Care

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National Alcohol Treatment Payment by Results Pilots(source: Alcohol Learning Centre web site, 2 August 2011)

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Article citation: , (2011) "National Alcohol Treatment Payment by Results Pilots(source: Alcohol Learning Centre web site, 2 August 2011)", Advances in Dual Diagnosis, Vol. 4 Iss: 3, pp. -

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Article Type: News From: Advances in Dual Diagnosis, Volume 4, Issue 3

Background

Payment by Results (PbR) was first introduced in the NHS in 2003/2004 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. The four pilot sites are Wakefield, Rotherham, Nottingham, and Middlesbrough.

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; and
   • 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 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.

Pilot site evaluation

On the 1 July, the pilot sites met for the first time to explore the products to be tested in their local areas.

Higher risk drinkers and dependent drinkers represent a very high-risk group for alcohol-related hospital admissions. Providing evidenced based, effective treatment as well as increasing treatment opportunities for these groups may offer the most immediate opportunity to reduce alcohol-related harm. NICE has recently published guidelines on the treatment of alcohol problems and the pilot sites will be implementing packages of care based on this guidance.

The aim of the PbR scheme is to provide a more transparent funding system for specialist alcohol services with clarity as to what care is being provided, how it is paid for and what outcomes are delivered.

The pilot phase of the project will run from July 2011 until the end of March 2012 and each pilot site will be involved in the preparation and field testing of nationally developed products, including:

• Nationally utilized individual needs assessment tools.
• National approach to classification for needs-based clusters.
• Best practice needs based packages of care.
• Individual outcome measure(s).
• Appropriate minimum data set.
• Costing of best practice packages of care.
• National auditing process.

The products are likely to be amended following feedback from the field, particularly in relation to their practical implementation. The primary purpose of the pilot phase is to design an approach to PbR for Specialist Alcohol Treatment Services that is both understood and able to be implemented.

In addition, the pilot phase will include the development of a guidance booklet and training programme covering all products involved with the introduction of an Alcohol Treatment PbR approach.

For further details please contact at: don.lavoie@dh.gsi.gov.uk