News / Survey reveals lack of confidence over mental health payment proposals

The two bodies responsible for tariff and payments systems consulted on proposals for changes to payment rules in November. The proposals would require commissioners and providers of mental healthcare to adopt a payment approach based either on year-of-care/episodes of treatment or capitation and for a proportion of payment to be linked to outcomes.

But an HFMA survey to inform a response to the consultation found that only 42% of 36 providers replying were moderately confident (27%) or highly confident (15%) of being able to meet the requirement in 2016/17. Confidence was low in 44% of providers and very low in those making up the balance.

There is greater confidence that new contracts could be in place for 2017/18, with 85% of providers believing this is a realistic ambition.

Monitor and NHS England are keen to eliminate the use of crude block contracts in mental health and to have greater transparency for local contracting arrangements. The proposed approach would build on requirements to move towards cluster-based contracts in recent years, although contracts written in cluster days have been ruled out.

However, in its response to the consultation, the HFMA has pointed out the gulf between where the service is and where it needs to be. According to the survey, 89% of respondents have block contracts in place for 2015/16 – although this falls to 47% in planned contracting arrangements for next year.

‘Although this indicates a positive direction of travel, it is clear that a number of local health economies are some way from implementing new or different arrangements,’ said HFMA policy and technical director Paul Briddock.

The response says that clinical commissioning groups are vital to any change over. Moving from block contracts to new payment approaches would result in ‘gainers and losers’ across commissioners.

Robust data to inform contracts remains a challenge across the sector and the association said that a mandatory data format would be important, particularly to operate outcome measures. The HFMA also said that greater clarity of the use of clusters as the basis for the payment mechanism was important, so that clinical engagement around the use of the recently adopted currency was not lost.